hiv risk

[tosss44]

I made a horrible decision and had protected sex with a sex worker .  We had vaginal intercourse with a condom for several minutes.  She then pulled me out and started rubbing my penis with the condom on and did this for about a minute.  After this she took the condom off and she gave me a handjob without the condom.  I'm worried because her hand would have had vaginal fluid while she was rubbing my penis.  What is my risk of contracting hiv?  I'm thinking of going to the er to see if I could start on pep.

[Edward W Hook, MD]

Last answer.  I repeat, I would not have given you Combivir for this exposure.  I would not recommend continuuing taking a medication you do not need.  

I think the estimate of your risk made by the doctor was far too high.  As I said, your exposure did not put you at risk for HIV. Your concern was an overeaction.  EWH

[tosss44]

Thank you for your response doctor.  I saw an er doctor ( who I most likely will never be able to see again)and he said his reasoning for giving me combivir was that I was at low to intermediate risk because her hand had vaginal fluid while rubbing my uncovered penis.  He said my risk was 1 in a thousand, but there was still a risk. Was he mistaken in his analysis?  Should I stop taking the combivir?  Thank you.

[Edward W Hook, MD]

I hope that the doctor who gave you the combivir will also be willing to answer these questions for you, as well as provide you with follow-up.  As I have already told you, I would not have given you PEP for this exposure.

The irritated areas you note are likely due to friction.  As I told you earlier, the exposure you had was no risk for HIV. That there is some irritation does not change this.  EWH

[tosss44]

Also noticed little red lines right underneath the head that could be small cuts.  I'm just worried that the virus could have gotten in this way.  Does this put me at greater risk. Thank you doctor

[tosss44]

I should note that I have a spot on my penis that is slightly red and tender.  As far as I can tell the skin is intact but it may not be.  Would that put me at greater risk since it would be an avenue for the vaginal fluid to enter the body since at the end I didn't have the condom on while she gave me a handjob(and I know her hand had a lot of vaginal fluid on it)?  I appreciate  your time doctor.  BTW, I saw the doctor last night and he thought there  was enough of a risk to put me on combivir for 28 days.  Should I continue it? Could it put me at greater risk for hiv?

[Edward W Hook, MD]

Welcome to this Forum.  These are questions we have answered many time on the site.  There is no risk for HIV at all from and the activities you describe. condom protected sex is no risk for HIV.  The same is true for the sort of rubbing you describe (whether or not a condom was used- you still had your condom on) or from masturbation.  It is typical for partners to get each others' genital secretions on one another yet no one has EVER gotten HIV from this, no ever.  

For you the risk of side effects from PEP is far greater than the risk of HIV.  If you were my patient I would tell you that you do not even have a medical reason for testing, much less for PEP.  I hope my comments are helpful to you, there is no reason for worry.  EWH