Best doctors in the world please help me!!!!

I am a 22 year old heterosexual circumcised male from London.Please doctors i am writing to you with high hopes that you would help me. I have not been sexually active in the past because of my background (Middle east).In the beginning of september i had one exposure which was unprotected blowjob for the first time in my life ( no penetrative sex) from an escort & i remember after that event i went absolutely crazy with fear of HIV as i was never taught about it.i was tested for that exposure at 30 days & 8 weeks both Hiv Duo test & thankfully both of them were negative. I decided not to do anything ever again but stupidly after partying all night (NOT drunk) on new years eve i made a big mistake again & i went to see an incall 23 years old spanish white escort at Bond street near oxford street. This time i made sure that the condom was used even for blowjob  but there was protected vaginal penetration too ( MAX 3 minutes). The only thing unprotected was kissing and me fingering her vaginally. Now as far as i know the condom was always on my penis and didnt break because my siemen was in it after the brief intercourse and it was not dripping out from it. Questions
(1) My biggest concern is that i have never had any broken condom experience or seen one so my mind is saying it could have broken or have tiny holes or tears etc ( i guess anxiety & guilt).what are the chances of this happenning? I have read on internet even intact condoms can transmit hiv by passing through, is it true?
(2) Second do you have any rough general estimate of escorts in UK with HIV. I read recently on the government website that in UK sex workers don't have significantly high rates of HIV .my optimistic guess is 1 in 200 would you agree I am not going to do this ever ever  again never but asking  to assess my risk ?
(3) should i test again,i will be frozen with fear for the next 3 weeks test atleast please tell me i dont have to test please please

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  You can relax:  you had zero risk sexual exposures; there is no way you caught HIV.

Given your geographic origins and perhaps social background, I suspect you may have inflated perceptions about how common HIV and other STDs are in urban Western countries.  My understanding is that even among commercial sex workers and other very sexually active women in the UK, including London, fewer than 1 in 1,000 have HIV.  Further, the chance of HIV transmission from oral sex is so low that most experts believe it never happens, i.e. zero risk. As for your second exposure, it was entirely condom protected, both for vaginal and oral sex.  So there should be no worries there.

Your HIV test results prove you were not infected during the earlier exposure.  With the duo test, a negative result any time more than 4 weeks after exposure is 100% reliable, so ryour 8 week test proves you didn't catch HIV.  The second exposure was zero risk for the reasons already mentioned.

To your specific questions:

1) A broken condom is obvious; you would have noticed.  The condom ring would be around your penis, with shreds of latex hanging from your obviously bare penis.

2) This was already answered above.  According to the UK Health Protection Agency, the chance your partners had HIV was in the range of 1 in 1,000.

3) There is no reason to be "frozen with fear".  For sure you weren't infected during the first exposure, and it is exceedingly unlikely you were infected in the second one.

5) (Below):  If I were in your situation, I would not have had any HIV tests at all (and I would continue unprotected sex with my wife, with no fear for her health).  But since you are nervous, have another duo test 4 weeks or more after the second exposure.  It will also be negative.

I hope this helps calm your fears.  Really, you are not at HIV risk from these events.  This isn't worth such anxiety.  All will be well.

Regards--  HHH, MD

[peace12345]

(5) Assuming you were in my position would you test or be afraid of hiv after this exposure based on your decades of your experience & knowledge?

As far as symptoms go its been only one week therefore didnt have any symptoms yet

Doctors believe me i cant do anything or concentrate & i have locked myself in my room , i have already failed my exams so i have suffered enough financially & wasted my time i cant even talk to my parents properly as i feel i have cheated on them & because of my background this would be a full stop for me whatsoever. I fully trust your advice.Thanks

[H. Hunter Handsfield, M.D.]

See above.

[peace12345]

Thnx very much doctor your comments have calmed me down very much just want your advice on two or three matters to control my anxiety & fear a little more.
(1) I have read that condoms are not 100 percent effective (maybe 95%) in preventing hiv even if they remain intact & in place. Does that mean they have tiny holes through which hiv can pass through? or do they incorporate condom failure & other practical things (slippage) too when they say it. I mean scientifically or under labortary conditions can hiv pass through an intact latex condom?
(2) Secondly in your experience have you ever seen or heard about someone getting infected for the first time even in protected insertive vaginal sex?
(3) Lastly when the statistical risk for unprotected insertive vaginal sex is 1 in 1000-2000 what would you guess about protected insertive vaginal sex & how should one interpret these statistics in analysing risk of transmission
(4) i am circumcised too will it reduce my risk further
i am thinking to go back to the escort again tomorrow & then ask her about her status (she is independent escort)  what is your advise
Many thanks i will try not to post other silly questions sorry
  


  

[H. Hunter Handsfield, M.D.]

These additional questions are irrelevant, since your test results prove you weren't infected.  Worrying about how high the risk was, when it is certain you didn't catch HIV, is a waste of time and mental energy.

1) Condoms are virtually 100% protective if they are properly used and remain intact.  HIV definitely cannot and does not pass through intact latex.

2)  It happens I have never come across a patient who acquired HIV from a first and only sexual exposure.  But this is irrelevant.  It happens, but it is rare.  But perhaps you will be reassured that in the 7 years since this forum started, no user has ever asked a question about a possible HIV exposure and then returned to say his or her test had been positive.  Your test results prove you are not the first.

3) Protected vaginal carries zero risk for HIV, for all practical purposes.

4) Your circumcision status doesn't make any significant difference in this sort of situation.

You came here for reassurance.  I gave it.  That's all I can do.  That will be all for this thread.

[peace12345]

Sorry Dr i think you misread my post. I was tested for the first exposure (unprotected blowjob only) but not for the second one (protected blowjob & protected vaginal sex) yet as its been only 11 days but your comments are really very assuring & i would try not to worry too much until 28 days duo test but honestly time is really not passing for me Thanks again i will post any update then  & until then i will keep my mouth shut.

[peace12345]

woohooo Dr Hunter i have a very good news and i am so happy you wont believe it, perhaps the one of the happiest moments of my life after the darkest days. I went for another Hiv DUO test at a private clinic in London and the result was negative (Thank God!!!).
i took the test at exactly 28 days but it was 5 hours short of exactly 28 days to be precise because of the weekend. is it still conclusive?? Please can you give me your final advice & comments
Given my exposure (protected blowjob, projected vaginal sex for 3 mins, vaginal fingering) can i consider these results as finally conclusive. If i add up all the odds that are protected sex, low risk of escort being HIV positive, no symptoms yet at 4 weeks & duo test at 4 weeks can i completely forget about it without any need for retesting. Doctor because i have decided not to do any casual sex until i am in a long term relationship or perhaps until i get married therefore i dont want to be thinking of hiv on my wedding night, Therefore please give me your final advice & then you can close this thread
Finally Doctor HHH you are doing such a great job and you are a very straight forward and honest person ,you always give clear advice & opinion based on real risks & your personal experience. May Allah bless you and your loved ones A big thank you once again

[peace12345]

Doctor kindly if u can also see my risk assessment now and give your final comments on it too. if the escort was confirm hiv positive & if i had done unprotected vaginal my average risk would have been 1 in 1000 & if i multiply this by lets say chances of her being hiv positive as 10% it would go up to 1 in 10000.Then i had protected brief vaginal sex without any obvious burst or slippage & i assume condom (Durex extra safe) was 99% effective my risk would go up to one in 1 in 1 million then if i add duo test at 28 days as 99% accurate it would go up to 1 in100 million and then if i add the percentage of people not showing symptoms in 4 weeks it would increase it further.
I know this sounds stupid but as i want just a final comment from you on this thread kindly consider this too in it thanks

[H. Hunter Handsfield, M.D.]

I confirm my previous opinion and advice that you were not at significant risk and did not even need HIV testing.  In any case, your negative test results are reliable; of course being 5 hours short of 28 days makes no difference.  Your odds calculations seem about right, i.e. they amount to zero risk you have HIV.

That's all I have to say, and this ends this thread.  Take care.