Clamydia and HIV risk

My question is about possible HIV infection. In February 2007, I had sex with a prostitute. I was so drunk that I could not easily get and maintain an erection, but when I did, she put a condom on my penis. I would lose my erection in less than 2-3 minutes. We tried vaginal sex for 2 or 3 occasions during which none lasted more than 3-4 minutes. She also performed oral sex on me for 2 times during which she also put a condom with her hands. She changed 4 or 5 condoms, after each attempt at vaginal and oral sex. About a month ago, I went to get tested for STD`s not including HIV test. It came out that I had Chlamydia. I was given 4 pills and told to come in again in 4-5 weeks to get retested to see if the treatment work. I am 100% sure that I got Chlamydia off this sex worker because I have not had sex for a few months before and after that night. Also, 2-3 days after that night, I had some real bad itching in the top of and inside my penis which at the time I did not recognize as a sign of Chlamydia. 1. I do not understand how it is possible that I got Chlamydia off this person when I always had a condom on and I have never engaged in a lengthy intercourse that could possibly point out to a condom break. I have red that Chlamydia can be transmitted with hands, if the infected person touched her genitals and then touched my genitals, is this true?2. Since I was diagnosed with Chlamydia, I am now VERY anxious that the girl might have had other illnesses including HIV. I haven`t had any symptoms associated with HIV, I have even gained 20 pounds that I should lose. My anxiety is getting bigger since I discovered a few little red dots on my chest and one on the left side of my stomach. I know the chances are low, but what really eats me alive is the fact that I got Chlamydia off this woman and this even with always using condoms. So if this STD was transmitted, could HIV be as well, assuming she was HIV positive?

[H. Hunter Handsfield, M.D.]

I agree it is likely you caught chlamydia during the sexual encounter you describe, but it isn't certain.  With so many changes of condoms and attempts at sex with not fully erect, it sounds like there was opporunity for secretion exchange.  Since you did not have symptoms of chlamydia, and it can be carried without symptoms for many months, it remains possible that your infection dates back to some previous exposure.  Most likely you'll never know.

To your questions:

1) As I said, it sounds like a lot of secretions could have been sloshing around.

2) You are right to be concerned that catching chlamydia also implies increased risk for HIV.  However, chlamydia is much easier to transmit than HIV.  For unprotected vaginal sex, if the woman has chlamydia, each exposure carries about a 20-30% risk of transmission to her male partner's penis.  By contrast, the risk for HIV averages about 1 in 2,000 -- that's several hundred times less efficient than for chlamydia.  Further, HIV is uncommon in CSWs in the US (although you don't say where the exposure occurred).   All things considered, the chance you caught HIV is extremely low.

It is a little puzzling that the provider who treated your chlamydia did not recommend an HIV test. HIV testing is pretty much automatic whenever someone has another STD.  Four weeks is a little early, but still about 90% of people with new HIV infections would be positive by that time.  Anyway, get tested now.  You can expect negative results.

Best wishes--  HHH, MD

[ja246]

Sorry to hear your dilemma, I am too in the window period awaiting results. In the mean time, from reading past posts from the good doc I think the symptoms of Chlamydia came on too soon and you were possibly infected prior to this event and it laid dormant. I don’t think they will accept that you caught it with a condom on as protection is protection. I think your risk is very low mate and I would seriously question your infection of Chlamydia from that event. Even by a long shot it did, it does not mean HIV was transmitted.

For reassurance believe what the docs say! overall CSW’s have a low HIV prevalence rate. They are health conscious, and are more likely to be tested regularly and treated for STD’s than the normal population due to their profession, on the basis she’s not an IDU.  


Hope all goes well and this offers reassurance until the doctor answers.

[H. Hunter Handsfield, M.D.]

I meant to say that I don't know quite what to make of your penile itching.  That doesn't sound like a symptom of chlamydia or any other STD. Even the "inside" part is questionable.

[CD5]

Thank you for your answers,

I would just point out that it was not unprotected sex. I always had a condom but she would always put it on.
Can you please tell me if Chlamydia can be transmitted other than through vaginal sex. What I mean, is it possible that she could touch her genitals and then by putting a condom on me transmit Chlamydia that way? Also, if she was hiv positive, could the secretions from her hands transmit the disease as well?

Thank you so much.

I am in such anxiety that it is changing my life 360 degrees around. I am going crazy, picturing all the worse case scenarios in my head

[H. Hunter Handsfield, M.D.]

I explained as best I can when and how you might have acquired chlamydia.  Please re-read my original reply.  You're never going to know, so it isn't worth worrying about.  I also told you why HIV isn't a serious worry, but that you can be tested to know for sure.  There is nothing more I can do.