Condom Slipped Dont know when,so at Risk, Kindly advice

[veryconcernednow]

Last thursday night, 20th March, early 21st March am, after many rounds of drinks, my friends and I went for a massage in Beijing. I had her on top of me, I was protected by the condom and after a few thrusts, I ejaculated. There is no reason or experience for me to believe that the condom was not on me that time. Even after I went limp, she thrusted for a couple more time, not sure how many times, but maybe less than 1 minutes and when I finally pulled her away ( she was on top still), I saw that the condom was not on my penis, but rather hanging off from her vagina (I think I remember It was hanging). I did see was that the semen was inside the condom she pulled off from her vagina. I dont think so there was a condom break, cannot say it for sure, as I have never experienced comdom break before.My worry is when my penis went limp, I have no idea when and how the condom came off my penis and was clung on to her vagina, I have no idea if she has HIV, I have read that overall  HIV infection rate is 0.05% of population in CHina, presumably more in CSW?, but again this was Beijing and not rural China. I really need your opinion, pov ( honest and straight) if you think
1. this episode is high risk ( I think it is), 2. In the sexual position I was, i.e limp penis after ejaculation when condom was on while ejaculating, but I stayed on and when I pulled her away, the condom was not on my penis but hanging from her vagina, is it possible for transmission of fluids to possibly contract HIV? 3. Would you recommend testing for this scenario? 4. I have developed a slight redness in my right eye since yesterday, does this count as any symptom I should be worried of?5. What are my chances of exposure to HIV for this episode?
Please advice , please suggest anything you wish I must think/do. For what its worth, she did look clean and healthy ( I know this does not mean a lot), but anyone with acute HIV infection could have have symptoms right? she didnt see feverish, no rash etc, quite healthy.

[Edward W Hook, MD]

You had a single exposure to a commercial sex worker (CSW).  You were, in large part, protected.  The condom slipped and you slipped out, thus there was no penetrative exposure on your part.  Thus, your chances of having gotten HIV from this exposure are extraordinarily low.  Here's why:

1,  Chances are, your partner did not have HIV.  Most CSWs do not.
2.  Your chance of getting HIV, if she was infected and you had penetrated her is less than one in 1000 per exposure.

When you put these facts together, your chances of being infected from the exposure you describe is less than one 100th of 1%.  

As for your questions:

1.  No, you r penis was not inside her in an unprotected state.
2.  Unlikely
3.  You have to make this decision, for the reasons above I probably would not.  If you get tested, wait till at least six weeks.  Any result after that time should be considered definitive.
4.  Symptoms are irrelevant with regard to assessment of HIV risk.

If I were you I would forget about your risk of having gotten infected and move on with your life.  I would not get further testing.  Hope this helps.   EWH

[veryconcernednow]

Dear Dr. EWH:

Million thanks for a detailed, and most importantly a confidence building answer. You have no idea how much your answer has put my mind to rest. However, I would very genuinely appreciate if you could kindly answer the following for the last time:
1. If I were to find the CSW and ask her to do the test ( as it is indeed killing me to wait for 6 weeks) and hope she tuns out HIV -ve, do I still need to do my test after 6 weeks?
2. is 1/1000 chance a data for totally unprotected sex? Does it hold true for my case as well?

Many thanks in advance again.

[Edward W Hook, MD]

1.  If she had a negative test, you would have no further worries.  Other clients have done this.
2.  Yes, that was for totally unprotected expsoure.  Your risk is still lower.  EWH

[veryconcernednow]

Again many thanks for your kind reply. I will now try my best to see if I get the CSW to agree for testing. I will update you with the developments as it progresses. Many thanks again and your reply has indeed helped me calm down substantially.

[maddyjets]

A related discussion, My Condom Tore While in Intercourse was started.