Exposure risk for my situation!

Hi Doctors:  For several years in the past, I traveled a great deal internationally out of the US.  Unfortunately, I did on a regular basis visit with escorts and occasionally non-escorts (i.e. regular girls).  All Russian ladies, mostly in Moscow.  I stopped all of these terrible activities two years ago.  However, recently, I read an article on the internet about spread of AIDS in heterosexual population, and now I am terrified and think about this issue constantly.  

In all cases, I wore condoms, however there were couple types I performed oral sex/cunnilingus on regular girls (not escorts).  Also, on two occasions with Russian escorts, once in Moscow in 2003 and once in UAE in 2004, the condoms broke and I must have had some unprotected vaginal sex for at least a couple minutes (didn't *** though with condom off).  I think these were healthy girls (the ones the condoms broke with), and one of them even assured me she had no problems, but of course given their activities i assume they must be walking disease carriers with high chances to have HIV.  Also, since this was outside of the US, I am even more worried.  I am a circumsized, 38 year old white male.  My questions are:

1)  What is the chance of catching HIV HIV from performing cunnilingus, say, on 3 different regular women, not escorts?

2)  What is % chance of catching HIV from the two cases of unprotected vaginal sex when the condom broke?  Does the fact that I am circumsized make any difference in all this?

3)  For all of the other times, where I used condoms and there were no breakage issues, was there any risk whatsoever?

I am looking for an honest assessment of my actual TOTAL chances of having HIV from these various activites - 5%, 10%, 20%??  Now, I have become quite anxious and depressed thinking about this.  I plan on getting tested, but want to get a sense first of what my risks are so I can prepare myself psychologically for the worse.  

[Edward W Hook, MD]

1.  Really no difference between less than 1 in 1000 which is what I say and 1 in 2000 which is what Dr. Handsfield says.  We're on the same boat here, just expressing it differently.
2.  The characteristics of the shin on the head of the penis change following circumcision, thickening and becoming a bit more resistant to disruption
3.  The Oraquick test is a point of care test which is performed on oral secretions.  It is as accurate as a blood test for HIV diagnosis.  EWH

[Rob63317]

This is from Rob 63317 as follow-up.  Also, what would be the main signs of ARS/primary HIV infection, based on your experiences?

[Edward W Hook, MD]

Overall your risks are low.  Oral sex (receiving or giving) is very low risk with the odds of getting HIV quoted as 1 in10,000 per episode.  As for vaginal sex, the odds are less than 1 in 1000 per episode of sex.  In each of the estimates quoted above, these reflect risks if your partner is infected.  Since the likelihood that your partners had HIV is low (even most commercial sex workers (CSWs) - varies from country to country but always less than a 50% probability and in most "high prevalence" places more like 10-15% HIV prevalence among CSWs).  As for your specific questions:

1.  See above.  Very, very low.  The figure I quoted is, in my judgement, conservative.  Neither Dr. Handsfield nor I have ever seen or heard of a well documented case of HIV transmission through oral sex.
2.  Again, see the figures above.  Circumcision does reduce risk of HIV acquisition by about 50% compared to persons who are not circumcised.
3.  No.

As for your question on the ARS, I will not provide information other than to say that the flu-like symptoms which comprise the ARS are very non-specific and should be used to influence assessment of HIV risk.  For more information, look at an 10 posts on this site.  You will find that in at least 7 of those 10 we informed clients that looking for ARS symptoms is a waste of time.

So what should you do?  Get tested, not only for HIV but for other STDs as well (gonorrhea and chlamydia).  I advise this not because of the exposures you report but because that is the advice we give to everyone who has had more than two sex partners since they were last checked.  this is a matter of routine health maintenance.

Hope this helps.  EWH

[Rob63317]

Hi Doctor:  Thank you for your reply.  It gives me reassurance that probably I am getting all psychologically twisted up over nothing.  Just some small follow-up questions:

1)  Having read many replies on this forum by you and Dr. HHH, I noticed you both say 99% the same thing, but one small difference I am curious about.  He says the risk for unprotected vaginal sex for man (if woman was infected) for sex one time is about 1 in 2,000.  You say it is 1 in 1,000.  Just curious as to the difference?

2)  I guess its good I am circumsized - can you briefly explain though why that lowers risk for a man?

3)  This "Oraquick" test I keep reading about:  Since I am worried about things from years ago, does this mean it will be as accurate as any blood test in your opinion?  Is it something you can find out about on the spot, like within 15 minutes?

Thank you for a wonderfully informative site!