HIV

[Moron2000]

I am concerned about about both HIV transmission and STD transmission after safe sex, so I wasn't sure where to post, but here goes. I made a horrible mistake on april 18th in philadelphia and I am completely freaking out.

Here are the details: I went to a massage parlor, was given a shower by a sex worker (sw), and then proceeded into the massage room. The worker put a condom on my penis (with her hands, not her mouth, and gave me oral sex for approximately 1 minute. After this, I had vaginal intercourse (using the same condom) with her for approximately 2 minutes. I then turned her over and had vaginal intercourse with her from behind for approximately 3 more minutes. Once I finished, she took the condom off of me and cleaned my penis with paper towels. I have had no symptoms yet, except for very minor discomfort in my penis, but I could be just focusing so hard on trying to find something I’m imagining it.

Here are my questions:

1) After reading some of this forum, I am thinking my HIV risk is almost nil. Please tell me this is true?

2) I am very concerned about contracting HPV, Herpes 2 and syphilis as many internet sources say you can still contract these very easily when using a condom. I didn’t notice any warts or sores on the SW, but was quite drunk. I know that it is impossible to give exact figures on how likely I am to contract these three STD’s, but could you give your personal best guess? When I was behind the sex worker during intercourse, I am sure we had skin to skin contact with my scrotum and above my penis.

3) I am getting a full STD screening tomorrow and on May 18th, one month from the experience. How effective will these screens be (assuming I use a typical quick service...tSTD perhaps) in detecting Herpes 2 & Syphilis?  The medical testing service called tSTD said they could detect Syphilis, Gonorrhea, and Chlamydia after 48 hours. They said 4 weeks would be enough for Herpes 2 and HIV. Do these times sound right?

4) Should I be worried about any other STDs besides HPV, Herpes 2 and Syphilis from this experience?

5) I will see my girlfriend after a long absence on May 26th. If the full screening results come back negative after both the test tomorrow and May 20th, should I be worried about giving her anything if we have unprotected sex?

Thank you so much. It is so hard to get good info!

[H. Hunter Handsfield, M.D.]

You could hardly have safer sex than you did.  Your risk of HIV acquiring HIV or any other STD was extremely low.  To your specific questions:

1) True, your HIV risk was zero, even if you partner had HIV (which she probably didn’t).

2)  Although condoms are less effective against those STDs than others, there is still a high degree of protection.  The chance you acquired HPV, HSV, or syphilis during that single exposure is very low, probably near zero.

3) If you are otherwise at risk from time to time (depending on your and your girlfriend's sexual habits), you should have routine STD screening once a year.  So if you haven't been tested in the past year, do it now.  But you do not need any STD testing as a direct result of the exposure you describe.

4) No; even those STDs are not a serious concern.

5) I see no reason for you to not have unprotected sex with your girlfriend.

Good luck--  HHH, MD

[Moron2000]

Doctor, I have one follow up question. I am trying to reconcile what you said about the risk of getting HPV with some statemest I have found around the internet. I totally trust your advice, but I just want to understand.

On the National Institute of Allergy and Infectious Disease website, there is the following statement.

"About two-thirds of people who have sexual contact with a partner with genital warts will develop warts, usually within 3 months of contact."

This statement, coupled with the fact that HPV is so prevalent, would seem to indicate the risk of HPV infection might be greater than the estimate you gave in your response above.

Sorry to question your estimate...but the internet info out there has really freaked me out and I want to calm myself down once and for all. Again, thanks for the advice.

[H. Hunter Handsfield, M.D.]

Knowledge about HPV, especially transmission and prevention, is a very rapidly moving target.  Some internet and other sources don't have the latest information, simply because it is impossible to keep up.  Others are biased by polictical perspectives; the religious and political right, for example, has long over-emphasized the dangers of HPV, risks of transmission, and supposed lack of protection by condoms.  Happily, this (probably) does not pertain to the NIH (NIAID) site you quote.

The NIAID statement does not mean a 67% risk of transmission per episode of sex.  Further, note that it refers to warts, not asymptomatic genital HPV infection.  Among people who have partners with recognized (symptomatic) gential warts, 2/3 eventually develop warts themselves.  Most of those people have multiple exposures to their wart-infected partners, mostly without condoms.  Evolving data--improving all the time--make it clear that the per-exposure risk of acquiring HPV in condom-protected sex is low.  In any case, no test is available to determine whether someone in your situation acquired HPV, so the issue is moot in terms of your question about being tested for STDs.

HHH, MD

[Moron2000]

Doctor,

Thank you so much. This is the only place on the internet that provided me any comfort. I will not make the same mistakes again. Thank you.

[Moron2000]

I am not sure if you will still respond to this post, but I have one more question. Tonight I noticed a small bump, about the size of a pin head, on my scrotum. It was on the front of hte scrotum, about one and a half inches from the penis. The top of it looked somewhat pimple like, but perhaps a little clear on the top.

I popped it, and some whitish clear liquid came out.

This bump does not itch or hurt in any way. There is only one bump so far, no cluster. It has been 13 days since my exposure.

1)Does this sound like herpes 2 or syphalis?

2) Do herpes bumps always show up in clusters? Do the clusters form one bump at a time, or show up one at a time?

3) Since I popped this one, if it is herpes, what should I expect next from the bump...just so I can be on the look out. Will it reform in a pimple like bump, or perhaps weep?