Am i at serious risk?

[buddy1015]

I recently (Feb 5th) went to an asian massage parlor and engaged in vaginal sex with the masseuse. after I had ejaculated i noticed the the condom had broken... but the most it would have been broken for was a minute or 2 before completion because before changing to the final position the condom was fine. Now i have read that female to male transmission is very rare, if this woman even may have had HIV in the first place, but needless to say i am a bit concerned. How worried should I be and what actions should i take from here? A local clinic offers rapid HIV testing, how long should I wait to take this test? I have been losing sleep over this, should I be worried? Thanks

[Edward W Hook, MD]

Welcome to our Forum.  I can completely understand how you would feel, having done the "right thing" in using a condom, only to have it fail during use.  It is a disconcerting and anxiety creating event.  Fortunately, your risk is really quite low, as I will point out.  Here are the reason not to be too concerned:

1.  Your partner was a commercial sex worker.  Most CSWs do not have HIV.
2.  Even if your partner had HIV, the risk of getting HIV from a single episode of vaginal intercourse is less than 1 infection in 1000 exposures.  In your case the risk may be even lower given the short duration that you were exposed.

What to do.  First, realize the risk is very low and do not spend your time worrying if every fever, skin abnormality or ache you have might be a sign of HIV.  Use of symptoms to determine if a person has HIV is a waste of time.  It does not work because the symptoms of the ARS are TOTALLY non-specific, mimicking the sort of community acquired viral infection that most people get once or twice a year. As a result, when people experience "ARS symptoms" they are much more likely to have something else, usually some other, more typical virus infection.  When this has been studied in the US, less than 1% of persons seeking medical care for "ARS symptoms" are found to have HIV, the remainder having symptoms due to other processes. In contrast, over a given year, there is almost no one who has not had a viral illness, night sweats or both (sometimes on multiple occasions).  In addition, it is also important to realize that many persons who acquire HIV do not experience the ARS.  For a person to try to judge their HIV risk based on "ARS symptoms" is a waste of time.

Second, your exposure puts you at higher risk for other STDs like gonorrhea or chlamydia than HIV.  Get yourself checked for gonorrhea, chlamydia and NGU when it is convenient.

Third, you should go on and get a blood test for HIV.  To do so now, less than 2 weeks after your exposure will not tell you much.  In contract, at 4 weeks over 90% of persons who are infected have positive blood tests, thus a negative test at that time will be quite reassuring.  Another test at 8 weeks when over 99% of tests will be positive should be considered definitive for this exposure.

Hope these comments are helpful to you.  EWH

[buddy1015]

Please doctor, do not take what I said as a slight to your opinion or an affront to your expertise. I truly appreciate your concern and time in making your judgements. Thank you for your time and and care in easing my mind, I already feel SOOO much better.

[Edward W Hook, MD]

I find the suggestion that I am suggesting you get tested becasue you are likely to be HIV infected offensive.  That is not the way this site works.  If your risk was substantial I would tell you.

Rapid tests arefine.  They are as sensitive as blood tests for antibodies performed in laboratories.  They have a very slightly higher false positve rate.  EWH

[buddy1015]

Thanks so much for the quick response... Would you recommend the "rapid" tests in 2 more weeks from tomorrow? Like I said previously, there is a local clinic that offers free HIV screenings. Honestly though, are you suggesting I get tested because it is the right thing to do, or because you feel that there is a better than outside shot I might be infected? I was planning on going anyway cause i am the kind of person that worries my head off. I just noticed from reading other posts that you have stated there is no need for people to get tested.

[buddy1015]

I went to the Dr yesterday for a sore throat and he gave me ZPak and Methylprednisolone and i feel great today... I had no idea what ARS was but my blood really ran cold when I saw that... I have had no fever and nothing more than a sore throat and headache... Should I be worried about this?