Unique Question About my Risks

Hi there,

I visited a somewhat higher classed massage parlour in Shanghai, China, and had vaginal intercourse there while quite intoxicated. The girl seemed clean, and that place is known to always use condoms with their customers. But after having sex for a few minutes, I became softer and took off the condom and proceeded to have sex with her unproteted for less than a minute, before she put another condom on to finish.

My questions are:

1) Given such a limited exposure time (I am std free, circumsized) am I still at risk with such a event?

2) Does ejaculating help push whatever was in the mucousal membrane of the urinary tract out thus reducing my risks?

Thank you for your attention on this matter.

[H. Hunter Handsfield, M.D.]

What makes you think your question is somehow unique?  Virtually the same question must have been asked 100 times on this forum.

Straight to your questions:  1) You had a period of unprotected vaginal sex, so of course your risk was not zero--but it was certainly very low, less than 1 chance in 2,000.  2) There are no data--that is, nobody knows whether ejaculating or not changes a man's risk of catching HIV if exposed.

All in all, the risk was low enough that you don't need HIV testing.  But nobody can say it was zero risk, so if you're nervous, get tested.

HHH, MD

[LennyBruce]

Ok, doc, now I'm no expert and you clearly are, but I have to ask -- how can HIV testing not be indicated after unprotected vaginal intercourse with a sex worker?  I've taken comfort in reading your responses to other questions -- including my own -- but after reading this advice, I can't help but wonder whether your advice is on the "liberal" side (as opposed to hotline workers, who seem to always err on the "conservative" side, i.e., always recommed testing).  Please note that I mean no disrespect by this comment, just my thoughts.

[HFan00]

Hi Doctor,

So being intoxicated does not play a factor in increasing my risks through dilating my blood vessels? Thanks

[monkeyflower]

Dr. Handsfield was alluding to the fact that the risk of a guy contracting HIV from vaginal intercourse with a *known* HIV positive woman is only 1 in 2000.

[H. Hunter Handsfield, M.D.]

I never recommend HIV testing after a single potential exposure unless the risk is quite high, as might apply with a partner known to have HIV, or for unprotected anal sex between men who don't know each other.  The risk of heterosexual transmission after a single exposure to a CSW doesn't make the cut.  (If every man who had sex with a CSW got tested every time, the HIV testing services in most cities couldn't handle the load!)  Such people should just have an HIV test (and testing for other common STDs) from time to time, such as once a year, but not worry so much about individual exposures.

HHH, MD