Unprotected Oral Sex + Protected Vaginal Intercourse but Condom Slipped off.

[patient101]

Dear Doctors,
                    I would sincerly appreciate a honest answer on the following concerns of mine.
2 Days ago i recieved unprotected oral sex from a prositute for 10 - 15 minutes. I have no sores or lashes on my penis. Afterwhich i had protected vaginal intercourse for about 5 minutes where she was on top. During this preiod my penis became limp and i pulled out from her. When i pulled out i noticed the condom was not on my penis, the condom was stuck inside her vagina, the bottom end of the condom was sticking out a little from her vagina, as in she could pull it out right away without having to enter her vagina with her fingers. I feel the condom could have slipped of as i pulled out, not while intercourse as otherwise it would probably be deeper inside her. Touching my penis i didnot find it to be wet from contact with any vaginal fluids. but nevertheless I have been extremly worried if i have got HIV infected, i would like you advice me on what you feel are the probablilites of being HIV positive as well as if you believe i should get tested? and if so how many times and when? I read somewhere the probabibility of contracting HIV in unprotected sex is 1 in 200,000 for males. Is that a correct estimate?

[H. Hunter Handsfield, M.D.]

You don't say where you are, but if in the US, the chance is your partner didn't have HIV.  When commercial sex workers ask their customers to use condoms, it usually means they don't have HIV and want to stay that way.  If she had it, the risk of transmission from male to female for any single episode of unprotected vaginal sex is estimated at 1 in 2,000.  In your case, it was less than that, since the exposure was brief and it apparently was condom-protected during most of the event.  So let's estimate that the chance she had HIV was 1 in 500 and the risk of transmission to you, if she had it, was 1 in 5,000.  that makes your risk.  Your chance of having HIV from the event then is 0.002 x 0.0002 = 0.0000004.  That's less than 1 in 2 million.

In other words, I wouldn't worry about it and you don't need testing. Of course if you find this reassurance doesn't settle your anxieties, it's fine with me if you decide to get tested.

Regards--  HHH, MD

[patient101]

Another thing i forgot to mention, this was the only time i have had sex with a prostitute.

[alienshadow]

its 1 in 2000

[patient101]

i am in the UAE, Dubai and the prostitute was russian. What is the earliest conclusive test i could to take and when to give me some peace of mind. Assuming she was infected with HIV and the time of unprotected sex was minimal (less than a minute). What would be the probablilty, as your answer didnt assume her to be HIV +.

[H. Hunter Handsfield, M.D.]

I still would not assume she is HIV positive.  But I would be happy to raise that chance to 1 in 100 instead of 1 in 500.  That would raise your risk from 1 in 2 million to the 1 in 200,000 risk you cited yourself.  Still too low to lose sleep about.  Even if you assume she definitely had HIV, my estimate of 1 in 5,000 would apply.  That is equivalent to having the same exposure every day for 13 years and maybe never getting infected.

But I already said it's fine with me if you want to get tested.  A test 6-8 weeks after the event would be fine.

[sonnylevy]

Dear Dr.
I have read most of the threads and I appreciate your answers.  Why do you insist that almost in all cases the chance for contracting HIV is almost nil for males in heterosexual intercourse?  Certainly there is a large demographic of males who acquire HIV from heterosexual encounters.  How can you explain this apparant contradiction?
Thanks.

[H. Hunter Handsfield, M.D.]

This is off topic for this thread, and that question has been addressed several times.  But it bears repeating, since it probably is the single least understood aspect of HIV epidemiology among the general population -- certainly among most people who ask questions on this forum.  So here it is again.

I only "insist" on what the data support.  The epidemiology of HIV and heterosexual transmission varies widely and your premise is not universally true.  In the US and most industrialized countries, there is not a "large demographic" of heterosexually infected males.  In 30+ years of the HIV/AIDS epidemic in the US, only a relative handful of men (a few thousand) have acquired HIV through heterosexual exposre -- in a country with something like 120 million heterosexually active males.  Further, most men infected heterosexually were the spouses or other regular partners of infected women, not infected during casual, one-time partnerships.  Similarly, most heterosexually infected women in the US were the regular partners of infected men, who usually acquired their infections from injection drug use or from sex with other men.  Looked at another way, there is little sustained heterosexual HIV transmission in the US and, say, Western Europe.  Instead, heterosexual transmission is sporadic and uncommon, usually the result of "bridging" from more high risk populations.

The situation is very different in much of the world, especially in some (but not all) developing countries.  The reasons for the differences include differing sex partner networks, background rates of circumcision and other STDs, differences in sexual practices, stage of the HIV epidemic (which translates into the proportion of infected people who have high viral loads and thus are more efficient transmitters), and numerous other factors, not fully understood.

There are exceptions; i.e., there have been and will continue to be pockets of sustained heterosexual transmission in the US, and there is continuing fear that it could become much more common -- maybe just from the bad luck of a few people transmitting infection to a few others at just the wrong time and place.  But until now, that hasn't happened, and sexual behavior experts really don't see much potential for it.

[H. Hunter Handsfield, M.D.]

This isn't your thread and I deleted yet another anxiety-driven follow-up comment.  See my reply in your own thread.

[patient101]

Dr,
    Is it alright for me to to take a at home rapid test after 6 weeks would the result be 100% conclusive. As if i am + i will be deported from UAE after a test at a lab? If yes, which test would you recommend.


Regards.

[H. Hunter Handsfield, M.D.]

Seems to me you should just get tested in a routine lab.  The result is going to be negative, so you won't be deported.  And if it should be positive, would you really want to stay in UAE?  Or return to the US (or other western country) for proper health care by providers familiar with HIV?  So what does it matter?

In any case, none of the rapid tests is approved in the US for self-testing at home.  I'm sure they would work and all are reliable at 6 weeks, but I cannot recommend one test over another.

[patient101]

Sorry Dr. for another message. Your last reply got me anxious. Earlier you mentioned "i didnot need to get tested", in your last reply you said "if i was poitive" . I hope you understand that in this situtation words are analyzed indepth and this made me feel that you were not 100% certain that i wouldnt be hiv +. Kindly let me know if you are 0.001% uncertain. This would be my last question. If you feel you are certain that i do not have hiv +, i will not get tested. Thank you for your time and patience.

[H. Hunter Handsfield, M.D.]

Sorry, but I am not responsible for people who are trying to convince themselves they are infected and are reading between the lines of my comments to prove it.  I said nothing that even hints that I think you are infected or at risk.

Presumably you came here for reassurance. I gave it.  Accept it and move on.

[robroy461]

A related discussion, first time protected sex did not ejaculate was started.