Worried about my risk

Hi Doctor, I had sex with a sex worker here in the UK. She was white but from Australia, during the sex the condom broke but only half way so my penis end was never exposed. I also received unprotected oral sex and gave oral for less than 2 seconds. She also fingered her anus and fingered mine and it may have been the same finger but 5 minutes or more passed between that time. The condom couldn't have been broke for that long because we were changing positions and I would have realised. I went to a GUM here 3 days after and they said I had an infection from my swab. I got tested for all STDs including HIV and they were negative. It has been two weeks now but they say it's 4 weeks for a test? What is my risk of getting HIV? I am really worried that because I had an infection I have HIV.

Also the day after the incident I had a fever for a few hours and a sore throat, now 2 weeks on I have another sore throat but it is that time of the year and my best friend had a cold.

Thank you for taking the time to answer my question.

[Edward W Hook, MD]

Welcome to our Forum. Your risk for HIV form this encounter is very, very low and not something to spend a lot of time worrying about.  You have now dealt with your risk for STDs so my further comments will deal only with my reasons for being confident that you should not worry about the possibility of HIV from this encounter.

1.  If your partner was a practicing CSW in Australia where CSW is legal, she would have been checked regularly.
2.  Even if she was not, her likelihood of having HIV is low- few CSWs have HIV.
3.  Most of your encounter was condom protected, both through most of your encounter and because it sounds as though the tip of your penis remained condom protected even when the condom failed.  Without any condom use at all, if your partner had HIV (unlikely), the risk of becoming infected is 1 infection per 1000-2000 exposures.  In your case the risk would be even lower due to the at least partial effect of the condom.  

For all of these reasons, you really have a very, very low risk for HIV form this encounter. To find out definitively, I agree that an HIV test at 4 weeks using a DUO (combined HIV p24/HIV antibody)  test will provide you with definitive evidence that you did not get HIV form this exposure.  

I did not comment on your oral exposure or your anal masturbation activities as neither of these have any meaningful risk for HIV.

Finally, please do not let this event keep you from using condoms in the future. Condoms do fail, about 1% of the time they are used but they still offer the best protection form HIV for persons having sex with new partners.

Take care.  EWH

[Worried_guy123]

Also after the condom broke she put another one on.

[Worried_guy123]

Hi Doctor, thank you for replying. What about me having an infection? The nurse said that increases the risk? This has got me really scared.

[Edward W Hook, MD]

There is a slight increment in risk of infection if you have an STD but that increase is very small.  I would guess that you "infection" you had was non-specific urethritis (NSU) from the oral sex and if that were the case there would be no increase at all.  There really is very, very little risk that you have HIV.  EWH

[Worried_guy123]

Hi again Dr, I hope it's ok if I post again. I'm not sure if you read the part where I put on another condom, the broken one was taken off and it could only have been less than 30 seconds where I used it. I thought if my urethea was protected at all times, there was no risk. After that I used the new condom and ejaculated on her body. Is a test at 24 days too early?

[Edward W Hook, MD]

The data on conom protect for HIV is based on intact condoms.  I don't know how to judge what happens when a condom is partially broken- there are no data.  that sai, your risk is minimal as I said.


As far as 24 days is concerned, again, the data are for 4 weeks (28 days) for the DUO tests, not 3 and 1/2.  EWH

[Worried_guy123]

Hi Dr, I had a test at 28 days which came back negative. However I don't think it was a DUO test and she said it's 80% accurate. It was a rapid test which pricked my finger and then put it on a piece of paper. The results took 20 minutes. Do I need testing again?

[Worried_guy123]

It was this test Dr, on their website it says it's 100% after 4 weeks.
http://www.tht.org.uk/mediacentre/pressreleases/2009/september/september28.htm

[Worried_guy123]

Is anyone going to answer my question?

[Edward W Hook, MD]

The link you describe is an advertisement and tells us nothing about the test you had.  You should ask them.  If it was a combined HIV p24 antigen/HIV antibody test, the result should be believed.  

Most rapid tests of the sort you describe test only for antibodies.  In such cases, these tests detect about 90% of infections at 4 weeks.  If you wish to be completely sure that you do not have HIV (it is unlikely that you do have HIV), you can either have a combined HIV p24 antigen/HIV (DUO) test at this time or wait until 8 weeks after exposure.  In either circumstance, I anticipate that the result will show that you did not get HIV for all of the reasons mentioned above.  EWH

[Worried_guy123]

Hi Dr, I took a combined duo test at 41 days which was also negative. Thank you so much for your help. I've learnt from my mistake.

[Worried_guy123]

Hi Doctor, hopefully this is my last question and this will be over. For the month after the exposure I was being vaccinated for Hepatitis, would this affect the results of my test? Thank you ever so much.

[Edward W Hook, MD]

No, hepatitis vaccination will not impact your test results.

This ends this thread. Further answers will be deleted without comment

EWH

[Worried_guy123]

I'd just like to follow up and say thank you very much for all your help. You are providing a great service and seem like a great guy.