was i at risk please help

Dear Dr last weekend I went out to the bar got very drunk met a 26 year old woman form Tibet who lived in India until she was 16 of unknown status took her home gave her oral for about 15 minutes then i had protected vaginal sex with her for about 15-20 minutes i could not ejaculate so i removed the condom and she gave me oral for about 10 minutes after that i picked up the same condom i used earlier which had her vaginal fluids all over it and put it on backwards (so the side that had her vaginal fluids were now on my penis) we had sex for another 15 minutes until i ejaculated now since the condom was put on the oppisite way with her vaginal fluids trapped in the condom touching my penis am i at risk for hiv/stds? i also put my penis in between her breasts with no condom and gave and recieved oral without one does that put me at risk? do i need testing? please help

[Edward W Hook, MD]

Your exposures are essentially unprotected. To re-use a condom and particularly to re-use a condom inside out is the same as not using a condom at all.  Thus, my answers will be based on the assumption that you gave and received un-protected orals sex and had unprotected vaginal sex with this woman of unknown status from a country in which HIV is relatively common.  As a result, although your risk for HIV is rather low (your risk for STDs, because they are a bit more common is a bit higher), you should be tested for both STDs and HIV.  Here are my thoughts:

1. Even though your partner is from a country where HIV is more common than in North America and Western Europe, statistically is remains unlikely that she had HIV.
2. If, she had HIV, your risk of getting infection is still VERY low.  The risk of getting HIV from vaginal sex with an infected partner is about 1 infection per 1000 exposures (1/10th of 1%).  The risk from giving or receiving oral sex is at least 1o times less likely.
3. STDs are more common than HIV so your risk of STD is still be bit higher but still not high.  
4. I would recommend that you get tested for STDs (gonorrhea, chlamydia, nongonococcal urethritis) at any time 3 or more days after your exposure.  Syphilis and HIV blood tests should wait till longer – 4 to 6  weeks after your exposure.

Bottom line, your risk is low.  Assuming you do not develop symptoms, I would suggest you get tested as above to be sure.  If you develop symptoms at any time, please go on and see a health care professional.

Finally, in the future use condoms but now use them correctly.  EWH

[sckeet]

ok now lets say if i was to just re use the condom and it was put on the rite way would this be considered safe? when can i stop testing? Thanks Doc im glad i paid $15 to get to talk to a real hiv expert i posted the same question in the hiv community and was told "no risk" even recieved a warning from the people who owns the med help hiv forum Lizzie and Teak

[Edward W Hook, MD]

Condom use is not recommended, whether or not you put it on inside out or correctly.  

A test at 8 weeks will provide you with evidence that you can have confidence in.  This is the end of this thread.  EWH

[sckeet]

doc i dont get what you mean when you said "Condom use is not recommended, whether or not you put it on inside out or correctly." my question was lets say if i have vaginal sex with a girl i have only one condom after a few minutes she wants to give me oral i take off the condom she gives me oral then i put it back on the same side would i be at risk for hiv then? thank you for your answers i will get tested at 8 weeks  

[Edward W Hook, MD]

As I said, the situation you describe is still not a recommended use of a condom.  There is NO information as to how much your risk would be increased in this situation.  It is likely that in taking the condom on and off, gential (genital) secretions would get into the condom or it would weaken increasing risk of breaking and/or slipping off.  As to how much such your risk would be increased with condom use, it is unknown and I hesitate to guess.  There are just too many variables in play.  EWH

[sckeet]

ok thanks doc how long does hiv live outside the body?

[Edward W Hook, MD]

It depends on the conditions, longer if it is blood or some other bodily fluids but typically only minutes.  You are now getting into "what if" questions which tells me that it is a good time for this thread to end.  No further questions please.  EWH