HIV risks

Firstly, thank you for taking the time to provide such sensible and pragmatic advice. My story is similar to many I have seen on your site in the last 2 days. Recently I was working in eastern Europe and feeling low I got drunk and ended up having sex with a working girl. The lady in question was clean and showered before intercourse. She did not give any appearance of being an intra-venous drug user, which, according to the UN, is the highest risk group in that region. I received oral sex and vaginal intercourse, both using condoms which the lady put on me very professionally. At one point when I was withdrawing the condom slipped off, however, my penis was clear of her vagina before it came out of the condom ie. The condom was half in and half out of the lady. I also briefly indulged in cunnilingus.

From the answers you have given to previous questions am I correct in thinking that my risks of contracting HIV from this single exposure would be approx. 1 in 1000 if the lady was already HIV positive? Assuming that there is a 10% chance that she was (conservative?) and a 1 % chance that the condom was ineffective, is the chance of me contracting HIV around 1 in a million? If that is the case I will move on and be grateful that in the one moment of crass selfishness I was lucky to find such a responsible lady!

I will probably get a test in a few weeks, but in the meantime my prime concern is my wife

[H. Hunter Handsfield, M.D.]

It is dangerous to try to apply population-based odds to individual cases.  In general, your analysis seems correct, i.e. your odds of acquiring HIV perhaps 1 in a million.

But you do not mention (and in most cases cannot know) other pertinent aspects that would influence the odds:  whether or not you are circumcised (lower risk); whether your or your partner had other STDs, especially herpes (increased risk); if she is HIV infected after all, whether or not she is on antiretroviral therapy (lower risk) or has advanced immunodeficiency or a high viral load (increased risk); whether in fact she is an injection drug user or the partner of one; and so on.  On the other hand, your encounter was as safe as it possibly could be, and your estimate of the odds of her being infected (10%) probably is too high; and 1% is far too high a risk of condom failure when used properly, as you clearly did.

So your actual risk probably was much less than 1 in a million, probably lottery jackpot or lightning strike range.  In my opinion, you do not need testing and can be 100% confident you will not infect your wife.

Good luck-- HHH, MD