potential exposure

I am a 24 year old male who had protected vaginal sex with an asian escort (unknown hiv status) in a massage parlor in NYC. This was my first time having sex. I had had sex twice with the escort. The first time, I came early in 15 seconds, and pulled out with the condom in tact in 3 seconds or so. The second time, I was occasionally not fully erect when I was inside her and at times I even got flaccid, and so I fear my condom might have slipped of from time to time, and thus exposed me. However, when I finally pulled out my penis (without cuming, and after 15 minutes of sex in different positions), the condom appeared to be in place for the greater part (perhaps shifted up a bit, but covering the eye of the penis confortably).

(1) What is my risk level?
(2) Is it possible that the condom slipped of sufficiently so that I was exposed?
(3) I am going to get an antibody test done, but should I get a pcr as well in 2 weeks post-potential exposure?
(4) If a condom breaks, is it normally easy to tell or can the tears be subtle enough to missed by eyes/ears?
(5) If I had also smoked marijuana a day before this encounter, and hardly eaten anything the day of the encounter until after the encounter, would this make me more susceptible to infection?

I have been extremly stressed for the past couple of days (my potential exposure was 3 days ago). I have also had a sore throat and cough with phlegm (and sometimes without)-are these symptoms of the virus.

[H. Hunter Handsfield, M.D.]

To answer your last comment/question first, there is no reason for the level of stress you describe.  And your sore throat and cough definitely aren't due to HIV or any other STD.  Your other questions, one by one:

1) Almost zero.

2) If the condom was in place when you pulled out, it almost certainly was in place the entire time.

3) No, PCR testing would be a waste of money.  I wouldn't even recommend you have an antibody test, except that the negative result will help you sleep easier.  If every person in the country had an HIV test after every episode of unprotected (or semi-protected) sex, we could run the Iraq war on the tax revenue.  (I exaggerate, but you get the idea.)

4) If a condom tear is small enough you can't see it, it's unimportant.  Most condom breakage isn't just a nick, but the entire thing splitting open.

5) No.

Relax.  This exposure isn't worth losing sleep over.  Good luck--  HHH, MD

[albert101]

Hi Doc,

Thanks in advance for your reply!
As an additional thing, how long do I have to wait for the pcr and elisa to accurate? I read in one of your replies that elisa is 99% accurate at 6 weeks.

(1) Is that the 4th generation elisa (which I understand is some kind of hybrid of the 3rd generation elisa and the p24)?

(2) Do you infer that accuracy from experience, or from statistical studies? I don't mean to sound skeptical about your opinion since you are clearly an expert in the field, but some of your colleagues (for example, on www.thebody.com) still seem to recommend 3 month elisa, and since I have little knowledge about the technicalities of this, I am confused by the conflicting opinions.

Sorry for the additional questions, and thanks again.

[albert101]

I also have the following symptoms now: barely visible rash that burns a bit on my left chest with a few popules, couple of red soft patches (probably lymph nodes under and to the left of my right armpit), same patches in and above the groin area (by the way, do SWOLLEN LYMPH NODES look like this because I am pretty sure thats what they are), I have sore throat with cough, sometimes with phlegm, I had a stuffy nose but that went away with medicine, and I am slightly feverish (though not particularly so).
The sore throat was within a couple of days post-possible exposure. Within a day I developed cough, and around 2 days after that I started noticing these lymph nodes/swelling etc.

[H. Hunter Handsfield, M.D.]

My knowledge about HIV testing is based loosely on my understanding of the scientific literature plus the "general knowledge" of STD/HIV experts.  There are few absolutes in biology or medicine, i.e. there are exceptions to everything.  But the latest ("4th generation") ELISAs are almost always positive by 2 weeks.  Some early results are weakly positive and the confirmatory testt (western blot) will be indeterminate, but a negative ELISA 6 weeks after exposure can be relied on as truly negative.  If there are exceptions, they are extremely rare.  When you factor in an exposure that has less than one chance in 1000 of resulting in HIV transmission (even if your massage parlor partner were known to be HIV infected, which she probably wasn't), the odds are astronomical that a negative result at 6 weeks would be false.

It sounds like you have a viral respiratory infection.  The timing makes it possible you caught it from your recent partner, but through exposure to oral/respiratory secretions, not by intercourse.

Good luck again--  HHH, MD

[albert101]

DOC pls help!!! I have (since day 6) started developing a non-itchy maculopapulor rash that is now in two small patches on my upper chest...I am besides myself with trepidation...I tried to harm myself last night and I am going to see a pscyhiatrist today. I have taken the PCR and ELISA yesterday (10th day post-encounter). Do I have the typical ARS rash???

Pls help and thanks a ton in advance