Chances of HIV exposure?

[HMMNN]

I am a 25 y.o. male and I have been with one female partner for 10 months now.  Approximately a month and a half ago I had a sexual encounter with another female that is known to be very promiscuous.  I used a condom, however when I was about to ejaculate I pulled out and masturbated with the condom still on. Figuring I was done with the sex and the risk for STD's I decided to take the condom off to finish and masturbated without the condom.  I am concerned about the risk of transferring vaginal secretions from the outside of the condom to my hand and than to my genitals.  What is the Risk of contracting HIV or other STD's in this manner?   Also, my original female partner had an abnormal pap showing severe dysplasia. Does this add to the possibility that I may have contracted some sort of disease (HIV) from this other encounter?

[H. Hunter Handsfield, M.D.]

There is definitely a connection between race/ethnicity and HIV -- not primarily a biological one (although it is possible that the genetic make-up of some ethnic groups makes them slightly more susceptible to HIV), but related to behaviors and social networks.  So your conclusions from your research are not correct; in the US, African Americans on average have higher HIV rates than people of other racial/ethnic origins. (The geographic relationship is true, i.e. higher HIV rates in inner cities and the southeast.  But those relationships are partly because of where African Americans live.)

Nevertheless, the vast majority of young, sexually active African Americans don't have HIV.  That your partner's apparent cervical HPV infection is persisting longer than average is not, in itself, an indicator of HIV; her provider probably is being conservative in requesting that she be tested.  That said, if her provider has requested an HIV test because he knows things about her that you do not (e.g., has she been an injection drug user? the partner of men known to be at particularly high risk of HIV?), maybe she will turn out to be HIV positive.

But even if she has HIV, that affects only the first of the four main points of my reply above.  Please re-read my second, third, and fourth points.  In other words, you still would not be at signficant risk.  If she turns out to be HIV positive, definitely get tested for peace of mind.  But you still could expect negative test results.

[HMMNN]

Thank You Doctor.  Your reassurance was golden.   I may need it one  more time while I am awaiting my test results. I am freaked out again because my original partner has gone in for her follow up PAP and her doctor has sent her for HIV testing as well as a cancer specialist, because he can't figure out why her immune system is not fighting off the HPV.    She is also 25 and young enough that her HPV and abnormal cells should not be this progressed according to her doctor.  

My original partner is African American. Is there any correlation to race and HIV?  If my studies are correct there is no significant correlation by race but yet only by Geography.  

[H. Hunter Handsfield, M.D.]

First, few women in the US and other western industrialized countries -- including "promiscuous" ones -- have HIV.  Second, in the 25 years of the known HIV epidemic and thousands of STD clinic patients per year, I have never once had a patient with HIV who was infected after a single exposure; every one of my HIV patients had experienced multiple unprotected high risk exposures.  Third, even if your casual partner had HIV and you had completely unprotected vaginal sex, the average estimated risk you would be infected would be once in every 2,000 encounters (equivalent to sex with infected women once a day for more than 5 years).  Finally, if that's the risk with several minutes of unprotected vaginal sex, what could it possibly be with the miniscule exposure to your partner's secretions that you describe?  Many lay people assume that "just one virus" is enough to transmit HIV. Not true.  It takes lots of virus introduced in a way to access susceptible cells inside the body.

So the likelihood you caught HIV was zero for all practical purposes.  You don't even need HIV testing on account of this event, except to the extent you need a negative test result for reassurance to help you convince yourself. Also, to feel even better about it, why not call your casual partner and ask if she is infected or at risk?  You'll probably find she is as worried about your HIV status as you are about hers.

Your and your partner's HPV infection makes no difference.  (No, I don't know for sure that you also are infected with the HPV strain causing your partner's abnormal pap.  But it's a good bet.  But if so, it will go away without ever causing harm.)

Bottom line: You have no HIV worries from this event.  But if this reassurance doesn't completely calm your fears and you would sleep better with a negative test, go ahead and do it.  It's no big deal.

I hope this helps.  Best wishes--  HHH, MD