Welcome to the HIV forum.
This was a low risk exposure. It is unlikely your partner had HIV; most sex workers are not infected, and when a sex worker uses condoms it's an additional good sign she isn't infected and intends to stay that way. Even if she had it, the average risk of transmission for an unprotected vaginal sex exposure (female to male) has been estimated to be around once for every 2,000 events (equivalent to having sex with HIV infected women once a day for 5 years and not necessarily catching the virus). Blood exposure or having penile psoriasis might slightly increase the risk, but not enough to worry about. To your specific questions:
1,2) The brevity of the expousre probably makes the already low risk against infection. You should not be very worried at all. However, we have never said brief exposure definitely reduces transmission risk. That's a logical assumption, but there are no data on duration of interecourse and how it correlates with transmission.
3) There are only 2 doctors on this forum and our answers are the same. There haven't been very many studies of HIV prevalence in various groups of sex workers, but the available data suggest it is rather low in the US and most industrialized countries. But there certainly are exceptions; some sex workers (e.g., inner city brothel workers, street walkers, etc in some parts of the country and in some racial/ethnic groups).
4) Obviously the most common cause of vaginal blood is menstruation. Beyond that, I cannot guess. There are lots of potential causes. Most of them have nothing to do with HIV or other STDs. Blood on skin absolutely does not usually result in HIV transmission, and neither does blood contact with psoriatic skin lesions.
Bottom line: All things considered, the chance you caught HIV is very low. From a risk assessment standpoint, you don't even need HIV testing. However, you'll probably want to do it; most likely my reassurance won't entirely calm your nerves and you'll need testing for the anxiety relief from a negative test result. And it would be reasonable for your to be tested for gonorrhea, chlamydia, and syphilis -- although I expect those results to also be negative. I recommend you visit your local health department STD clinic, or your personal physician, then follow the advice you get there about exactly what tests to have and when to have them.
Best wishes-- HHH, MD
I can't tell you how much I appreciate what you do. I have a couple clarifying questions:
1) You mentioned the risk of transmission at 1 out of 2000, but I thought I've seen you mention it elsewhere around 1 out of 1000. Could you explain the discrepancy (I'm sure there is good reason)?
2) You say this is a "low risk exposure", I'm interested in what you would consider a "high risk exposure"?
3) Should I also be tested for Herpes, you didn't mention that one?
4) How soon after can I feel confident I do not have any STD, like syphilis, etc? I plan on going to the clinic 5 days from yesterday, but should I go back even if I have negative results the first time? (I understand from reading other posts HIV tests are closing in on 100% accurate around 6 weeks)
Thanks again. Your words do help a great deal, but I'm sure a negative result will allow me to move on completely (and never, EVER, do that again). From here on out, I'm keepin' it to very safe (protection, lube, known partner, known status), sexual encounters. Hopefully this helps others in my situation who read this. I'll come back and let you know my results.
1) The data on sexual transmission risk are not very precise. For vaginal sex, CDC calculated 1 in 2,000 for famale to male transmission and 1 in 1,000 male to female. Both are very rough figures, and sometimes we round them off. You should not interpret any difference between 1 in 1,000 versus 1 in 2,000.
2) Compared to shaking hands, you had a high risk exposure. Compared to anal sex between gay men, or unprotected sex with a woman known to have HIV, you had a very low risk exposure. There are no standard definitions for the terminology to describe risk. Don't get hung up on words. The important issue is whether there is a significant risk you caught HIV from the events described. There is not.
3) Herpes testing is rarely if ever recommended after any particular exposure; the risk is too low (probably also under 1 chance in several thousand).
4) Every day that passes without symptoms increases the odds against having caught an STD. Follow the clinic's advice. Most likely they will do urine tests for gonorrhea and chlamydia and recommend blood tests for syphilis and HIV after a few weeks. They may also do blood tests now, but not because they could be positive from this event -- only to assure you are negative at this time, to help interpret the repeat tests in a few weeks.
Feel free to post your test results as they come in, but I won't have any further comments or advice unless something turns up positive.
Dr. Handsfield, I am very concerned. Since the encounter I have had no visible symptoms until about last week (one month later), when I thought my pee may have burnt a little. The other night, after having protected sex with my partner, I noticed that there was some sort of discharge coming from my penis (this was not semen, it was after I flushed the condom and I right before I went to the bathroom). Since then, it seems every time I let it go for a while, and then push on my penis this white colored discharge comes out. It is very runny, and not what I would necessarily call puss. It looks more white than yellow, but it's hard for me to tell. It's almost milky, like watered down semen. Is this gonorrhea? If so, I have had one encounter with my partner where she gave me unprotected oral sex. I am concerned that she may also have contracted it from me. What are the chances this may have occured?
1) What are the long term side effects if I have gonorreah? My understanding is it's treatable.
2) Does this increase my chances of herpes or HIV?
3) What else should I expect?
4) What is the best way to inform my partner about this?
These symptoms suggest you may have nongonococcal urethritis (NGU). Gonorrhea is possible but less likely. Both NGU and gonorrhea are easily treated. Herpes does not cause such symptoms. HIV remains extremely unlikely. Have you been tested? What was the result?
You need professional evaluation for your urethral discharge. Visit a doctor or clinic for examination and testing. Follow their advice about testing and about what to say to your partner. (I suggest you not say anything to your partner until you have been professionally examined.)
After you have been professionally evaluated and any test results are available, feel free to return with a comment to tell me the outcome -- but not until then.
Hi Dr. Handsfield,
I'm sorry it has taken so long to respond, I was waiting on the results of my tests. My initial visit to the clinic confirmed I have NGU, and so they gave me some medicine to treat it and the symptoms seemed to clear up almost immediately (I noticed a difference later that day). I no longer have any symptoms whatsoever.
All my blood work and urine sample tests came back negative for everything, including gonorrhea, chlamydia, herpes, and HIV. So I must have had some "other" form of NGU that apparently responded to the medication.
The HIV test was administered just a few days shy of 5 full weeks. They apparently only did one of the two HIV tests because the other one they generally only perform in gay men (3 months inside of exposure). The person I spoke to at the clinic said that the first one is pretty much accurate inside of 3 months for a majority of people, and the second test would only have confirmed that beyond any reasonable doubt I can't remember the name of the 2 HIV tests, but I'm sure you know which ones I am referring to. They took blood.
Can I breath easy that my negative results are conclusive, and that I don't have HIV or herpes a few days shy of 5 weeks post-exposure? I have not felt ill or abnormal in anyway other than what I experienced with the NGU.
Also, now that my symptoms have cleared up for my NGU, and I have finished taking my medication by about a week now, when I can feel safe engaging in protected sex again?
I wanted to also ask if I should have any concern about becoming sterile as a result of my NGU?
Glad to hear this came to a satisfactory conclusion. Your response to treatment was so fast that I have to believe your NGU was on the verge of resolving anyway. No antibiotic can resolve the symptoms of any infection in under a day, and for NGU symptoms usually improve gradually over several days. But it's good to hear the problem has gone.
As for the causes of NGU, your situation was entirely typical. In over half the cases, no specific cause can be found.
The clinic gave you accurate advice about HIV testing. Your negative result is 100% reliable.
As for resuming sex, you should ask the clinic that prescribed treatment what their advice is. Usually resuming sex is considered safe after a week or so.
Finally, nonchlamydial NGU is not known to cause infertility or any other complications. You should view this as a minor inconvenience, not an important health problem. It will never cause you any significant difficulty.
Thanks for the follow-up. Best wishes and stay safe.
Thanks, Dr. I appreciate your response and will move on with my life. Regards.
A related discussion, Condom broken