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Avatar universal

HIV Concerns

Drs:

On the evening of 9/20 while on a trip to Vegas I regrettably saw a CSW. Of course now I regret it and am quite worried about contracting HIV. The stupid things humans do….Here are the circumstances:

During protected sex while changing positions we noticed I had begun to lose the erection and the condom had become very loose. She noticed it and masturbated me back to erection and we continued and finished. The condom never came completely off, but since it was loose it exposed the top portion of my shaft (exposed an additional two or so inches ) and provided a possible entry point.

My concerns are that I do have genital herpes, I was not aware of any active sores, but who knows?
Also, I now have what appears to be a single ½ inch in diameter cold sore or rash near but not on my lips. I have never had one in my life and this popped up overnight on 9/24. I realize this is too soon to be a HIV indicator, but is that too soon for a cold sore?

What are my odds here? Is HIV testing warranted? How concerned should I be?
From reading here, I figure the earliest I can get tested is early November.  Does that sound right?

Thanks in advance for your educated input.
3 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
Welcome to the forum and thanks for your question, which came in while I was on the forum myself.  Thanks for your confidence in the forum and for your thanks in advance.

As we have said many times on this forum, HIV is less common in CSWs in most of the US than many people realize, and it's believed to be especially uncommon in Las Vegas.  The frequency of prostitution there, the presence of legal brothels, and relative sophistication of both CSWs and their customers probably work to increase awareness of risk, testing, and condom use.  I would guess the chance your partner had HIV to be no higher than one in 1,000.  And even without a condom, the transmission risk for a single epsiode of unprotected vaginal sex, if the female is infected, has been calculated at 1 in 2,000.  So even if you hadn't used a condom at all, I would put your risk of having caught HIV somewhere in the range of 1 in 2 million -- in other words, zero for all practical purposes.

Assuming your genital herpes is due to HSV-2, it roughly doubles the chance of catching HIV if exposed.  That would raise your odds all the way up to 1 chance in a million -- i.e. no significant effect.  (By the way, the increased risk of HIV from HSV-2 has nothing to do with open herpes lesions.  Just having the infection, without an outbreak, doubles the risk.)

And all that assumes no condom use -- but you DID use a condom. The details about looseness etc make no difference.  You had protected sex.  Given that fact plus the factors above, you can consider this a truly zero risk event with respect to HIV.  I doubt your oral lesion has anything at all to do with the sexual exposure, and it certainly cannot be related to HIV. New HIV infections don't cause any symptoms at all sooner than 10 days after catching it.

From a strict risk assessment standpoint, you do not need HIV testing at all.  If I were I your circumstance, I wouldn't get tested and would continue unprotected sex with my wife with no worry about infecting her with HIV.  However, if you decide to be tested anyway for reassurance, you could have a standalone antibody test at 6-8 weeks or a combo test (antibody plus p24 antigen) at 4 weeks after the exposure.

Finally, the biggest STD risk in all this is for your CSW partner, i.e. your herpes.  I hope you informed her.  From an ethical standpoint, you are equally obligated to inform commercial as well as noncommercial partners about the potential risk of infecting them with HSV-2.  

Best regards--  HHH, MD
Avatar universal
Thank you. I appreciate the rational response. Its easy to get caught up in the paranoia when you are out there "in the trenches". I just needed a sanity check to screw my head on right.

If you feel there is no need for testing I will put this issue to bed. If it still bugs me in November I'll get a test and report back.

This is an wonderful service you perform. Thanks again.
Avatar universal
Doctors,

I performed a home HIV test (Oraquick) at 4 weeks and 7.5 weeks post event. Both were negative. Is this enough to be considered conclusive proof of a negative HIV status?

Thanks in advance.
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