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Possible exposure to hiv from a csw

Hello Doctor,
Almost a week ago i had unprotected oral sex and protected insertive vaginal sex with a female escort. Since then i have been paranoid to the point that i have hardly slept and struggle to eat anything whatsoever. I am suffering from extreme anxiety over this encounter. I am almost positive that the condom did not break but i was unable to inspect it for any tiny holes afterwards because the escort flushed it down the toilet. I inspected the condom wrapper and did not notice any holes in it. The oral sex lasted for about 2 minutes and the insertive vaginal sex lasted only two or three minutes. As you can tell, i am extremely paranoid about this situation and cannot get it off my mind. Thank you for your time and i look forward to hearing your advice and or information you can provide me to help ease my anxiety.
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.

You ask among the most common questions of all on this forum.  I can accurately address your concerns based entirely on the opening sentence:  in the US and other industrialized countries, an average of around 1 in 1,000 sex workers has HIV, so your partner probably wasn't infected; even if she was, oral sex carries little or no risk (many experts believe HIV has never been transmitted oral to penis and the maximum rate is 1 in 20,000, the same as receiving oral by infected partners once daily for 55 years); and condom protected vaginal sex is no risk to speak of.  Accordingly, you can be confident you weren't infected; the risk of HIV is low enough that you don't need testing, except perhaps for additional reassurance -- but definitley not because of actual infection risk.  If this is your only potential HIV risk, you can safely continue unprotected sex with any regular parnter(s) you may have.

Now I have read the rest of your message.  It doesn't change my opinion or advice above.  It's an urban myth that microscopic leaks in condoms carry an HIV risk.  If a condom doesn't overtly rupture, protection can be safely assumed to be complete; we don't recommend inspecting condoms closely for small defects after sex.

I hope this information indeed helps ease your anxiety about this.  You really should be having no worries.  You might gain further benefit by scanning other threads with similar questions; there are 5-10 every week.

Best wishes--  HHH, MD
Helpful - 1
239123 tn?1267647614
MEDICAL PROFESSIONAL
That's a wise decision.  Thanks for the thanks. Good luck to you.
Helpful - 0
Avatar universal
Thank you for your support and guidance doctor. However, i cannot deal with this anymore so i am going to see a psychiatrist today. Wish me luck.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Reliability of the risk of HIV from oral sex:  Extremely reliable.  I would not advise abstaining at all, let alone for 3 months.  If I were in your situation, I would continune unprotected sex with my wife with no worry and would not be tested for HIV at any time.  The RNA test at 14 days would be highly reliable, but I don't recommend it; it's a very expensive test.
Helpful - 0
Avatar universal
Thank you for your thoughts, I understand you are a very busy person. I'm just losing my mind over here.
Helpful - 0
Avatar universal
Thank you for you're advice and thoughts it really has helped ease my mind. As for the statistics you mentioned regarding hiv through unprotected oral, how reliable are they? Also, if you were my primary care doctor would you advise me from abstaining from any sexual contact for three months until i am completely cleared of any doubt about having HIV? Lastly, what are your thoughts on the RNA PCR tests after 14 days of exposure? Should i just simply wait it out since i am in a low risk situation?
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
This doesn't sound like urethritis (urethral infection) due to chlamydia or anything else, and the exposure described carries no appreciable risk for it.

HIV probability does rise in the presence of other STDs, but based on the information above, even doubling the risk would still leave you with well under 1 chance in several million of having acquired HIV.

See a health professional if your urinary symptoms continue, but from your description I really don't think anything is wrong.
Helpful - 0
Avatar universal
Thank you doctor, i also have a question about chlamydia,
have been frequently urinating and last night i woke up in the middle of my brief few hours of sleep and noticed a clear leakage from my penis. It smelled like urine and i was in the middle of a dream that involved sexual contact so maybe it was just a wet dream. I have not noticed any discharge throughout the day since my encounter which was six days ago. Also, does the probability of contracting hiv increase if the csw did have another std which i may have contracted during my encounter?
Helpful - 0

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