What is my risk for HIV/STD's / Do I need to test?

[needadvice578]

I am a 43 year old man married for 13 years and had never cheated on my wife until March 28, 2008. I went on a trip with a group of friends to Las Vegas. While at a wild party at our hotel I got very intoxicated from alcohol. I am not a heavy drinker and have never used drugs. I had vaginal sex with the same prostitute three times that night within 30 minutes.

The first sex act - I put on a condom and had vaginal sex for a couple of minutes. I did not ejaculate and I pulled out. After walking away from her I noticed I didn't have a condom on. I looked down and the condom was on the floor near where I was standing. I have no reasonable doubt that it was my condom.

The second sex act - I picked up my condom on the floor and reused it since I couldn't find another one and I hadn't previously ejaculated into it and had vaginal sex with her again. I did not ejaculate and I pulled out. I don't remember the condom falling off or slipping but I can't be sure and I don't even remember taking it off. I'm sure I put it on.

The third sex act - Fully protected - I found a new condom and had vaginal sex with her again. I ejaculated into the condom and there was no breakage.

The girl is a prostitute/escort from Minnesota flown in by one of my friends who had prior dealings with her. She had sex with multiple men over the 4 days that she was there. I have since contacted her and she will be taking a test for HIV and STD's.

I am horribly ashamed of myself and scared to death that I contracted HIV or STD's and could pass it on to my wife. I will not have sex with her until I know I'm OK.

Question 1 - What is the risk that I contracted HIV or STD's from the three times I had sex?

Question 2 - Do I need to be tested if the prostitute tests negative (window issue) and if so, would a pcr test be accurate if I took it now? Do I have to wait 6 weeks?

Question 3 - Am I nuts to be so worried? This incident has scared me to death.

Thank you.

[H. Hunter Handsfield, M.D.]

You cannot keep coming back with every anxiety-provoked additional "yes but" or "what if" question that comes to mind.  Penile red blotches don't sound like an STD and it doesn't change my advice above.  But it is a mistake to use steroid cream without a health professional's advice about it, which I will not give, not knowing what you have.

This thread now is truly over.  Also, second threads on the same exposure or clinical issue are not permitted.  There is no point in starting a new one, which will be deleted without response.  Any further advice needs to come from your personal health care provider.

[needadvice578]

Sorry Doctor , but I have another question. I hope you will answer it. This morning, 10 days after contact, I woke up with a flat red blotchy rash on the head of my penis. No raised bumps, itch, burning or trouble urinating. No other symptoms. I put some hydrocortisone oitment on the rash three times today which has definitely lessened the redness, although upon close inspection I can still see some minor redness. If it were an STD would such ointments affect the rash? If it is herpes, will blisters always form from the symptoms I describe?

Thank you. This will be my last question on this thread. If I have to ask another one, I will start a new thread.

[H. Hunter Handsfield, M.D.]

Just tell the clinic the story and let them decide what tests to so.  Most likely they'll just do routine tests for chlamydia, gonorrhea, syphilis, and HIV.  You don't need more than that.  If any tests are positive, it won't be from the exposure you describe above; it will mean you were infected before then.

That's the end of this thread.

[needadvice578]

One final question -

When you say I should go to an STD clinic if she doesn't test, which tests would be appropriate for me to take given my scenario? And thank you again, doctor.  By your answers I think a can relax (a little).

[H. Hunter Handsfield, M.D.]

No.

[needadvice578]

Disregard the last comment, our responses crossed. You answered question #1. Based on my scenario, is there a valid reason for me to take a test other than for my mental well-being?

Thank you so much, Doctor.

[H. Hunter Handsfield, M.D.]

I should that whenever a person suggest that s/he might need counseling, usually they are  right.  Please follow-up on your own advice.

[H. Hunter Handsfield, M.D.]

Less than one chance in several thousand.  Your odds of dying tomorrow in an accident or surprise illness are higher than the chance you acquired an STD or HIV.  Get tested to calm you nerves, but don't lose sleep over it.  And don't forget your seatbelt.

[needadvice578]

I'm sorry but for question #1, I forgot to ask you if you could quantify the risk as well so that I can understand how likely or not I could have contracted HIV or STD's. I hope you can answer my questions soon. I am very worried. I can't sleep or eat and this whole thing is affecting me at work. Please help. I'm sure that I will need counseling for cheating on my wife.

[H. Hunter Handsfield, M.D.]

Like a lot of monogamous (or recently monogamous) persons outside the currrent youth generation, you probably have an inflated view of STD/HIV risks outside committed relationships.  Don't take literally all that you read and hear.  STDs are real, but the risk for any particular encounter is fairly low for all STDs, including HIV; the large majorty of exposure don't result in infection, even if someone's partner is infected.  In any case, it sounds like all your exposure events that night were protected, a condom falling off after exposure doesn't increase the risk.  All the other details you describe don't make much difference than the simple fact that your vaginal exposure were condom-protected.  That means there was little or no risk.

To the specific questions:

1) The risk might not have been zero, but it was pretty close.

2) If you can contact the sex worker and convince her to be tested, good for you. But good luck; I'm skeptical it will happen.  If that doesn't happen, visit your local health department STD clinic (or other provider) a week or so after the event.  You can expect negative test results.

3) "Nuts" is a bit strong.  But the odds are you weren't infected.

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