Concerned

[JoeJoeBlow2012]

I'd like you to assess my risk. I tested negative for HIV (during my annual exam--in which I tested negative for all STIs) back in May of this year.  This has been my only sexual encounter since. About 9-10 days ago, I engaged in protected vaginal (I'm a female) and receptive oral sex from an african american man (who I do not know the status of).  He wanted to have unprotected sex, but I insisted that he leave to purchase a condom.  He did so.  Upon his return, he put the condom on and we began intercourse.  At one point, I glanced at his penis and it was only a little more than half covered by the condom.  I didn't think anything of it.  When he finished, I glanced again at his penis and observed that the condom was intact and that the semen was inside the condom.  He removed and flushed it, so I didn't get to test it to see if there were holes in it.  

My questions to you are:

1. If there were holes placed in the condom, would it have completely broken during sex and if it had not broken (but did contain holes) could I still become infected?

2. Am I at risk because he was only half covered by the condom?  I've been feeling a little dizzy lately and have had a headache for the last two days and it worries me that I may have contracted something.

3.  Am I overly worried about this situation?  I've tried to convince myself that because we used protection, that I have placed myself at no risk for becoming infected.  With that being said, do you recommend testing at all under these circumstances?  And if I do decide to test, do you opine that it will be negative?

Any advice is helpful!
Thanks so much!!!

[H. Hunter Handsfield, M.D.]

There are glimmers of data that overt genital warts may slightly raise the risk of HIV if exposed.  However, abnormal pap smear results, HPV detected only by pap smear, whether high or low risk, has no known effect.  You can continue to expect negative HIV test results.

[JoeJoeBlow2012]

I forgot to mention that I was diagnosed with "high risk" HPV.  Does this make me more susceptible to HIV? And would this change your assessment?  

[JoeJoeBlow2012]

So, do you think that if I put this behind me and wait until my next annual exam (April/May 2013) to be tested for the works, I'll be okay?  

Thanks!!

[H. Hunter Handsfield, M.D.]

With entirely unprotected vaginal sex (several minutes, with ejaculation), if a male has HIV, the average transmission risk to the female partner is once for every 1,000 exposures.  With brief unprotected before the condom was in place, your risk is lower than that -- and of course you don't know the man had HIV.  Probably he didn't.

So this really doesn't change my opinion or advice.  The odds remain very strongly in your favor, for both HIV and other STDs.

[JoeJoeBlow2012]

Doctor, I apologize but I'd like to add that after speaking with this man, he admitted to not putting the condom on immediately.  So, for about two or three minutes we were unprotected.  I could have sworn I saw him put the condom on, but it was dark and I could have been mistaken.  I'm not sure if he's lying to me or if he is telling the truth.  I'm so angry right now, I told him that his actions were completely unacceptable and unresponsible and unfair to me.  Needless to say, I no longer speak to him.

My question is this:  if the first 2-4 minutes were unprotected, what are my chances of having acquired HIV?  What about testing, is it warranted?  And in your earlier response, you mentioned not hold off sex with my regular sex partner.  Of course other STDs come into play.  How long before I should be tested for those and resume sex with my regular partner?

Thanks!

[H. Hunter Handsfield, M.D.]

Thanks for the thanks.  I'm glad to have helped.

[JoeJoeBlow2012]

Thank you Dr. Hansfield, your advice has been most helpful and reassuring!

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

Congratulations on a smart approach to sexual safety.  You were right to insist on a condom and I'm glad you were assertive about it.  Many women are not!

In general, African Americans have substantially higher rates of HIV than other racial/ethnic groups in the US.  That doesn't mean most black men are infected, but it does warrant an extra measure of caution.  The reasons are not because of promiscuity; most AAs in the US have no more sex partners than whites, Asian Americans, Latinos, etc.  Below are links to a couple of threads that address this issue.

http://www.medhelp.org/posts/show/717093
http://www.medhelp.org/posts/show/1261996

To your specific questions:

1) The notion of microscopic holes or leaks in condoms is an urban myth.  When a condom breaks, it splits wide open.  If the semen was contained, protection was complete.

2) Condoms work.  For HIV prevention, their success depends on containing semen and having the head of the penis and urethral opening covered.  Coverage of only half the penile shaft is quite common and although this may somewhat elevate the risk of herpes, HPV, and other skin-to-skin infections, protection against HIV, gonorrhea and chlamydia isn't affected.  The symptoms you describe are typical for anxiety, not HIV; they don't concern me.

3) The problem here is the difference between your objective, intellectual analysis (no measurable risk of HIV) and your subjective side.  Call it left brain versus right brain, if you wish.  I recommend you be tested; until you have a negative test result, I predict you'll continue to wonder and worry, despite any reassurance I can give.  When you test, you definitely can expect a negative result.

In the meantime, if I were in your situation -- or if I were advising my daughter or anyone close to me -- I would not advise holding off on sex with any regular partner you may have.  It is exceedingly unlikely you caught HIV during this exposure.

I hope this has helped.  Best wishes--  HHH, MD