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DR. HHH to Answer PLEASE
Dear Doctor Handley: I am American. In the past, I traveled a great deal to Russia and other places for business . Unfortunately, visited with escorts and occasionally non-escorts (i.e. regular girls). All Russian ladies, mostly in Moscow . Couple months ago I read an article on the internet about spread of AIDS in heterosexual population, and now I am terrified and think about this issue constantly.
In all cases, I wore condoms, however there were couple types I performed oral sex/cunnilingus on regular girls (not escorts). Also, on two occasions with Russian escorts, once in Moscow and once in Dubai in 2004 the condoms broke and I must have had some unprotected vaginal sex at least a couple minutes. One of them even assured me she had no problems, but I assume that escorts must be frequent HIV carriers. I am a circumcised white male. I have never had any of the symptoms such as rashes, lymph nodes swollen etc. My questions are:
1) What is the % chance of catching HIV from performing cunnilingus, say, on 3 different women? From what I have read on the internet, it seems pretty low risk activity but not sure.
2) What is % chance of catching HIV from the two cases of unprotected vaginal sex when the condom broke in 2004? Does the fact that I am Circumcised make any difference in all this?
3) Does the fact that this was outside of the US , i.e. Russian girls, make it much worse for me? I am extremely worried about this part of it.
4)For all of the other times, where I used condoms and there were no breakage issues, was there any risk – how safe are condoms really?! (maybe they break without people realizing it sometimes)
5) I recently got a My CBC for a regular physical and it shows WBC of 4.6 and Lymphocytes of 28.3% - does this seem low to you? Could this be an indication of HIV having developed?
This all occured several years ago, but anxious and depressed thinking about this since reading that article.
Mark
In all cases, I wore condoms, however there were couple types I performed oral sex/cunnilingus on regular girls (not escorts). Also, on two occasions with Russian escorts, once in Moscow and once in Dubai in 2004 the condoms broke and I must have had some unprotected vaginal sex at least a couple minutes. One of them even assured me she had no problems, but I assume that escorts must be frequent HIV carriers. I am a circumcised white male. I have never had any of the symptoms such as rashes, lymph nodes swollen etc. My questions are:
1) What is the % chance of catching HIV from performing cunnilingus, say, on 3 different women? From what I have read on the internet, it seems pretty low risk activity but not sure.
2) What is % chance of catching HIV from the two cases of unprotected vaginal sex when the condom broke in 2004? Does the fact that I am Circumcised make any difference in all this?
3) Does the fact that this was outside of the US , i.e. Russian girls, make it much worse for me? I am extremely worried about this part of it.
4)For all of the other times, where I used condoms and there were no breakage issues, was there any risk – how safe are condoms really?! (maybe they break without people realizing it sometimes)
5) I recently got a My CBC for a regular physical and it shows WBC of 4.6 and Lymphocytes of 28.3% - does this seem low to you? Could this be an indication of HIV having developed?
This all occured several years ago, but anxious and depressed thinking about this since reading that article.
Mark
MEDICAL PROFESSIONAL
You're going to make yourself even more crazy by repeatedly and compulsively analyzing the risks. Testing is the only answer. You could have the highest conceivable risk for HIV (of course you don't), but if the test is negative, you don't have it.
1) Your calculations are OK, except that chance of HIV in your partners probably is more like 1-5%, not 10%. But let's say you're right at 1 in 20,000 odds. Have you thought that through? It is equivalent to repeating the same exposure once a day for 55 years and maybe not getting infected (20,000 divided by 365). And if you live in the US, it is 11 times lower than the chance you will be dead of an accident within a year (1 in 1,756, according to the National Safety Council).
2) I agree with your estimate of the relative health risks of HIV versus heart attack, stroke, etc. Heterosexual transmission is a major risk in some settings, but in most of the US -- especially in relatively educated, non-minority populations -- heterosexual transmission remains rare. Most heterosexually acqured cases in such persons occur in the spouses or other regular partners with known HIV or at obviously high risk, and not in one-time, casually exposed people.
3) Meaningless. The test result is important; symptoms are useless in assessing the likelihood either for or against HIV.
I won't have any further responses unless/until you return to tell of your HIV test result, which will be negative.
1) Your calculations are OK, except that chance of HIV in your partners probably is more like 1-5%, not 10%. But let's say you're right at 1 in 20,000 odds. Have you thought that through? It is equivalent to repeating the same exposure once a day for 55 years and maybe not getting infected (20,000 divided by 365). And if you live in the US, it is 11 times lower than the chance you will be dead of an accident within a year (1 in 1,756, according to the National Safety Council).
2) I agree with your estimate of the relative health risks of HIV versus heart attack, stroke, etc. Heterosexual transmission is a major risk in some settings, but in most of the US -- especially in relatively educated, non-minority populations -- heterosexual transmission remains rare. Most heterosexually acqured cases in such persons occur in the spouses or other regular partners with known HIV or at obviously high risk, and not in one-time, casually exposed people.
3) Meaningless. The test result is important; symptoms are useless in assessing the likelihood either for or against HIV.
I won't have any further responses unless/until you return to tell of your HIV test result, which will be negative.
Dear Doctor Handley: Thank you for the reply. I've been making myself crazy last couple months, and of course the right thing to do is to just test. Just a couple quick follow-up questions though:
1) Do I have the math right here? If I understand what you are saying, since I am CIRCUMSIZED, I have only a 1 in 2,000 chance of catching HIV from unprotected sex one time with an HIV positive Girl. Assume maybe 10% chance she even has HIV. That comes out to 1 out of 20,000 chance - or 1 out of 10,000 for my two incidents combined. I will assume condom-protected sex and oral is essentially negligible.
2) Assuming my math is right, being slightly overweight and not getting much exercise, I probably have a better chance of dropping dead from a heart attack then from having contracted HIV. In that case, I wonder why I have read so much about hetrosexual HIV transmission, what a great risk it is, etc.?? (after a reading a few of those articles I was convinced I had contracted it)
3) Finally, I have never had any of these ARS symptoms I read about, like rash or generalized lymphoma - is that a good sign or I suppose meaningless?
Thank you again - I feel so relieved to have finally discovered an informative site on this HIV subject, and I shall now follow-up with testing.
1) Do I have the math right here? If I understand what you are saying, since I am CIRCUMSIZED, I have only a 1 in 2,000 chance of catching HIV from unprotected sex one time with an HIV positive Girl. Assume maybe 10% chance she even has HIV. That comes out to 1 out of 20,000 chance - or 1 out of 10,000 for my two incidents combined. I will assume condom-protected sex and oral is essentially negligible.
2) Assuming my math is right, being slightly overweight and not getting much exercise, I probably have a better chance of dropping dead from a heart attack then from having contracted HIV. In that case, I wonder why I have read so much about hetrosexual HIV transmission, what a great risk it is, etc.?? (after a reading a few of those articles I was convinced I had contracted it)
3) Finally, I have never had any of these ARS symptoms I read about, like rash or generalized lymphoma - is that a good sign or I suppose meaningless?
Thank you again - I feel so relieved to have finally discovered an informative site on this HIV subject, and I shall now follow-up with testing.
MEDICAL PROFESSIONAL
First off, a word of reassurance: based on all you describe, the chance you acquired HIV in Russia is very low, close to zero in fact. Some explanation follows in response to each of your questions. But regardless of that, and regardless of my replies to follow, the answer to your anxieties is to have an HIV test. Why sit around stewing and worrying when the answer to calm your fears will take only a few dollars and an hour of your time? Anyway, HIV testing is recommended once in a while -- like once every 1-2 years -- for every person who is sexually active outside mutually monogamous relationships. Since you apparently have not been tested recently, it probably is time to do it. But not specifically because of the encounters you describe.
To the questions:
1) HIV transmission by cunnilingus (in either direction) has never been proved. It makes sense that it might occur, but extremely rarely. in general, HIV transmission is rare by oral exposure to anything, even blood or semen.
2) The risk of HIV transmission for vaginal sex, from female to male (if the woman is infected) averages once for every 2000 episodes of unprotected sex. Being uncircumcised roughly doubles the risk. Thus, your risk calculates at 1 chance in 500, tops; and that's only if both those partners were infected, whereas probably neither one had HIV.
3) The rates of HIV indeed are much higher in Russia than in most industrialized/western countries. But they are nothing like Africa, India, or parts of Asia. Even in Russia, I would not "assume that [all] escorts are HIV carriers". Most are uninfected.
4) Condoms don't break without the users' knowledge. (OK, if the user were blinding drunk, maybe -- but not a serious consideration in most circumstances.) Intact, properly used condoms provide close to 100% protection.
5) Your CBC is normal and doesn't mean anything about HIV one way or the other.
Bottom line, repeating the main message from my opening comments: Stop dithering and stop trying to analyze the probabilities. Have an HIV test. You can expect it to be negative.
I hope this helps. Best wishes-- HHH, MD
To the questions:
1) HIV transmission by cunnilingus (in either direction) has never been proved. It makes sense that it might occur, but extremely rarely. in general, HIV transmission is rare by oral exposure to anything, even blood or semen.
2) The risk of HIV transmission for vaginal sex, from female to male (if the woman is infected) averages once for every 2000 episodes of unprotected sex. Being uncircumcised roughly doubles the risk. Thus, your risk calculates at 1 chance in 500, tops; and that's only if both those partners were infected, whereas probably neither one had HIV.
3) The rates of HIV indeed are much higher in Russia than in most industrialized/western countries. But they are nothing like Africa, India, or parts of Asia. Even in Russia, I would not "assume that [all] escorts are HIV carriers". Most are uninfected.
4) Condoms don't break without the users' knowledge. (OK, if the user were blinding drunk, maybe -- but not a serious consideration in most circumstances.) Intact, properly used condoms provide close to 100% protection.
5) Your CBC is normal and doesn't mean anything about HIV one way or the other.
Bottom line, repeating the main message from my opening comments: Stop dithering and stop trying to analyze the probabilities. Have an HIV test. You can expect it to be negative.
I hope this helps. Best wishes-- HHH, MD
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