Worried

[Jamjay26]

Dear doctors, a couple of nights ago I slept with a girl I didn't know. I used protection during the sexual intercourse, so I'm not too worried about this. However, before I put the condom on we were rubbing our crotches together, I was wearing my underwear and she was wearing nothing. My penis slipped into her vagina, as mentioned i was wearing underwear, so this covered my penis but i assume it doesn't offer protection (this only happened once for a few seconds and after this I put a condom on).

I'm worried because she seemed quite slutty (she wasn't wearing much at all when i met her) and she did say when I was looking for a condom that 'it didn't matter' if I used a condom or not, which leads me to think that she has a lot of unprotected sex. She was White and I think English. But I was drunk at the time and can't place her accent, might also have been from the Mediterranean (Italy / Portugal) or south America. This all happened in London UK which I believe has a higher rate of HIV than other places in the UK

I should also mention that just after this episode (2 days later) I went to an STD Clinic as I noticed some red spots on the tip of my penis. The people at the clinic looked at it and took a swab and said I could have balanitis, thrush or chlamydia

So it's possible I could have had one or all of these at the time of this happening, and I've heard that having an STD makes you more susceptible to others, the day after this happened I also noticed a red Mark on my penis. Wasn't bleeding but it did look like a scratch so I guess it could of left me more open to std's at the time although I'm not sure if I had it at the time of contact as I noticed it after. My guess is it happened during

Based on all of this do you think I need PEP?

Many thanks

[H. Hunter Handsfield, M.D.]

This also makes no difference.

Your anxiety is leading your mind to contemplate unrealistic scenarios, and I'm sure others will arise.  But there is no point; you can be sure there are no circumstances you can think up that would change my opinion or advice.  Try to accept the evidence and the reasoned reassurance you have had, then move on.  I won't have anything more to say.

[Jamjay26]

Hi again, sorry to ask so many questions, I just have one other thing I failed to mention before. I did notice that the girl had a lot of dark moles on her. I thought nothing of it at the time but I have read that people with compromised immune systems (aids) develop cancers of the skin that do look like dark moles.

Does this change your answer at all?

[H. Hunter Handsfield, M.D.]

I understood the nature of the clothing.  This doesn't change my opinion or advice.

Most GUM clinics would test for HIV when they test for any other STD.  You might double check whether they did an HIV test, if you had blood drawn.

[Jamjay26]

Sorry my mistake I posted my last question to the wrong Docter. I meant to post it to yourself (Dr Hunter Handsfield). Please see it above

Many thanks

[Jamjay26]

Thanks for the response, unfortunately I didn't ask the clinic about HIV as I had forgotten about the 'unprotected' incident.

Just to add I was only wearing 1 layer of clothing (my underpants / boxers) when my penis went into her vagina, and the fabrick they're made with  thin, they also have an opening at the front that was buttoned closed, but as it's only a button this could have come slightly open when my penis went into her

Does this make any difference to your answer?

[H. Hunter Handsfield, M.D.]

Fingering or other hand-genital contact has never been known to result in HIV transmission, regardless of cuts, nicks, eczema, or other rashes.  In theory these things increase the risk, but for practical purposes it makes little difference.  So this additional information doesn't change my opinion or advice above.

And by the way, although London indeed has higher HIV rates than in most of the UK, heterosexually transmitted HIV remains rare.  Last I heard, the UK Health Protection Agency (equivalent to CDC in the US) estimated that even among the highest risk populations of women, fewer than 1 in 1,000 in London had HIV.  Your own GUM clinic probably will confirm this if you ask them.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

I agree you describe a partner at high risk; she sounds very irresponsible in her sexual decision-making.  However, neither HIV nor any other STD can be transmitted through clothing.  The STD clinic's judgment you have balanitis seems reasonable, based on painless red spots.  (However, chlamydia doesn't cause red spots, so I'm not sure you correctly understood their comments about it.)  I would assume you asked the STD clinic about HIV risk, PEP, etc -- and if you did, I'm sure they reassured you.  Certainly PEP is not warranted in this situation, and I doubt you would be able to find any doctor or clinic willing to prescribe it.

HIV testing still makes sense, simply because it is routine whenever someone is tested for other STDs, and because all people who are sexually active outside mutually monogamous relationships should be tested for HIV from time to time, like every 1-3 years depending on risk level.  But not because of this particular exposure.

Follow-up with the STD clinic for your test results, and follow their advice if they recommend HIV testing.  In the meantime, you shouldn't worry at all about HIV or other STDs from this event.

Regards--  HHH, MD

[Jamjay26]

I should also mention that I also inserted my fingers into her vagina  and I do have a an excma like rash on my hands and fingers. I had also cut my hand the morning before this happened, the cut is about 0.5cms in width and a couple of mm's in length, it's quite deep but wasn't bleeding at the time of the incident, however it did look moist and stung when washed. when I inserted my fingers I did feel her vaginal fluid on my hand with the cut

Based on this and the things mentioned above, do you think I should seek PEP?