Really worried, please help

[stupid475]

Good evening Doctor's

I did something really stupid tonight.  I went to visit two female escorts at the same time.  they both gave me unprotected oral and the first one I had protected vaginal sex and also with the second one, The second one however while I was doing my thing the condom broke and I did not realize it untill I was done, so now I'm really worried,  The second female I speak of I have seen a few times before in the last few months ( if that matters )  I got teates myself this past september with a negative result,  <the second woman I speak of also has what appear to be scabs on her face, ( not sure if that means anything ) maybe acne or something, not sure.  Sorry to be all over the place just worried right now,  We had sex for about ten minutes and I do not know at which point the condom broke.  These are not high dollar escorts but they are not streetwalkers either, sorry to sound bad but I'm just giving you the best mental picture that I can, By the way they were both white and I am a white man.  Would you suggest PEP given this account.  I came home in about 25 mins after this and showered, does that mean anything?  Please give me your advice, Thank you

[H. Hunter Handsfield, M.D.]

No apology is necessary; you didn't come off negatively to me, only (maybe) to your partner.  In any case, this additional information doesn't change my opinion or advice.

[stupid475]

I'm sorry if I came off like a jerk.  I did have another conversation with said female.  i was very polite and she seems to be ok with the conversation.  She said that she got tested sometime around this past August but didn't really seem to know exactly when ( I did not press her ).  She also said that she always uses condoms and this was this first time that she had a condom break, so given all that, that does make me feel a little better asuming she is telling the truth.  Not to be redundant but should I worry about being tested?  And i'm sorry if I came across in a negative manner.  Thank you

[H. Hunter Handsfield, M.D.]

It's irrelevant whether I have seen anyone who caught HIV from a single vaginal sex exposure.  Not that I know of, but I also have never taken care of a patient struck by lightning.  Rare events happen, and my experience doesn't change your risk one way or the other.

My only "insight" is that your partner may have been justified in getting annoyed with you.  Most people don't lie about STD/HIV status when asked directly, and you should have accepted her inital reassuring comments without continuing to press her about it.

[stupid475]

One other thing.  Given the situation I told you should I worry about getting tested?  I just get tested this past September and the test was negative.  I asked the female if she gets tested and she said that she does and she asked me if I get tested, she said she always uses condoms, she she seemed a little annoyed that I asked her that.  Could you give me any insight on this?  thank you so much for your help

[stupid475]

Thank you for your reply.  I'm just curious if you have ever seen a female to male infection after a single vaginal exposure?

[H. Hunter Handsfield, M.D.]

Welcome back to the forum.  Sorry to hear you are so concerned.

As we discussed a few months ago, the large majority of sex workers don't have HIV. When they do, a single episode of unprotected vaginal sex carries an average risk of HIV of only once for ever 2,000 exposures.  Since your exposure after the condom broke probably was brief, your risk is even lower.  Unprotected oral sex isn't a concern; HIV is rarely if ever transmitted that way.

Recommendations for PEP vary widely from one place to the next, but from all you say, I would not recommend PEP.  But you should call your local or state health department in the morning and ask their advice.  Most likely they will agree it isn't necessary.

Showering after sex probably makes no difference one way or the other.

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