Protected intercourse but unprotected oral with a drug user

[worriedsew]

Here is my story and it happened on 06/06/2011 around 3pm. I had a sexual encounter with a white female CSW (don’t know if it makes any difference) and used a condom. A minute into to the intercourse, the condom popped and immediately pulled out. The condom was broken. I checked my penis for any sign of fluid and it looked dry .The lady put another one on me and we continued the act. She also performed unprotected oral sex on me for about a minute and we also French kissed. After I left the scene of guilt, I began to freak out thinking about the broken condom. I contacted the lady and mentioned my concern over the broken condom and she dismissed my concerns (she laughed it off). She mentioned that she donated plasma (justification that she is HIV negative) and that there is nothing to worry about. The next day I bothered her again with my concern and asked her when she was tested  last time.  She said she get tested every three months and told me to “stop tripping.”
Doc, I am worried although I know that the unprotected encounter was very brief and that it is very low risk. My question to you: (1) Do I need to see a Doctor immediately to find out if this encounter warrants PEP (I have about 40 hours left to meet the 72 hours window) (2) What are my chances of contracting HIV from this brief encounter? I am getting nervous as I read conflicting information from the web.

[Ann]

Worried,

Calm down. In the ten years I have been a member of these forums, I have yet to see the insertive partner end up hiv positive following a condom break. I do not expect you to be the first.

Your situation does not warrant PEP.

Make sure you read through the condom and lube links in my signature line. A correctly used condom rarely breaks. The two leading causes of condom breakage are 1) not using enough lube and 2) not making sure there is no air pocket in the tip of the condom.

While you have had a very small risk and you do need to test to be sure, I fully expect you to test negative.

The earliest you should test is at six weeks. The vast majority of people who have actually been infected will seroconvert and test positive by six weeks, with the average time to seroconversion being only 22 days. A six week negative must be confirmed at the three month point, but is highly unlikely to change.

You should also test for the other, more easily transmitted STIs. You can test for these at around two weeks after the incident, or sooner if you develop any symptoms like a discharge from your penis. Please keep in mind that some STIs like chlamydia or gonorrhea do not always show symptoms, so the wise thing is to get tested at two weeks regardless of the presence or absence of symptoms.

Stop feeling guilty over seeing a sex worker. Unless you treated her badly, there is nothing to be ashamed about.

And just in case you were wondering, getting a blowjob is absolutely NOT a risk for hiv infection.

Ann

[worriedsew]

Ann,

Thank you for the reply and greatly appreciate the comforting response. The CSW also tried to calm me down when I contacted her afterwards. She mentioned that she is a mother of three who takes her health seriouosly. I will definitely get tested for the other STDs soon and at the six weeks mark for HIV.

Again, I greatly appreciate your response.

Sincerely,
Worried

[Ann]

Worried,

You're welcome.

Ann

[worriedsew]

Hello Ann,

Hope all is well. I am back after three weeks caught concerned and freaked out. Over the weekend, I felt pinching pain in the testicles. I also saw two cold scores (painless on my penis). I am back to square one where I am worried that my brief encounter has put me in bad situation? What should I do? Is this early symptom of HIV or curable STD? Please advise.

Thank you Ann.

[Ann]

Worried,

It sounds like you need to see a doctor. "Cold sores" aka herpes hurt - they're very sore. Syphilis sores, on the other hand, are painless and therefore often go unnoticed. You need to have that checked out. Syphilis is nothing to ignore and just because the initial sore goes away does not mean the syphilis has also gone away.

Regardless of what it is, it does not change your risk assessment for hiv. You are not likely to end up positive over a condom break but you do need to test at the appropriate time.

Ann

[worriedsew]

Ann,

Thank you for the quick reply. I am wondering about the likelihood of acquiring STDs from receiving oral. I have had herpes for about five years now; I had cold sore breakouts two or three times. When I had the breakouts, the sores were clustered and painful. But the one I have now are painless and are not clustered. In any case. I am going to see a doctor tomorrow morning. I will update if it helps the forum.

I have to admit I was a bit shaken (and still am) when I see those blisters.

Thank you again for help and quick reply!

[Ann]

worried,

The main STIs transmitted through getting a blowjob are herpes, chlamydia, gonorrhea and syphilis. Make sure you get that painless sore checked out - it does sound like possible syphilis. Syphilis is treatable, so don't freak out.

This doesn't change your hiv risk assessment. Please re-read your entire thread.

Ann

[Ann]

Worried,

You may want to read through this post concerning syphilis. I must caution you, however, DO NOT post in that thread. I'm only directing you there so you can learn a bit about syphilis and syphilis diagnosis. Again, DO NOT post in that thread.

Ann

[worriedsew]

Ann,

Thank you so much for sending the link. I went to see my Doc. yesterday. He visually examined the sore and fluid. He said that it is Herpes. I told him that I have Herpes and the sores do not look like what I had in the past. He said it has to be Herpres and prescribed antibiotics. I am going to have blood work done for HIV, Herpes and Syphiilis (at my own insistence). He refused to test for Chalmya and Gonorreha as there are visible discharges from the Penis despite my demand to get tested.

This painless blister is confusing me for the following reasons:

1) the blisters have started to disappear (within 3 days). When the Doctor squezzed one of them to visually examine the fluid, I did not feel a pain. In addition, that blister is almost gone. However, WebMD says the Syphillis Chaucer lasts between 27 to 42 days.
2) in the past my genital area would each itch before I see cold sores and the cold sores would last at least two weeks. These blisters just showed up.

I started taking the antibiotics and will do the lab test. But I begin to think this might not be STD related at all. I will let you know once the results are in.

[Ann]

Worried,

Sounds like you need a new doctor. He should know that up to 60% of men never have symptoms of gonorrhea or chlamydia. He should have just run a full panel of STI tests once you told him you had unprotected intercourse.

Ann

[worriedsew]

Ann,

As you usual, thank you for your quick response. I will go back and demand a full panel of STD tests. By the way, I never had unprotected intercourse. There was very bried encounter when the condom broke where I pulled out and put another one. However, I received unprotected oral.

Thank you again.

[Ann]

worried,

While you're highly unlikely to end up hiv positive as the insertive partner during a condom break, it is totally possible to become infected with one of the other more easily transmitted infections through such an incident. Also, herpes, chlamydia, gonorrhea and syphilis can all be contracted from being blown. 

Ann

[worriedsew]

Ann,

Thank you again!

I chckled at the phrase "being blown". I just contacted my Doc. who again insisted to do what he ordered. I will move my insurance to a new Doc. By the way, how come the blisters are gone so quick?

Thank you,

[worriedsew]

Ann,

Hope all is well. I am back with my worries. I was at the lab to get my blood work done last Thursday (07/21). I got a voice mail from the Doctor's office around 6pm Monday (07/25). They asked me to call them. I called back the Doc's office, no one answered. I am freaking out thinking about the reason they called.  My blood work included general check up Cholestrol etc and I have high Cholestrol. But I am freaking out thinking about the very brief encounter when the Condom broke. I know you and people in other HIV forums repeatedly said that my risks are remote but I freaked out. A voice inside me is trying to calm me down. Sorry about bothering you with my problems.

Thank you so much again!

[Andy Velez]

Fortunately doubts and fears are not facts. We still expect you to come out of this ok.

Your mind is just going whacko with this stuff and all to no good purpose.

Get in touch with your doc's office.

[worriedsew]

Andy,

Thank you for your response. You are right the HIV and HSV tests came negative more than six weeks after the broken condom exposure. The Doc's office mentioned that the Syphillis result came poisitve and will refer me to an infectious disease specialist. I had been treated for syhphillis in the past and am planning to ask the Specialist to run another test to  confirm the result.

You are right, I feel a big relief knowing that the HIV test came negative.

Thank you!

[Andy Velez]

OK. It's always a happy thing to get a negative result.

[Ann]

Worried,

I hope you've changed your doctor. His cavalier dismissal of your concerns about the sore on your penis is reprehensible. I hope you also got checked out for chlamydia and gonorrhea, two other concerns he dismissed due to your lack of symptoms. Many people do not have symptoms for these two easily transmitted bacterial infections.

It's not surprising that you tested negative for hiv. Remember to always use condoms in future - and use them correctly to avoid breakage - and you will remain hiv negative.

Ann

[worriedsew]

Ann,

Hope all is well.

The fact that I tested positive for syphillis some how compelled my Doc to refer to an infectious disease specialist. I asked to get tested for all STDs including HPV and HIV. All came back up negative. The Doc gave me a shot of pencillin for the syphillis. Due to the low titer, he suggested that single dose is enough and told me to come back in six months.

Around mid August I had a protected encounter (both oral and vaginal) with a woman of unknown status but she said she is STD free. When I had the HIV test at infectious disease clinice, it was at 5 weeks mark since my last protected encounter. I recently attended a meeting in cold auditorium where I felt chilly the entire time. On the second day of the meeting, I began to experience signs of cold and body aches. Now my mind raced back to my last encounter despite the fact that I tested negative 5 weeks after the protected encounter.

I know exactly what you would say, so I will not dare ask the question but I have to admit I am a bit concerned.

Thank you for your time

[Andy Velez]

Whatever is going on with you regarding chills and anything else you can come up with ...the point is you did not have a risk for HIV based on anything you have reported. So this is not an HIV situation.

Period. 

[worriedsew]

I just made the dumbest mistake. I met two girls at a bar who invited me to their hotel. These are two white girls from a city in southern Ohio with a population of about 20000. They are in my city visiting. Once we got in their room, they asked me if I get high and I said no since I don’t take drugs. One of the girls offered sex. She performed unprotected oral on me for about a minute or two until I realized that she had sores on her lips and at the corner of her mouth. I put condom on and continued the oral. We had brief protected intercourse (probably 3 or four thrusts of the penis into her vagina). I pulled out, took out the condom and finished on her breasts. I came home and showered. I did neither kiss her nor perform oral sex on her. When I reflected on the encounter, I freaked out thinking about the potential exposure to HIV/STD. I never thought I would put myself in such dangerous position.
Here is what is stressing me out: It appears that she and her friend are hooked on drugs and use heroine (I overheard her friend calling her dealer). I saw a band aid on the arm of the girl I had intercourse with clearly showed that they are IV drug users. As mentioned above, the girl had sores on her lips. When I asked her about it she said that she gets sores whenever she is stressed. I found that hard to believe. The girl would like to see me again but the encounter scare the hell out me. Here are my questions:
(1)   Based on the description I gave about my encounter, how do you rate my risks for HIV and STD including Hepatitis? Assuming that the girl is HIV positive (God forbid), what is the risk of acquiring HIV from the brief unprotected oral encounter?
(2)   Do you think this brief encounter warrants PEP considering the fact that she is a drug user?

Thank you so much

[Andy Velez]

Your situation absolutely does NOT warrant the use of PEP. You used a condom for intercourse which is exactly right. They provide very effective protection against HIV transmission.

Receiving oral including without a condom is absolutely NOT a risk for HIV transmission.

Other STDs are easier to acquire than HIV so if you are sexually active you ought to regularly have a full STD panel done. That means at least once a year and more often if you have any symptoms like a dripping penis or such.

The only confirmed risks for the sexual transmission of HIV are unprotected vaginal and anal intercourse. So use a condom everytime for those activities.

This time there is no need for HIV testing nor for further concern about HIV. 

[worriedsew]

Hello Andy,

I am getting ready for my full STD check up including HIV. I am a bit concerned since I had a couple of times where I received unprotected oral and had protected vaginal intercourse with sex workers. I know there is no need to be concerned given the fact I consistently used condom for vaginal intercourse and even for some of the oral encounters. Should I be concerned?

[RapidRod]

You never had a risk of contracting HIV from a blowjob.

[worriedsew]

I have developed pain in my throat which alarms me. I feel pain when I swallow and observed white spots on my throat. I feel tired but has no fever, no running nose or teary eyes. I also have discomfor when I urinate but no discharge or sores on my penis. The discomfor seem to go away if I drink a lot of water. All my encounters has consistently been protected for intercourse and have received unprotected oral on a couple of occasions. Should I be concerned?

[Andy Velez]

Based on what you have reported, whatever is causing you discomfort has nothing to do with HIV. Consult your doctor for an explanation.

Other STDs are much easier to acquire than HIV. We always recommend that anyone who is sexually active to at least annually have a full STD panel done.

HIV is not your problem. Period.