I visited a massage parlour. The original intention was just to receive masturbation to relief, but, against all previous practice, I went beyon this. From start to finish, I was in the room with her for about 20 minutes. The sequence was as follows:
Receipt of protected oral, followed by some protected manual masturbation. I then had protected vaginal sex, with the lady on top facing me. I can’t recall exactly, but this wasn’t for long due to unease with the situation. The vaginal sex probably lasted less than a minute, without ejaculation. On withdrawal, the lady continued the manual masturbation (10 minutes?) to ejaculation. I was the given a tissue, removed the condom, which wasn’t obviously damaged or incomplete, and used the shower head to wash down my lower body. Warm water was used, but no soap. I then dried with a clean towel. I then bathed properly when I got home, after 30 minutes later.
Given that some vaginal sex took place, and that the same condom was used throughout, I am concerned at the possibility that the rough masturbation after withdrawal may have exposed me to her vaginal fluids which would have been on the condom and then on her hands. (For greater pleasure, with her facing me, I asked here to apply her foot to base of my scrotum whilst masturbating me rigorously. This may have been an awkward position for her, resulting in changes of manual position, and given that varying pressure was applied from different angles, I’m concerned that there may have been unnoticed abrasion or damage to the integrity of the condom that would provide access to the possibly contagious vaginal fluid.
(I noticed also when washing at home that I had a small lesion or abrasion on the soft skin of the shaft of the penis just below the base of the glans. Like a very small “ulcer crater”- no blood, but sensitive and emitting clear liquid. I wasn’t aware of it previously. I am concerned that this may have been caused by finger nail damage whilst changing positions during quite rough manual masturbation, exposing the lesion and broken skin to possibly contaminated vaginal fluid that would have been on the condom following vaginal penetration.
I have no knowledge that the woman was HIV+, but identify her as high risk due to being a sex worker and being from Eastern Europe (said to be Poland.) The massage parlour is also in an ethnically very mixed student area of Manchester. (I note from your website the percentage likelihood of meeting a HIV+ woman, but presume that this is based on general population, with the percentage being much higher if the “target group” is East European sex-workers.
I’ve added graphic detail to better describe the circumstances. I feel acutely anxious. .Please advise on the risk and need for a HIV test.
Hello there,
Thank you very much for your post and welcome to our forum.
After reading your detailed description of your sexual encounter, I can coclude that you have not put yourself at any significant risk of HIV infection, even if the lady was indeed HIV positive, and even if the head of your penis came into contact with some of her vaginal fluids. If you had a fresh open wound at the time of the manual masturbation coming into contact with infected fluid, it might put you at some risk, but I still think this would be extremely low. We do not know the status of the lady in question; it is statistically more likely that she is negative, even among Eastern European sex workers. However, as you seem to be worried about this low risk encounter, the only way you can get complete peace of mind is by having a test (a Duo test after 28 days), which I am sure that it will be negative. Also make sure that you arte tested for the most common STIs, such as Chlamydia and Gonorrhoea, as these would have been much more likely than any other infection.
Best wishes,
José
Thank you for the response. I really am immensely appreciative of an honest opinon. I will of course test in due course, but its more the question of risk that concerns me now. To say that I'm stressed is a massive understatement.
Inevitably, since I sent the post I've thought about it further:
The woman was on top of - more squatting over me and lowering than sitting on me - but I closed my eyes during the brief period of penetration and could not see what happened . I don’t know how deep I penetrated, therefore, whether above or beyond the condom ring.Pentration may have been materially less than a minute - it wasn't long at all, but it's hard to say.
When I took the condom off, with a tissue, I am concerned that I may (?) have brushed the condom over the small sore, providing an opportunity for vaginal liquid on the condom to mix with the subcutaneous liquid from my lesion and enter my body.The room was in low light: when I took the condom off with a tissue, in the usual way, holding the tip, the condom wasn't obviously ripped in pieces or shredded, but I didn't have the presence of mind to look for damage and wouldn't have necessarily seen anything that was there.
I washed thereafter, just washing warm water from the shower head over my penis, but I didn’t have a full shower and I didn’t wash rigorously or with soap and I’m thinking of the possibility of vaginal/hiv bodily fluid being residual on part of my body or pubic hair and making contact with the legion between leaving the parlour and having a disinfecting bath at home, which is when I spotted the lesion and the flow of clear subcutaneous liquid.
I don't how any of the above might affect your risk assessment.
Also, the initial masturbation post-withdrawal was "light" and there was short period when the condom on my penis was left untouched. Greater pressure was applied at a later stage. I've noted previous references to the fragility of the HIV virus outside of the body and to references to "an inert surface" not being conducive to infection. How does this fit in with my circumstances? Also, would the movement of any infectious material on the condom, being then in the literal sense not an "inert surface" make it more likely that the infectious material would maintain its strength outside of the body?.
Lastly, in abject panic, having spent the night on the internet researching the risk, I came across the reference to PEP and, for various reasons, managed to obtain the PEP formulation that you offer.This I did, to buy time whilst coming down from a high of acute anxiety. (I'm still anxious). I've since read about short-term and unknown log-term effects of the medication, includiing the possibility of carcinoma/changes to the immunity system. I don't know what to do - discontinue of a cost-gains basis or continue to give myself the optimum chance of being negative, given the the existence of some risk (i don't know how and when I got the cut or the open lesion, cannot fully confirm confirm the integrity of the the condom etc, ) If PEP was stopped well short of the 28 course, how would this impact on recommended Post PEP testing periods?
I'm sorry for the long message - but you obviously understand the mix of emotions that I am going through. This is all a nightmare!
Hello there,
I really think that you are in a real state! You need to calm down.
My risk assessment has not changed even after having read the additional information that you have given in your last post. I still think that the risk is very low or none at all. And bearing this in mind I would have never recommended PEP for you. I strongly believe that it is not necessary. PEP can have side effects like nausea and diarrhoea, for which you can take medication. Because it needs to be taken for 28 days, you should not worry about any potential long term side effects. The only problem with PEP is that it is going to delay any conclusive test that you might want to have, as it can affect the reliability of all the diagnostic tests.
Best wishes,
José
Thank you for your response. I very much appreciate your time and advice.
With hindsight, I wish that I hadn't pursued PEP, but, on the night in question, I was in a blind panic and I had to make a quick decision.
I just have a few more questions, please, and then I'll put the matter to rest.
Risk of PEP:low risk isn't, obviously, zero risk. I'm therefore inclined to continue with the PEP tablets to further reduce what risk there may be, based on my understanding of the incident in question and taking into account any other factors of which I'm not aware.
AT MY OWN RISK, I might be inclined to terminate the course early (I'm currently, 8 days into the course) if I thought (a) the risks from taking PEP much outweighed the risk from not taking it and (b) that it would allow me to take a fully conclusive HIV test at a much earlier point than post-PEP usually provides for, given that I will struggle with the uncertainty and the time-lines.
Therefore:
(a) I am on Truvada (1 tablet every 24 hours) and Kaletra (2 talets every 12 hours). I understand short-term or immediate effects, such as diarrhorea and nausea, but I've also read about potential permanent liver and similar problems associated with the drugs within a 28 day PEP timeframe, as well as a potential permanent damage to the immune system if PEP is given to someone without HIV exposure.These are presumably part of the cost-gains criteria in the user guidelines that restrict recommendations for use to high-risk individuals, the risk-benefit calculation obviously being different, depending on the potential risk of exposure and infection. Is it your view, that PEP is generally safe to take, apart from the side-effects that you mention? You obviously consider that on the basis of my descriptions you wouldn't have recommended PEP, and I accept this as an honest opinion, based on the most accurate descriptions of the incident I'm able to give, and it's in accordance with prescription guidelines I've read, but how much of this is due to the perceived health risk from PEP arising from other than the specific side-effects you mention?
(b) If I stopped the drugs, for whatever reason, within 10 days, would that allow an earlier conclusive test?
(c) I've seen mention of it in various places in your forum, but, in your view, and from your experience, what do you consider to be the earliest point at which, post-28 day PEP, (a) a fully reliable negative result may be obtained and (b) an inconclusive, but normally reliable result may be obtained?
I'm sorry to contact you again, but a further response would be very helpful to me.
(Please be frank in your opinions or comments: I'm sure you won't, but please don't tell me what you think I may wish to hear.) I will make my own decision, ultimately.
The recommendations to give PEP or not are based solely on risk assessment, not on side effects, possible risks or financial considerations. Risks are always possible, but are very rare, and if the medication is not tolerated by the patient, it can always be stopped. After many years of experience prescribing PEP, we have never had any patient developing the serious effects that you mention.
To answer your second question: yes, of course. The window period for the different tests starts the day after finishing PEP. You can have a PCR RNA after 7 days of finishing PEP, which would be highly realiable-not fully conclusive, or a HIV Duo test after 4-6 weeks of finishing PEP can be considered conclusive in my experience. Antibody tests would need to wait at least 8 to 12 weeks. I am giving you my frank and honest answers, to the best of my knowledge.
Best wishes,
José
Dr Jose, thank you, again. You've been very patient and extremely generous with your time. Your responses have been clearly stated and easy to follow, unlike mine, possibly, which have been written in a highly emotional state. There's just one last point I'd like to clarify, please.
My central concern, as previously stated, is that (a) the condom contained infectious fluids from, albeit relatively brief, penetration, (b) that the condom and the soft skin of my penis (as previously described) was cut/ripped/sliced by a finger nail during post-penetration masturbation and (c) that this would have provided a transmission and infection route for HIV at the time of the trauma and also for a while afterwards, due to the roughness and duration of the masturbation with the infected and possibly ruptured condom still on. The lesion that I discovered when I got home, and which I wouldn't necessarily have noticed at the time of the incident, was entirely consistent with fingernail damage (or similar) and it was an open cut.
In your previous post, you indicate that if infected fluid had come into contact* with the open wound this would put me at risk, but that you considered this (the risk) to be extremely low. Why, in the circumstances described, would you consider the risk of infection to be extremely low? I would have thought that infected fluids into an open wound would be exceptional risk.
There are far too many factors that have to coincide for you to become infected: that the other person has to be positive with a high viral load, that significant amount of fluid had come into contact with a wound and that the wound was definitely open and bleeding for it to be an open access into your bloodstream. Also statistically this is not a common way of transmission.
Having said all of this, I can only suggest that infection is highly unlikely, but of course not impossible. You can go on and on worrying about it and imagining all the different scenarios. This is not helpful and there is not much you can do anyway one way or another apart from trying to be as rational as possible and try to accept that the chances of you having become infected are very, very low; try not to keep thinking about it until you can have a test. I know it is not easy but to go on and on worrying about it is not going to help you at all and will only increase your worry and anxiety.
All the best,
José
Very Scared
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