Concerns About HIV Infection Risk After Protected Intercourse: What You Need to Know

I'm very worried. Could you please tell me if this could lead to an infection?

Hello Doctor, I had vaginal intercourse with a sex worker, using a condom throughout the entire act.
However, after ejaculation, when the penis became soft and shrank, I continued to thrust while it was still inside the vagina.
The penis remained inside for a few minutes before it was withdrawn, and the condom was still on the penis at that time.
Although the condom was not very tight after the penis softened, the semen remained inside the condom.
Afterward, I took a shower and used body wash without experiencing any pain.
Six hours later, when I showered again and used body wash, I noticed pain in the penis.
Upon inspection, I found a small white abrasion on the middle underside of the penis, which was not present before.
I suspect this injury may have been caused during the sexual encounter.

I am concerned that during the thrusting after ejaculation, when the penis softened and shrank, the condom may not have fit snugly, and I am unsure if the condom was covering the abrasion on the penis.
I worry that if the abrasion was exposed to vaginal fluids, it could lead to an HIV infection.
What is the likelihood of infection in this scenario? Should I consider taking PEP?

hen dan xin, 20~29 year old female. Ask Date: 2018/07/31

Dr. Du Mingyi reply Urology

If the time since exposure is not long, the risk of infection is low.
However, if there are concerns, you can go to the hospital for a blood test.

Reply Date: 2018/07/31

More Info

When it comes to concerns about HIV infection risk after protected intercourse, it's important to understand the transmission dynamics of the virus and the factors that influence risk. Based on your description, you engaged in vaginal intercourse with a sex worker while using a condom throughout the act. However, you noted that after ejaculation, your penis became soft while still inside the vagina, and you continued to thrust for a few minutes before withdrawing. Upon inspection later, you discovered a small white sore on the shaft of your penis.

First and foremost, the use of condoms significantly reduces the risk of HIV transmission. Condoms act as a barrier that prevents the exchange of bodily fluids, which is the primary mode of HIV transmission during sexual activities. However, there are a few points to consider regarding your situation:
1. Condom Integrity: If the condom remained intact and did not break or slip off during intercourse, the risk of HIV transmission is considerably low. Even if the condom was not tightly fitted after ejaculation, as long as it was still covering the penis, it would still provide a level of protection.
2. Presence of a Sore: The presence of a small sore on your penis raises some concerns. If the sore was caused by friction or irritation during intercourse, it may not necessarily be a direct pathway for HIV infection. However, if the sore was open and bleeding, it could potentially increase the risk if it came into contact with vaginal secretions that may contain the virus.
3. HIV Transmission Risk: The risk of HIV transmission through vaginal intercourse is higher when there are open wounds or sores on either partner. However, the overall risk is still considered low, especially if the condom was used properly throughout the intercourse. Studies indicate that the risk of HIV transmission from a single act of vaginal intercourse with an HIV-positive individual is approximately 0.1% to 0.2% when a condom is used correctly.

4. Post-Exposure Prophylaxis (PEP): PEP is a treatment that can prevent HIV infection after potential exposure to the virus. It is most effective when started within 72 hours after exposure. Given your situation, if you are concerned about the risk of HIV transmission due to the sore and the circumstances described, it would be prudent to consult a healthcare provider. They can assess your risk and determine whether PEP is appropriate for you.

5. Testing and Monitoring: Regardless of the immediate risk assessment, it is advisable to get tested for HIV and other sexually transmitted infections (STIs) after potential exposure. The standard recommendation is to wait at least 4 to 6 weeks for an initial HIV test, as this is typically when the body begins to produce detectable antibodies. Follow-up testing at 3 months is also recommended to confirm your status.

6. General Recommendations: Moving forward, it’s crucial to practice safe sex consistently. This includes using condoms correctly and consistently, getting regular STI screenings, and discussing sexual health openly with partners. If you have any symptoms or concerns about your sexual health, seek medical advice promptly.

In summary, while the risk of HIV transmission in your described scenario is low, the presence of a sore does warrant caution. Consulting with a healthcare provider for personalized advice and potential testing is the best course of action.

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