condom slipped off while with escort

[sam615]

hello doc,
i been reading your site great work here let me tell you about my case i live in nyc and went to see an escort first time let me tell you my case we were having sex she was on top when she got off i saw the condom was no longer on
in was in her vagina i freeked out went to clean my self and stopped i dont think my exposure was to long but it really freeked me out alot i went to my general doc and asked to be given pep meds to prevent hiv my ? is what are my chances that i have gotten something form this i am not circumcised and my forehead skin is very tight can you please tell me my chance that i have gotten hiv from this should i continue my pep treatment that i stated at 24 hours
i am very scared here do i have hiv now after this thankyou so much for your help in this matter please get back to me as soon as possible to hep me out

[Edward W Hook, MD]

We have many questions of this sort on the HIV prevention site so to verify what I am seeing or to take a look at variations on this answer (there are many) feel free to search the HIV prevention site. To summarize, you had a single, partially protected exposure to a commercial sex worker (CSW).  Your chances of having gotten HIV from this exposure are low.  Here's why:

1.  Chances are your partner did not have HIV.  Most CSWs do not, even in NYC.
2.  Your chance of getting HIV, if you were totally unprotected and if she was infected is less than one in 1000 per exposure.  This average figure includes both circumcised and uncircumcised men.  

When you put these facts together, your chances of being infected from the exposure you describe is less than one 100th of 1% (i.e. 1 in 10,000) are probably are considerably lower.  

As for your PEP, I am sorry to hear that you were given it.  You chances of having side effects are higher (considerably) than your changes of having gotten HIV.

I understand your fright but would urge you to try not to worry.  As to whether you keep taking the PEP, this is your call.  You haven't had side effects on day one and I hope you don't.  Good luck. EWH

[sam615]

just wanted to let you know that my lymph node feels smaller now and i have an idea on that a day before my lymph node got a bit swollen i was working in my yard and i was bare foot and i got stuck with a stick prity deep i read some were online that a foot injury
can cause swollen node in the groin area anyway just a breif brief update

[sam615]

thanks so much your the best you made me at ease a bit

[Edward W Hook, MD]

The bump is in a location where there are lymph nodes so it could be a lymph node.  If is is, SO WHAT!!  Everyone has lymph nodes, and most people can feel them, particularly in their groin if the push long and hard enough.  Furthermore swollen nodes are by no means indicative of HIV.  If this is a node, it is meaningless.

You have made your decision to take PEP, now that has to play out with follow-up blood tests.  this is just about certainly not a sign of HIV.  If you continue to think that every bump, sore, and ache you experience between now and 12 weeks from the end of PEP when you get your final test results, you will be a basket case.  Relax.  EWH  

[alienshadow]

Look as I stated before PEP is a strong drug . You will have all kinds of things going on with your body,again stress dosent help neither does anxiety also please remember your test will not be conclusive until 3 months after your pep treatment. Which I think you should not of done but that was your choice. If you need to talk pm me.Dont probe at your nodes they tend to feel bigger when this occurs!!!!

[sam615]

hello again doc just have a follow up ? but firt off am almost done with my pep treatmet i have a few more days left but to the ? i was in the shower last night and i felt a bump between my leg and my groin can this be a swollen lymph node its been there for 24 hours now and its freeking me out a bit could this be a sign of hiv i have no other swelling on my body other than that area or fever do you think this is something bad thanks for the help doc all the best :) this is scaring me a bit :(

[Edward W Hook, MD]

I hope so too.  Please just make sure that you are taking the PEP under the supervision of a health care provider who can do the appropriate blood tests (liver function, etc) to monitor you for developing adverse effects.  EWH

[sam615]

i just want to thank the Doc and alienshadow for your help i have made my self a promise that i will never put myself in this position again i just hope i dont get any really bad long term side affects from the peps any ideas Doc on that and i will bring my self to do a test in 10 weeks and post my results praying for the best but scared still

[Edward W Hook, MD]

Sorry, the tests are the tests.  If the virus were there (very unlikely as mentioned before), taking even some PEP can modify the biology of the virus in ways that we don't completely understand.  As a result, I'm afraid you would need to wait to be tested.

As to why test.  You had an exposure to a partner whose HIV status is unknown.  We suggest that all who have exposures to unknown or new partners be tested, if they have not been tested in the past.  We recommend periodic STD/HIV "screening" (testing in the absence of symptoms) for all who have new partners of unknown status and those with multiple partners over a period of less than a year.  As a matter of personal protection, we recommend annual testing for anyone who has had two or more sex partners in the past year (we consider this to be health maintenance- we also recommend you get your blood pressure and cholesterol checked regularly).

[alienshadow]

Sam615
    I am not the Dr but when you are put on PEP and you take the whole course. Then you have to wait an additional 3 months to get your conclusive.
      If I where you I would stop just because of statistics you have a better chance of dieing in the next 48 hours than you do of contracting HIV from this one time exposure
     I only replied here because i was in the same predicament as you if it helps I stopped testing at 84 days and I was negative and I have not looked back PEP has real bad side effects goodluck if you stay on it

As for Dr Hook his advice to you I would listen to him hasnt he stated what your Dr stated???

[sam615]

thanks agian doc thats a long time to wait to get tested there is no way i can get a test sooner with a propper result do peps affect my test results in anyway and also sorry to ask this but what do you think am looking at a negative or possitive result after testing
i know you said am in a low risk but then you recomend tested thanks

[Edward W Hook, MD]

I would get tested after this mishap but would wait for 8-10 weeks before doing so.

As for PEP, in high risk exposures, it does work better when started soon after exposure as you did.  How little PEP helps is unknown. Personally, I do not think you need PEP, particularly if you are having side effects.  EWH

[sam615]

thank you so much for your quick reply doc i am having side affects its been 3 days on the pep so far just Nauseous so far it was more my decision as the doctore is my friend
and i asked him to give me the meds i explained to him i was very scared so he agreed
and gave me the pills to start the pep treatment he also said my chances were slim as you did in your reply but am scared every time you read something or ask someone you would think hiv is easier to catch but you say my chances are slim do you think i should get tested for hiv after this miss hap and also do peps work if started in the first 24 hours
thank you very much doc for your help