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2nd part of question
Feb 7, 2010

To Robert Frascino MD

My name is Greg, I wrote to you earlier in the day regarding an incident of mine in Pattaya.

Since writing the question to you I have gone to a local doctor and done an HIV test. I just received the results and they were negative (clean bill of health across the board). The doctor also prescribed me Truvada for a month.

Should my worries be gone?

Doc...how bad is it? (Submitted Jan 31, 2010) Dear Robert J Frascino, MD.

I so hope you can shed some light on a recent blunder on my behalf.

I am currently on holiday in Pattaya, Thailand. I am from Australia.

On the first night that I was here I went to a local go-go bar and took a girl home for the night. We had protected oral, and continued to protected vaginal sex. About 15 mins into sex, I withdrew for a moment, and then re-entered...at this point the condom was absolutely fine. I re-entered and felt something awkward, a rip on the condom. I pulled out and realized that it was indeed broken. My stupidity kicked in and I re-entered for about a minute before I pulled out without condom. I then gave myself a tug (away from her) and finished myself off. I then went into the bathroom and gave myself a thorough cleanse. The girl left in the morning.

I didnt pay too much attention to it at the time. But in the morning I felt week and fatigued. Five days later I have developed a nasty cough with a runny nose. I am still feeling under the weather today, although a bit better. At no time have I developed any rash, white tongue or any pain on my penis.

By the way, I have never been a good traveller. When travelling to warmer and humid climates, I tend to get sick with coughing, runny noses and feeling weak.

So, the questions that I am hoping you can answer are -

1. What do you believe is my chance of attaining HIV if the girl does have HIV, even if it was only for a minute? I have read some articles on the Internet which state impossible odds (like 1 in 10000 and others that say 90%. By the way, because of my panic, I am assuming that she is HIV positive, although she may not be. 2. What should I do now? 3. Are my concerns over reacting? 4. Is there any insight you can shed on the matter?

By the way, in my state of panic, I have great solitude reading your answers on this website. I can only imagine how many people would have been able to attain more knowledge from your responses.

Thankyou so much for your time, Greg

Response from Dr. Frascino

G'day Mate,

Your HIV-acquisition risk is broken-condom (unprotected) vaginal sex with a Pattayan go-go-gal of unknown HIV status.

The CDC estimates the statistical risk of acquiring HIV per episode from unprotected insertive penile-vaginal sex with a partner confirmed to be HIV infected is 5 per 10,000 exposures. Your estimated statistical risk would be even less, as we don't know if your gal-pal was virally enhanced or not. Assuming your PEP (post-exposure prophylaxis) was begun within 72 hours of your potential exposure, this, too, would significantly further decrease your risk of contracting the virus.

Should your "worries be gone?" Well, unfortunately I can't say "she'll be apples" just yet. Your overall HIV risk is very low, but not completely nonexistent. It is possible your go-go-gal was positive and that you contracted HIV following your decision to go commando-Rambo after the condom failed and that Truvada (PEP) might not abort the infection. Again, it's unlikely this would happen, but it's not impossible. There are indeed folks unlucky enough to acquire HIV with a single lapse in judgment, and there are cases of PEP failure. (Yours truly is an excellent example of that!)

So for now I'll offer you good luck and keep fingers crossed that your post-PEP HIV tests are negative.

Dr. Bob



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