My Son Paid a Woman for Sex. What's His Risk for HIV?

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Question

My 22-year-old son recently informed me that he lost his virginity with a woman who charged him 100 bucks. He met her on a smartphone app. He told me the sex was protected with a latex condom. He received unprotected oral sex as well.

What makes me worry is that when I asked him to describe how he removed the condom, he told me he pinched the tip with one hand and made a circle with his index finger and thumb of the other hand around the base of his penis. He then simultaneously pushed it off and pulled it off, kind of like pulling on a balloon. She took the condom from him and disposed of it, then gave him a tissue to wipe his ejaculate off his penis in order to clean up a bit. He is not circumcised, by the way, so he then describes wiping his penis forward from the base with the tissue.

He didn't use her bathroom when he left; he went downstairs to his car and cried, he was so upset. He then applied a Purell type sanitizer. He has eczema and may have had some small cuts from scratching previously, he's not sure.

He went to an urgent care clinic one week later, where he was screened for the standard sexually transmitted infections. He had a positive syphilis test, but I brought him to an infectious disease specialist at our hospital the following week, and a better test determined he was actually negative. He also had a fourth-generation HIV Ab/Ag test, which was negative, but I've read that two weeks is the minimum window.

What are your thoughts about all of this? He is going back for another fourth-generation test soon.

Answer

I can tell you have a genuine concern and interest for your son's wellness. But I think your parental concern in this instance is a little past warranted, medically speaking.

Let's begin with the facts: Based on the events you described, your son would be at no risk of acquiring HIV from this encounter. It's important to remember that in order for HIV to be spread sexually, it must transmit from the mucous membranes from one human directly into the mucous membranes of another, hence why intercourse is such a common route. It cannot be transmitted by receiving oral sex from another person. In order to consider HIV risk here, (1) the person he had sex with would have had to have been living with HIV, (2) she would have had to not be on treatment medications, and (3) he would have had to have his penis directly inside of her without a latex barrier. It sounds like we don't know about (1) and (2), but (3) was reported to you clearly: A condom was used for intercourse.

HIV dies immediately upon contact with oxygen. It cannot be transmitted through casual or surface means such as kissing, touching, crying, sharing utensils, sharing toilets, mutual masturbation, even frottage (genital to genital rubbing). Even if his partner was living with HIV and had a transmittable viral load, any detectable virus would have died immediately upon exposure to air once he pulled out of her vagina. So even if he took off the condom incorrectly, and even if her vaginal fluids got on the tip of the penis or the surface of his hands -- even with his eczema -- it would not have been transmittable by that point. There are no documented cases of people acquiring HIV through these casual means.

Let's say, for the sake of argument, that the woman was living with HIV and had a detectable viral load, and that he did not use a condom for penetration as an uncircumcised male. Even under these circumstances, his risk as the insertive partner for vaginal sex is quite low, less than 0.05%.

Another thing I'd like to note: Under some circumstances, sex workers are tested and treated for HIV and sexually transmitted infections (STIs) more frequently than the general population, thereby making them less likely to transmit these infections, not more. I don't know the context of your son's partner's situation, but I support the conclusion that a person who is paid in exchange for sex is not automatically at higher risk of transmitting infectious diseases.

Similarly, given that your son used a condom for penetration, that would significantly reduce the possibility of acquiring the other STIs you are concerned about. A standard blood test would indeed adequately deliver accurate results for syphilis by two weeks.

You mention that your son was quite upset after this encounter, but you don't mention why. Was he concerned about HIV for himself? Did he think he could acquire HIV from touching a condom incorrectly? Did something take place without his consent? Is it possible he is reflecting your anxieties and fears in his own distress?

With the deepest respect: I understand your fears about HIV and STIs. It's natural to want your children to be happy and healthy. However, at a certain point, I would invite you to consider if it serves you and your son to focus on these intimate details of his private sexual encounters together. Sometimes, adults at his age appreciate boundaries with their parents regarding the intimate details of these vulnerable moments. I'm not automatically assuming that's the case here. But as a caring father, I simply ask that you think about whether it's enhancing his pleasure and sexual confidence when he reports these details to you. Is it possible that he might benefit from sexual exploration absent of these discussions? Is there any other friend, mentor, therapist, or health care worker with whom feels comfortable?

In any event, I hope that if you and he continue these discussions, they are informed by medically based facts. Sexual exploration at any age can be a source of great curiosity, mystery, adventure, and wonderful fun, if approached from a place of being open-minded, well-informed, and willing to communicate. But it can also make one vulnerable to embarrassment and trauma if it occurs in an environment of fear and powerlessness. I do hope that your son has the opportunity to take advantage of healthy and meaningful sexual discovery in the future.