Anonymous
i'm a 28 years old male and recently had an encounter with a commercial sex worker and am extremely worried about the risk of hiv. before the encounter my foreskin had no open wounds or sores and neither was there any on my penis. we engaged in unprotected oral sex and 2 rounds of protected vaginal sex. in between the 2 rounds, the condom was taken off and she again performed unprotected oral sex on me before wearing a new condom for the 2nd round. right before ejaculation she briefly performed oral sex with the condom on (the condom had vaginal fluid from the intercourse) and took off the condom to perform unprotected oral sex (mouth might have vaginal fluid from the condom) for me to finish off. the next day i found that the under side of my foreskin had a raw reddish area that you would see if you scratched your skin hard enough to peel it off. im afraid that during the oral sex, her teeth sheared off the top layer of my foreskin and provided an open wound for hiv within the vaginal fluids that was in her mouth to infect me. even though hiv is supposed to die very quickly when exposed to air, im afraid that the exposure time to air was insufficient to kill the virus.
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Anonymous
Hi there and thanks for reaching out to the AIDS Vancouver Helpline. My name is Colin and I am happy to answer your questions today.

Right away I can tell you that this was a low risk encounter. This means that while there have been rare confirmed cases of HIV transmission via this method, it is generally under specific circumstances such as the known presence of a high viral load of HIV *AND* a broken condom *AND* significant trauma on both your and your partner's genitals, etc. If these conditions were not met, you can consider your risk to be *very* low. For there to be a successful transmission of HIV there must first be HIV present. Next there must be an exchange of bodily fluids with direct access to the bloodstream. Additionally, as you've read, once exposed to the air for even a few moments, though it may not die, HIV is immediately rendered non-transmissible meaning it can no longer be passed on from person to person. Of not here too is that there are only five fluids which can transmit HIV (blood, semen, anal secretions, vaginal secretions, and breast milk) and saliva is not one of them. In fact, the enzymes in human saliva severely degrade HIV's ability to transmit which is why oral transmission is so extremely rare. Finally with regards to the injury on your foreskin, when we talk about injuries or cuts as methods of entry for HIV, they must be very severe. Our rule of thumb is that if the wound isn't bleeding heavily and requiring immediate medical attention, then it can not act as a viable entry point to the blood stream. For a frame of reference, the only time HIV has been confirmed to transmit during injuries has been during knife fights when two people are actively bleeding into each other's wounds. Given that it doesn't seem like these conditions were met during your exposure, you can consider it to be *very* low risk.

I hope I managed to answer your questions today. Please feel free to post again if you'd like any more information or clarification.

All the best,

Colin

AIDS Vancouver Helpline
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