Q. What are the chances of acquiring HIV infection?

Hi doctor,

I am a 28 year old male, and a couple of months ago, I had availed an escort service. Ever since, I have been worrying all the time about possible HIV infection. I feel little embarrassed writing about all this. Please excuse if you find any content of my note below unwarranted. I will try to describe the experience in as much detail as possible. She appeared hygienic, and had a clean skin all over and seemed to be of good health. We had vaginal intercourse three times on that occasion. Each lasted not more than five minutes. We did it in a single position all three times, that is, the woman on top. I did not ejaculate at all. She neatly put on the condom, which I believe was a latex one, every time. I did not notice how she removed it after each act. However, I did not hear the condom rupture or tear.

Even if the condoms had failed, there was no such expression or reaction from her to that effect. I also do not think the condoms had slipped off totally, but it could have slid upwards at times during the act, but I am not sure though. I am uncircumcised by the way, and I have read quite a lot about HIV symptoms, which are similar to the flu. However, I did not have any such symptoms so far, at least nothing noticeable. At some places on the net, I found that 50 % people infected with HIV show symptoms, while at some places they say 80 %. Also, some say symptoms appear within four weeks from exposure, while some say it can appear up to eight weeks also. What are the exact figures for these, please? I have a small penis, 3.5 to maximum 4 inches when erect, and we had intercourse in a single position as I said above. Can it be implied that the risk was very low in such a case? I understand the foreskin retracts during the act exposing its inner surface. Given the size of my penis, did the condom had a higher chance to slide upwards to a vulnerable level? So far I recall, there was no fitting issue.

Through which area in the penis does HIV enter? Some say it enters through the glans, some through the opening at the tip, some say through the gap between glans and foreskin, and some say through the foreskin itself. Kindly clarify. Is it easy for HIV to cause infection once it enters through any of the above or does the body’s system resist and kill the virus at times? I have read the chance of one catching HIV is 1 in 263. What does this effectively imply? I know the only way to determine HIV is by doing a test. However, right now I definitely cannot have any such test done due to certain reasons. In the absence of the test, if you could reply with clear and specific answers to the above queries, it will help calm me to a great extent. Thank you so much for your patience and time.

Hi doctor,

Thank you for the prompt response. I wish to understand a little more, please. Regarding your reply to my question, I actually wanted to know if HIV infection is always caused once the virus passes through the skin or it is caused at sometimes only because the immune system fights it off? Regarding the risk of 5 out of 10,000 exposures mentioned by you, I have two queries. I have read this rate is applicable for high-income countries. Is it applicable for my country as well? What does this rate exactly signify? Does it mean that HIV infection has the chance of occurring only five times if the virus comes in contact with the penile opening or foreskin 10,000 times? In that case, it appears to be an extremely rare possibility. I have also read that once a person is infected, he or she will have some visible signs always like, persistently swollen lymph nodes, clubbed or curved nails, etc. Is this correct? I would also request you to share what you feel about the possibility of my having contracted HIV, based on the circumstances described. I know I cannot expect a diagnosis, but a general assurance based on the circumstances will also help in a big way. Thank you.

Hello doctor,

Thank you for your reply.

After much deliberation, I have finally decided to get an HIV Rapid Antibody Test done following your recommendation. I am traveling this week and the next week, so I will probably get the test done in the week following. I am right now in the state which one calls "Self-counselling", trying to build a positive outlook concerning the condition. I would like to seek your thoughts or clarification on a couple of queries or doubts:

1. I have read in many places that mouth ulcers often occur in the Acute HIV infection phase. In the third week from the possible exposure, I had developed sort of a mouth ulcer (A white spot. Rather, a dot) between the right upper and lower wisdom teeth. Photos attached. For the initial 5-6 days, there was constant pain on that side, which I believe is similar, but the supposed ulcer itself was not painful or sensitive to touch. After 5-6 days, that white spot or dot disappeared, but the immediate area surrounding it turned white, which a Dental Surgeon said was caused by trauma from the friction of the two wisdom teeth on that side with the skin. I got both wisdom teeth from that side extracted. I do not doubt the doctor's opinion on the said trauma, but I am not sure about the initial white dot or spot mentioned above. The doctor had not seen it because it was gone by then, and only the subsequent white surrounding area was visible when I met him. Could that initial white dot or spot be a mouth ulcer? (it was definitely not part of the unerupted or impacted tooth since it disappeared in 5-6 days, as I said.) If so, does a single mouth ulcer typically be an indicator of HIV infection?

2. If symptoms occur after HIV infection, are they typically severe, or can they be mild enough to go unnoticed? I have read contradictory views on this on the net.

Thank you.