What is the risk of getting HIV after protected sex at 28?

Hi doctor,

I am a 28-year-old male, and a couple of months ago, I availed myself of an escort service. Ever since, I have been constantly worrying about the possibility of HIV (human immunodeficiency virus) infection. I feel a little embarrassed writing about all this, so please excuse me if any part of my note below seems inappropriate. I will try to describe the experience in as much detail as possible.

She appeared hygienic, had clear skin all over, and seemed to be in good health. We had vaginal intercourse three times on that occasion. Each act lasted no more than five minutes, and we used the same position all three times. The woman is on top. I did not ejaculate at all. She carefully put on the condom each time, which I believe was made of latex.

I did not notice how she removed the condom after each act. However, I didn’t hear any indication of the condom tearing or rupturing. Even if the condoms had failed, she didn’t show any reaction or expression suggesting that something had gone wrong. I also don't think the condoms slipped off completely, though it’s possible they may have slid up slightly during intercourse, but I can't say for certain.

I am uncircumcised, and I’ve read quite a bit about HIV symptoms, which are said to resemble flu-like symptoms. I have not experienced any such symptoms so far, at least nothing noticeable. Some sources online say 50% of people infected with HIV show symptoms, while others say up to 80%. Additionally, some claim symptoms appear within four weeks of exposure, while others extend this window up to eight weeks. What are the accurate figures for this?

I also want to mention that I have a small penis, around 3.5 to 4 inches when erect, and as I said earlier, we only used one position during intercourse. Can it be implied that the risk of infection in such a case was very low? I understand that the foreskin retracts during intercourse, exposing its inner surface. Given the size of my penis, could the condom have had a higher chance of sliding up to a vulnerable level? As far as I remember, there was no issue with the fit of the condom.

Through which part of the penis does HIV enter? Some sources suggest the glans; others mention the opening at the tip, the gap between the glans and foreskin, or even the foreskin itself. Could you kindly clarify this? Once the virus enters through any of these areas, is it easy for it to cause an infection, or does the body’s immune system sometimes resist and eliminate the virus?

I have read that the chance of acquiring HIV from vaginal intercourse is 1 in 263. What does this figure effectively mean?

I understand that the only way to determine HIV status is through testing. However, due to certain reasons, I am currently unable to get tested. In the absence of a test, if you could provide clear and specific answers to the above queries, it would 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 would like to understand a little more, please.

Regarding your reply to my question, I actually wanted to know whether HIV infection always occurs once the virus passes through the skin, or if infection happens only sometimes because the immune system is able to fight it off.

About the risk figure of 5 out of 10,000 exposures that you mentioned, I have two queries. I have read that this rate applies to high-income countries. Is it applicable to my country as well? Also, what does this rate actually signify? Does it mean that HIV infection occurs only five times out of 10,000 exposures when the virus comes into contact with the penile opening or foreskin? If so, that seems to suggest the risk is extremely low.

I have also read that once a person is infected, they will always show visible signs, such as persistently swollen lymph nodes, clubbed or curved nails, etc. Is this accurate?

Lastly, I would request you to share your general impression about the likelihood of my having contracted HIV, based on the circumstances I described earlier. I understand that I cannot expect a diagnosis, but even a general opinion or reassurance based on the situation would help me a great deal.

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, so I will probably have the test done the week after. Right now, I am in a state one might call “self-counselling,” trying to maintain a positive outlook regarding the situation.

I would like to seek your thoughts or clarification on a couple of questions or doubts.

I have read in many places that mouth ulcers often occur during the acute HIV infection phase. In the third week following the possible exposure, I developed what appeared to be a mouth ulcer. A small white spot (or rather, a dot) located between the upper and lower right wisdom teeth. Photos are attached.

For the first 5–6 days, there was constant pain on that side of my mouth, which I believe was similar to the discomfort caused by an ulcer. However, the white spot itself was not painful or sensitive to touch. After 5–6 days, the white dot disappeared, but the immediate area surrounding it turned white. A dental surgeon later said this was due to trauma from the friction between the two wisdom teeth and the inner cheek.

I had both wisdom teeth on that side extracted. While I do not doubt the doctor’s explanation regarding the trauma, I remain uncertain about the initial white dot I mentioned above. The doctor never saw it, as it had disappeared by the time of my visit, and only the surrounding white area remained visible.

Could that initial white dot have been a mouth ulcer? (It was definitely not part of an unerupted or impacted tooth, since it resolved within 5–6 days, as I mentioned.) If it was a mouth ulcer, does the presence of a single ulcer typically indicate HIV infection?

Also, if symptoms do occur after HIV infection, are they usually severe, or can they be mild enough to go unnoticed? I have come across conflicting information about this online.

Thank you.