[Question #10095] STIs Exposure

25 months ago

Hi Dr., Im 32Y M living in dubai , on June 9th i received oral sex from a female CSW. After that we had protected sex, the problem is that my penis wasn't very hard and i noticed that the condom was slipping ( i saw part of my penis touching her vagina skin to skin contact) but my penis head was covered. This intercourse lasted for 2-3 mins max. I'm worried because she wanted to have unprotected sex and i believe she does this with all her clients. I dont know her HIV status. I'm extremely worried about HIV and other STIs. I haven't done any tests till now as im still 15 days only post encounter and afraid of the results.I'm having anxeity which is affecting my life and work.

My symptoms: 2 days after encounter i'm feeling that my head is very hot as if i'm having a fever but without real fever (temperature 31c- 38c) this symptom is still persisting until today.

My Questions are

1- What are my risks of having contracted STDs with HIV being my biggest worry ?

2-Do you recommend any country to have tests in which are confidential other than UAE as im afraid of the results and deportation?

3- I'm abstaining to have sex with my Girlfriend as im worried. is this logical ?

4- I understant that penetrative sex risk is low 1/2400 but i read on a website that if she has recently been infected with high viral load the risk can go up by 26 folds and if i have any STIs (which im not aware of) the risk can go up by another 8 folds so assuming worst case scenario my risk would be 1/2400 * 26 * 8 = 8.6% does this sounds right ?

Edward W. Hook M.D.

25 months ago

Welcome to our Forum and thanks for your questions. I’ll be glad to comment. We get many questions from persons who interact with commercial sex workers in Dubai. So we follow HIV rates there. The good news is that few CSWs in Dubai have HIV. Additional good news for you is that as long as the head of your penis was covered throughout the encounter, your condom did its job. I will also add that 2 days after your encounter is too soon for HIV cause symptoms and that an isolated fever is not a sign of recently acquired HIV. Thus, this was a low risk encounter and you can be confident that your possible fever was not due to HIV. In response to your specific questions:

1. Your risk for HIV is virtually zero and now, without symptoms at 9 days it is unlikely that you acquired a STI.

2. I’m not sure that you need testing but if you want to test, confidential testing is available throughout Europe and much of Asia.

3. Abstention is a personal choice. Your risk of infection however is low.

4. Your math is OK but your assumptions are far too high.

Hope these comments are helpful. EWH

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25 months ago

Hi Dr. Edward,

Many thanks for your reply, your reply has put me in a much better state now. I have a couple more questions please.

1- It's not a real fever that i have, I feel my head is constantly hot but when i measure my temperature it's within the normal range (31c-38c) is this a known thing or symptom ?. I forget to mention that i as well sometimes feel very cold that i need to put a jacket on while the temp is 35c. Does these symptoms change your assessment ? Could these symptoms be due my anxiety ?

2- Can this type of fever that i have be a symptom of UTI or any other STI ?

3- I wanted to understand as well the rationale behind that if the penis head is covered that means that the condom did its job? can't HIV be transmitted through any part of the penis or is it only the head that is prone to infection ?

4- do i have risks for Hepatits B or Syphillis from my encounter ? when should i get tested for those ?

5- I'm currently at 16 days post exposure without aggressive HIV symproms. could i take this as a good sign that i'm not infected ?

6- What is the best course of action that you would recommend in my case ? example test for HIV, test for other STIs, or not test at all and continue with my life.

Finally i would like to tell you that the work you do is amazing, before i knew your website i was lost in reddit and google and thought that my life is ending with all the wrong info that is there.

25 months ago

Forgot to add that among my symptoms was a couple of days with diarrhea followed by a couple of days of loose stool.

Edward W. Hook M.D.

25 months ago

I'm sorry you are having so much trouble moving forward. Your "but what about..." questions are really not productive. With your degree of anxiety, I suspect that nothing I can say will take the place of proving that you do not have HIV. If you are worried about your symptoms, despite what I have told you, then get tested and when the test is negative, that will prove that your symptoms are not due to HIV. On the other hand, about half or more of persons who acquire HIV do not experience the ARS. If that is your concern, then you can either do an RNA PCR test now which is very (but not perfectly reliable- even for persons with negative RNA tests, many experts suggest a follow-up 4th generation test at 6 weeks) or you can just wait until 6 weeks and get a 4th generation, combination HIV antigen/antibody test. In reply to your follow-up questions/comments:

The sort of feverish sensation that you describe is more likely to be a manifestation of your anxiety than anything else.

2- Can this type of fever that i have be a symptom of UTI or any other STI ?

UTIs are rare in men and when present typically do not cause fever.

HIV is acquired when the virus enters through the mucosal suface of the urethra. Surface contamination of the penis with infected secretions does not put you at meaningful risk for HIV.

4- do i have risks for Hepatits B or Syphillis from my encounter ? when should i get tested for those ?

Your risk for these is lower than your risk for HIV. Testing for both will be conclusive at 6 weeks. '

5- I'm currently at 16 days post exposure without aggressive HIV symproms. could i take this as a good sign that i'm not infected ?

Yes

6- What is the best course of action that you would recommend in my case ? example test for HIV, test for other STIs, or not test at all and continue with my life.

I wish I had away to help the anxiety which is troubling you. Your risk was low as already explained. You need to either test (if a negative test will let you move on without continuing "what if..." concerns or seek counseling to help you deal with your anxiety and perhaps guilt.

You have one follow-up left. EWH

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