[Question #10547] HIV exposure and symptoms
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21 months ago
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October - over 5 days.
A) 2 encounters: body to body massage: HJ only. Boils on my back which I scratch so possible broken skin. I shaved pubic hair 2 days earlier. Vaginal rubbing on my back and genitals. Any HIV/STI risk?
B) 1 encounter: oral without condom. Any HIV/STI risk?
C) 2 encounters with sex workers in Malaysia/Vietnam: vaginal sex with condom. No obvious breaks. Any HIV/STI risk?
Next 2 have me worried.
D) 1 encounter: 35 year old sex worker in Malaysia: vaginal sex with condom. After ejaculating I lost erection. As I pulled out the condom began to slip. It appears i ejaculated in condom but it may have come off as I pulled out. I’m worried about HIV/STI from vaginal secretions on urethra.
E) 1 encounter: 23 year old sex worker in Vietnam: vaginal sex with condom. During vaginal intercourse I struggled to maintain erection. I pulled out. She massaged my penis with the condom still on for a few SECONDS. She then removed the condom and used the same hand to massage my penis for a few SECONDS until erect. She immediately put a new condom on and we had vaginal sex for 5 minutes. I’m afraid vaginal secretions from the first condom were on my penis head/shaft and were under the second condom for 5 minutes during vaginal sex. I’m worried this is HIV/STI risk.
ARS: 4 days later I started with joint and muscle aches as well as nausea. It is now 10 days since exposure D and 7 days since exposure E. I still have muscle aches, occasional joint pains, intermittent nausea and tiredness. There is no fever, sore throat or rash.
Respiratory PCR was normal.
I’m worried I might have HIV.
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Edward W. Hook M.D.
21 months ago
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Welcome to our Forum. Thanks for your questions and for your confidence in our service. Congratulations as well on your regular practice of safe, condom protected sex. I'll provide some general comment and then address each specific event. As a generalization, HIV is transmitted ONLY through penetrative ano-genital sexual contact. There are no proven cases in which HIV has been acquired through receipt of unprotected oral sex. HIV is not transmitted through receipt of masturbation, even when participants transfer genital or other secretions from person to person during masturbation. Having shave your pubic regions or having broken skin does not change this, even if infected secretions get on the shaved or abraded/open areas. In addition, when condoms come off as a person withdraws froma partner, leaving the condom behind, the condom has typically done its job. Thus, regarding your specific questions:
A. No meaningful risk in terms of gonorrhea, chlamydia, HIV, hepatitis
B. No meaningful risk of HIV or hepatitis. If your partner had oral gonorrhea (uncommon) she could have transmitted it to you during oral sex
C. No meaningful risk of gonorrhea, chlamydia, HIV, hepatitis
D. Unlikely there is any risk of gonorrhea, chlamydia, HIV, hepatitis
E. Unlikely there is any risk of gonorrhea, chlamydia, HIV, hepatitis
My responses have focused on the most common STIs. There is a theoretical possibility that if your partners had lesion diseases such as syphilis in an area which directly contacted you and was not covered by a condom that you might have acquired such infections but this is VERY rare and would not worry me.
Your flu-like illness symptoms are those which are associated with HIV if there is also a high fever but even then it is unlikely. When at risk persons with flu-like symptoms have been tested for HIV, over 99% have something other than HIV including COVID-19, influenza, or other common "everyday" viral illnesses. If your symptoms are due to HIV, a 4th generation, combination HIV antigen/antibody test would be positive at this time.
Overall, your risk for HIV and other STIs from the encounters you describe is very low and your risk for HIV is virtually zero. EWH
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21 months ago
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Dear Dr Hook, thanks for your comprehensive reply. I have used your services in the past, including on older health forums.
Please can you clarify your statement "your risk for HIV and other STIs from the encounters you describe is very low and your risk for HIV is virtually zero" in regards to HIV: low risk or virtually zero risk?
Many websites including reputable ones consistently state vaginal secretions can pass on HIV. With respect, why in your assessment is it when these secretions are immediately taken of the condom and put on the penis and then covered with a condom and intercourse initiated not high risk?
From your answer I understand that IF seroconversion symptoms OCCUR then a HIV test will be positive, however early the test is taken. I'm really bothered by generalized aches and pains and daily transient fatigue, nausea. I only have a point of care HIV antibody finger prick test and an oral point of care test - it it worth testing if only 7-10 days post sexual activity or should I wait the full 4 weeks.
Any other words of reassurance or comfort would be much appreciated. I am really struggling mentally as well as physically with tiredness.
Many thanks
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Edward W. Hook M.D.
21 months ago
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Your risk for HIV is virtually zero. Your risk for other STIs, specifically gonorrhea from receipt of oral very is very low but not zero. That said, if you do not develop obvious (i.e. visible without squeezing or working to see it) penile discharge within 4-5 days after receipt of oral sex, personally, I would not be at all worried about gonorrhea either.
You are demonstrating why we urge (all too often unsuccessfully) clients to stay off the internet when trying to determine risk. Either the websites you are quoting are wrong or you are taking what they say about vaginal secretions out of context. Transfer of vaginal secretions from person to person on someone's hands is no risk, as it contact of skin with vaginal secretions without penetration.
4th generation combination HIV antigen/antibody tests would be positive IF your symptoms were due to HIV. An antibody only test might not be positive until several days after the onset of symptoms. In terms of evaluating symptoms, there is no need to wait 4-6 weeks for testing. On the other hand, for persons who acquire HIV but do not experience the symptoms associated with the ARS (not everyone experiences symptoms at the time they acquire HIV), HIV test results are not fully conclusive until 6 weeks after an encounter.
You have one follow-up left. EWH
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21 months ago
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Thank you Dr Hook.
For my final message.
I understand your assertion that vaginal secretions when transferred by hand to a Penis are not a risk for HIV. However in my case those secretions very quickly ended up under a new condom and I had sex for 5 minutes. Could the urethral microtrauma from intercourse allow such vaginal secretions into the bloodstream.
I have never had unprotected penetrative sex apart from with my long term partner. Aside from the interactions mentioned above, I have only engaged in protected oral sex and HJs infrequently with other partners.
I'm really worried about HIV.
My symptoms are getting better and I feel I will be ok in a day or two. But the timing of myalgia, nausea, tiredness and occasional joint pain is the only thing that got me worried otherwise I would not have thought about HIV.
Why do I keep feeling I will be the one rare case... Someone must be. I pray I won't.
I'm grateful for your support.
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Edward W. Hook M.D.
21 months ago
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Final responses:
I understood that your partner's genital secretions likely were under to condom. No change in my assessment.
You will not be "the one rare case". Given your level of anxiety however, my advice would be to seek a test to prove to yourself that you did not acquire HIV.
End of thread. EWH
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