[Question #11867] hiv risk
11 months ago
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Hi
M35 from Mauritius.
11 months ago
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Sorry I forgot to add my question.
On 24/08/2024 I noticed a wound/crust of 3-4mm around lower part of my penis shaft (where condom would end). Today I saw many small blisters on the base and lower part of my penis shaft, and my GP diagnosed me with Herpes.
My fear is that I may have had an open herpes sore on 23 August when I had condom protected sex (no oral) with a CSW and vaginal fluids may have come in contact with it (maybe not covered with condom). Only HIV Elisa test (window period 90 days) is available in Mauritius. . What is my risk? When should I test?
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H. Hunter Handsfield, MD
11 months ago
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Welcome to the forum. Thank you for your question and for your confidence in our services.
First, about your genital herpes: I hope your doctor or clinic sampled the sores to test them for HSV by PCR, including typing to determine HSV1 vs HSV2. The likelihood of recurrent outbreaks, transmission to partners, need for treatment to prevent both of these, and susceptibility to HIV all are far greater for HSV2 than HSV1. Discuss this with your doctor.
But your main concern is HIV. Statistically, you were at low risk: if a woman has untreated HIV, the risk to her male partner is roughly one chance in 2,500 for each episode of unprotected vaginal sex. HSV2 (but not HSV1) increases that risk by about double or even 4 times -- but that still leaves your risk at somewhere around one chance in a thousand. And that's unprotected vaginal sex; with a condom, your risk was a hundred times lower than that. Further, most CSWs do not have HIV (I don't know the situation in your country, but almost certainly there is under a 10% chance your CSW partner had HIV.)
So most likely you did not acquire HIV. However, it makes sense to be tested, both for HIV and syphilis. You might see a doctor or clinic with HIV/AIDS expertise for in-person advice; the doctor who diagnosed your herpes is a good place to start. Or contact public health services (looking online I find this https://health.govmu.org/health/ which includes phone numbers etc. I would be surprised if only older HIV ELISA tests are available, with 90 day window period. (There are 10 or more different HIV ELISA tests, including AgAb -- i.e. "4th generation" blood tests with 4-6 week windows. Probably HIV RNA/PCR testing also is available, if needed.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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11 months ago
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Thank you for the reply Dr HHH. Just a few more details. On 16 August I had another condom protected sex with a CSW. Both encounters were with Malagasy CSWs and there is no concrete data of HIV prevalence from people of Madagascar unfortunately. Before these CSW encounters I had sex only with one woman (my ex-wife) for my whole life until we separated last month after I found out she has been cheating for a long time:(. I am never having sex with CSWs or have any partner anytime soon as I am very affected for having contracted HSV. I saw my GP today and he confirmed that there are not many tests available in Mauritius except for main STDs like HIV, Hepatitis and Syphilis. He has advised to do HIV test 12 weeks post exposure.
As for the tests, there is only IGM herpes test in Mauritius and no type specific tests unfortunately. I have asked all clinics and labs. The HIV tests available is PCR test (7-10 days post exposure) and normal Elisa test HIV 1 and 2 (at least 6 weeks post exposure and repeat after 6 months). The PCR test is very much more expensive than the normal Elisa HIV test. TPHA and VDRL for Syphillis are also available post 6 weeks exposure. No urine test for Gonorhea or chlamydia - only blood tests available. Unfortunately though there is great medical care available for surgeries etc, STDs are still a taboo in Mauritius and not much is done for it in either public or private health facilities.
Given my exposure, I am planning to wait 6 weeks and do the normal HIV Elisa and TPHA/VDRL tests at a private lab. Would I be ok to move on if i have a negative result for HIV and syphillis by then or should i wait more please?
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H. Hunter Handsfield, MD
11 months ago
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Thanks for educating me about the STI/medical situation in Mauritius. I hope it improves one day. However I still would be surprised if the IgM is the only available HSV antibody test -- no IgG? The IgM test is horrible and never recommended or used by knowledgeable experts in herpes and STI; positive results are inherently unreliable and never to be believed. (Even the non type-specific IgG tests are better than IgM.)
It probably makes sense to follow your doctor's advice about timing of a final HIV test. But your plan for testing for both HIV and syphilis at 6 weeks makes sense too: all HIV blood tests (and the syphilis tests) usually are positive by 4-6 weeks in newly infected persons; negative results at that time would be very reassuring, even if final conclusive testing is delayed until 12 weeks.
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11 months ago
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Thank you for the help Dr HHH. I will do the test at 6 weeks and 12 weeks mark. I pray they are negative. I am very very very worried right now. I hope the odds and statistics are in my favour though. Thank you.
11 months ago
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I’m now getting cold flu symptoms and freaking out. I don’t want to overthink it. I’m being treated with acyclovir oral for herpes. I hope sincerely that my results for HIV be negative from the risky exposure. Really worried and it’s a long wait. I hope the condom protected me.
Thank you DR HHH and team for your time and for responses. All the best with your work.
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H. Hunter Handsfield, MD
11 months ago
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The 'flu like" symptom that go along with acute retroviral syndrome (ARS, i.e. initial HIV infection) are sore throat, fever, muscle aches, headache etc. Usually there also are enlarged lymph nodes in several areas (neck, armpits, groin) and often a skin rash. ARS symptoms do not include typical cold symptoms: no nasal congestion or drip, no cough.
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With these symptoms, you need wait no longer for a very helpful HIV blood test. It is not possible to have ARS symptoms and a negative HIV antibody test, because the symptoms caused by the immune response to HIV and not the virus itself. Therefore, everybody with ARS symptoms test positive -- so a negative result at this time will prove HIV is not the cause. You will need to be tested later to assure the result stays negative after a few weeks. But the expected negative result should settle your fears about your symptoms. Probably you have just a cold or covid. Alternatively, you could return to your doctor for his evaluation; if he thinks ARS in fact is a concern, an HIV RNA/PCR test could be done. A negative result also would rule out ARS as the cause, and perhaps he would advise testing for covid and influenza.
Threads normally are closed after two follow-up comments and replies, and we're there. But I'll leave it open for one more exchange, in case you get tested and would like to let me know the result(s). However, I won't have further advice or comment until and unless you get tested and want to report the result. OK?
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11 months ago
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Thank you Doctor. I got appointment for Monday to do test by HIV RNA PCR. I shall have the results by Monday evening or Tuesday. I shall post the results here as soon as I get them to let you know.
Thank you once again.
11 months ago
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Got a call from the lab. Unfortunately the HIV PCR test is not longer available for now. I will have to wait for a normal antibody test at 6 weeks. Furthermore, my cold symptoms cleared overnight. I did not get any cough, enlarged lymph nodes etc. Just some stuffy nose. It’s winter here. My doctor said it’s not ARS but rather just a stuffy nose. Sorry I was too freaked out yesterday.
I will test at 6 and 12 weeks with HIV antibody Elisa test for hiv 1 and hiv 2. I cross fingers the results are negative.
I thank you again for your help. Take care. Bye
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H. Hunter Handsfield, MD
11 months ago
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OK, that all makes sense. That ends this thread; I hope it has been helpful. I'm confident your future HIV test result(s) will be negative. ---