[Question #12324] Very risky exposure

8 months ago

Good day. Last night i had sexual encounter with a Thai Transsexual sex worker. I am a male. The sex worker said they were clean and had no sti. I am also clean i had a blood test 6 months ago. I had condom protected oral sex where i was receiving the blowjob for 3 minutes and then i had condom protected anal sex for 10 seconds where i inserted my for 10 seconds only. I am very worried as this was my first anal with a ts sex worker and the sex worker said they were clean. What are my risk for Hiv and other serious std such as herpes syphillis and many more? Should i get tested again? The condom looked intact. Pls advise

H. Hunter Handsfield, MD

8 months ago

Welcome to the forum. Thank you for your confidence in our services.

I don't agree with the title you chose for this question; this wasn't a "very risky" exposure. I would consider it nearly zero risk. Of course trans sex workers are at high risk for HIV as a group, but people rarely lie about HIV/STI status when asked directly, so probably this person isn't infected. Or if she has HIV, maybe on effective anti-HIV treatment and would be considered "clean". But most important, you had entirely safe sex, with all events condom protected. I would not advise testing for HIV or other STIs.

Of course you are free to be tested for reassurance, but if somehow I were in your situation I would not be tested at this time. But if you decide to get tested anyway, I would advise a urien gonorrhea/chlamydia test after 4-5 days, and you could consider syphilis and HIV blood tests in a few weeks. But really, I don't think it is necessary.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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8 months ago

So Pep should not be considered?

H. Hunter Handsfield, MD

8 months ago

I certainly would not advise it. However, we don't take direct stances on this: PEP decisions should only be made by providers familiar with the local HIV situation. If partners like yours are considered to usually be HIV infected, perhaps PEP would be advised. But be aware of an often forgotten downside of PEP: It delays by several weeks the time until you can have a conclusively negative HIV blood test. Would you be prepared for a longer duration of not knowing for sure?---

8 months ago

Good day. I decided not to go with pep but my anxiety and fear has reached extreme levels as a result i decided to book a hiv 4th gen test at 3 weeks out from exposure. I know its soon but just for my mental health i had to do it.

I have a few issue

1). 7 days after exposure i saw today my right part of the scrotum was red and itchy( rash ) and there are red dots only on the right side of the scrotum where the ts sex worker had sucked on. could this by Herpes?

2) i am going on holiday and will meet a friend that i have occasionally had unprotected sex with( female) after the hiv test( after three weeks) can i have unprotected sex with her or should i wait for 6 weeks test results? I will also report my results once i get them

8 months ago

And besides that i dont have any symptoms besides occasional headaches. No genital symptoms

H. Hunter Handsfield, MD

8 months ago

It isn't too soon for an AgAb (4th generation) blood test. Over 90% of newly infected people have positive results by 3 weeks. Your negative result should be reassuring.

1) Your description of the skin problems doesn't fit at all with herpes, or any other STD. It has nothing to do with the sexual exposure you have asked about.

2) It's entirely up to you whether to have sex before you have truly conclusive test results. On one hand, as we have discussed there is no realistic chance you have HIV. On the other hand, to be honest with her and yourself, probably you should first inform her of your situation. How would you feel if someone told you they were worried about HIV and had not yet had a truly conclusive test result? This does not mean I believe there is any chance you have HIV; I do. not. But this comes down to ethics, honesty, and respect for your partner.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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