[Question #12918] Exposure: Risk and tests

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3 months ago
Went to London to a brothel type place in an apartment. Legality was dubious unsure if they are tested. 2 females perform oral sex while I had a condom on and wet wipe on pubic area. Was never comfortable so never got an erection. They asked if using a toy would help.I thought they meant on each other but I was laying on my back with eyes closed when I felt that they tried to place the toy in my anus.Felt pain/discomfort but dont think I was fully penetrated. Never saw any blood, didn't feel pain/soreness afterwards. Dildo had a condom on it. I felt violated and asked to leave. 1 asked if she could use oil to give me a handjob no condom. I agreed but after a few minutes I said stop, I washed my hands and left. Never had an erection. Panties never came off, my mouth never touched them and my hands never went in any orifices. I did pull one of their thongs to the side while she was on top of me and saw her anus/vagina with no visible lesions.

I have not had any symptoms at all. I took a 10 panel STD test with HIV 1 RNA early detection at Quest 13/14 days post exposure. Everything came back negative except iGG HSV1: 52.00 and HSV2 1.96.

1.Based on how early post exposure I tested for HSV can my results be from a previos exposure/false positives? Should I take a confirmatory hsv2 test from quest? I've never had any HSV symptoms
2.I read at 13/14 days HIV-1 RNA PCR negative test can be considered conclusive. Is this correct? Im taking it again along with a 4th gen at 28 days anyways.
3.Should i get any anal swab tests?
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Edward W. Hook M.D.
3 months ago
Welcome to our Forum.  Thanks for your questions and your implied confidence in our service.  I'll be glad to comment.  The encounter you describe was no risk for HIV and close to low risk for other STIs  Specific comments:

1.  Most SCWs in brothels do not have STIs.  Because of their vocation they tend to be careful and to get checked regularly.  As a  generalization, the risk of an encounter in the sort of brothel you describe is lower than the risk of a casual "hook up" in a bar.
2.  Receipt of oral sex is a no risk event for HIV (there has never been a case of HIV proven to have been acquired from receipt of orals sex) and very low risk for there STIs.
3. STIs are not transmitted through penetration of a dildo, particularly of it was cover by a condom.  
4.  Your tests prove you did not acquire an STI. 

In reply to your specific question:
1.Based on how early post exposure I tested for HSV can my results be from a previous exposure/false positives? Should I take a confirmatory hsv2 test from quest? I've never had any HSV symptoms.
An HSV-1 value as high as yours is unlikely to be a false positive result and, in the absence of an outbreak, suggests a longstanding HSV-1 infection.  FYI, over 60% of adults have HSV-1 with most of which were acquired during childhood and are otherwise asymptomatic.  There is little chance that you acquired HIS-1 from the exposure you describe.  There is no evidence you have HSV-2  and HSV-2 is virtually never acquired through receipt of oral sex,  Personally, I would not be worried and would not seek further testing.

2.I read at 13/14 days HIV-1 RNA PCR negative test can be considered conclusive. Is this correct? Im taking it again along with a 4th gen at 28 days anyways.
You are correct.  Your HIV RNA PCR test is conclusive, providing still further evidence that you are not the first person to have acquired HIV from receipt of oral sex.  No follow-up is needed.

3.Should i get any anal swab tests?
No

I hope this information is helpful.  If anything I have said is unclear, please use your up to two follow-ups for clarification.   I would not be worried in the least.  EWH
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3 months ago
Wow, what a relief! Thank you for the prompt and thorough response. I have been disgusted with myself after this experience since I was talked into it by a friend and unfortunately for me, it was an act of infidelity.

Along those lines, I've put off any sexual activity with my wife in fear I may pass something on to her. When would it be safe to have unprotected sexual activity with her?

I also have an infant and toddler at home. Are they at any risks of transmitting anything from routine activities like diaper changes, showers/baths, etc? 

The RNA PCR test only tested for HIV-1, should I be concerned/test for HIV-2? 

I'm glad to hear the dildo is a low risk event as this was what had me the most concerned. I was worried that the condom could've not been intact or the dildo was not properly sanitized. Assuming either scenario was true, would that increase risk at all?

Lastly, I just want to clarify. Despite my tests being done only 13/14 days post exposure you do not believe it is warranted to test again for other STDs? I've read the window period for some STDs being in the 4-6-12 week range which is why I planned on testing again. 

Thank you again for the service you're providing, it is truly appreciated.
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3 months ago
Sorry also meant to add my concern about saliva on the dildo/around my anus from oral sex contributing to the risk of herpes/anything else being transmitted 
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Edward W. Hook M.D.
3 months ago
I really think you are worrying entirely too much.  There is almost no risk for hIV-2, even if you had been exposed and as I already said, there was virtually no risk for HIV of any sort.  

STIs including HIV would not be transmitted by saliva, whether on a condom, on a dildo or due to oral contact with your anus.  Herpes is NOT spread in saliva but by DIRECT contact.  

I see no reason to abstain from unprotected sex with your wife.

Again, you are worrying entirely too much.  EWH
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3 months ago
Dr.Hook, you're absolutely correct. I am worrying too much and I'm sure that's a common trait you see in your interactions on this forum but it is just that I am more concerned on what I could pass on to others moreso than what is going on with myself. 

Rest assured, your responses have already been extremely beneficial in lowering my anxiety and I am feeling ready to just move past this event and move on with my life.

With that being said, I just want to repeat this question as you did not directly address it in your response:

I just want to clarify. Despite my tests being done only 13/14 days post exposure you do not believe it is warranted to test again for other STDs? I've read the window period for some STDs being in the 4-6-12 week range which is why I planned on testing again. 


I realize this will be your last response so I just want to take this final opportunity to thank you once again for your response and reassurance.
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Edward W. Hook M.D.
3 months ago
I'm sorry you continue to worry, particularly given the virtually no risk nature of your encounter.  Your HIV results are conclusive, as are test results for gonorrhea and chlamydia.  I've already commented on your herpes blood tests.  Blood tests for syphilis can take 4-6 weeks to be conclusive but syphilis is rare and unlikely.  I continue to be confident that you do not have an STI.  Testing is always a personal choice and I remain confident that no matter how much more you test related to the encounter you described, your results will show that you were not infected.

This completes this thread.  Take care.  EWH
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