[Question #13746] Fear i contracted HIV

30 days ago

Hi Doc,

First of all, sorry for my english, it isn t my first language. I m a male,45 years old.

About 2 weeks ago after having been drinking too much, i visited the redlight district in Brussels,Belgium(where i live). I picked a Fsw who appeared to be in her twenties and who was from Albania. Once in the brothel, she put a condom on my penis and gave me a blow job for a few minutes. After, she came on top of me inserted my condom protected penis in her vagina and we started to have sex. It didnt last long. after aproximately 2 minutes, i ejaculated in the condom. She then removed it but i dont remember exactly what was it s condition, i didnt inspect the condom due to my drunken state. 4 days later, i started to feel pressure on my sinuses and had a cold sore on my lip. This pressure/sinusitis lasted for a week. 10 days after the encounter, i had a canker sore in my inner cheek, which lead me to be in panic as i read it can be a HIV ARS symptom. I now have a cold sore again on another part of my lips. I didnt experience fever or flu like symptoms but am absolutely terrified that i have contracted HIV, ruined my life and the life of my wife and kids.I strongly regret my actions and now am really scared i caught HIV. The Girls in Brussels redlight district always use condom with clients for oral and vaginal sex. The HIV prevalence among FSW is said to be low in Belgium, but that doesn t put my mind at ease. I must add i suffer from ocd and hypochondria. Doc, are my fears realistic? Could i have caught HIV despite the condom use?In your opinion, should i be tested according to my symptoms ? Thanks for the great work you are doing with this website!!

H. Hunter Handsfield, MD

30 days ago

Welcome to the forum and thanks for your kind words about our services. Your English seems fine -- or you may have used a good translation program.

You describe a very safe sexual exposure in regard to HIV. And there's little if any value in "inspecting" a condom after sex; if it didn't break open you can safely assume it remained intact and did its job.

ARS doesn't cause sinus "pressure", nasal conjection, etc. And despite what you read online somewhere, canker sores rarely are a sign of HIV infection. (I would guess that among people with new canker sores, recently acquired HIV was present in maybe one case in a million.) Also, these symptoms started too soon to be due to HIV acquired 4-10 days earlier. You caught a cold -- maybe from the sex worker, but equally likely from anyone among your personal contacts in the week before your symptoms. Finally, although I do not know the details of HIV epidemiology in Belgium, your comments about its infrequency and the low rate in FSWs strikes me as accurate.

So the brief answer is no, your fears are not realistic. Your symptoms were not from HIV. Should you be tested? Probably yes. Reassurance alone is a valid reason to test for HIV even if there is no risk. Anxious persons in particular -- and especially those with OCD and hypochondria -- tend to be more reassured by test results than by statistics and professional opinion, no matter how expert. In other words, you'll probably remain worried despite my advice. Enough time has passed for a conclusive HIV RNA PCR test ("viral load"); or you can wait a few weeks and have an antigen-antibody (AgAb, "4th generation") blood test.

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

HHH, MD

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29 days ago

Hello Dr Handsfield,

Thank you for the information you provided. I understood from your reply that a canker sore in the mouth rarely is a sign of HIV ARS. Does the same apply to cold sores on the lips? Despite the reassurance you provided, i will still take a 4th generation test. The guilt and shame certainly make me feel very anxious about this whole situation.I m now 17 days post exposure .Will a 4th generation test taken 4 weeks post exposure be reliable enough?

H. Hunter Handsfield, MD

29 days ago

Yes, "cold sores on the lips". If you really have this, you probably know it's oral herpes. Have you had that diagnosis?

The AgAb (4th generation) blood test detects almost all new HIV infections at 4 weeks (~98%), so a negative result at that time will be highly reassuring. For truly 100% certainty, you'll need another test 6 weeks or more after exposure. Alternatively, you might be able to find a lab that will do the HIV RNA PCR test, which would be conclusive now (any time >11 days after exposure). In the meantime, try not to worry. There is no chance you have HIV.

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15 days ago

Hi Dr HANDSFIELD,

I just got the results from my 4th generation hiv test taken 29 days post exposure. It s non reactive.

Considering the low risk ,according to to your expertise, can i put all of this behind me and go on with my life or do you reckon i should still test at 6 weeks post exposure for absolute certainty?

Thank you again for the good work!!

H. Hunter Handsfield, MD

15 days ago

Given the low risk of the exposure plus the negative HIV AgAb test (4th generation) at 4 weeks, it is 100% certain you do not have HIV. However, the test itself is ~98% sensitive at 4 weeks, i.e. might miss up to 2% of new infections. Another test at 6 weeks definitely will be 100% certain.

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. Thanks for the thanks!

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