[Question #1478] STI Risk & Testing

47 months ago
Docs,

About a week ago I had an encounter with a CSW or white/latino origin, probably in her mid 20's, in NJ.  She stated that she was from Florida.  Protected oral followed by protected vaginal.   Condom remained intact thru out encounter.   Prior to the encounter I asked her if she was "clean" to which she replied yes.   Also, she seemed to take great measures to make sure that safety and good hygiene were followed (no saliva exchange and vaginal penetration by finger).

I regretted the encounter almost immediately, and of course a day or so later I started feeling weird sensations including irritation at the tip of my penis, irritation on my groin area, feels like I'm dripping (kind of like right after you pee and you get a drip or 2) and sore testicles.     Of course, it seems to me more pronounced the more I think about it.   

Yesterday (exactly a week after encounter)  I started to feel a bit lethargic with a slight sore throat and  prob a low grade fever. 

I had read thru some of your prior responses on the subject  and this greatly alleviated my concerns.    Then I had the misfortune to read a local newspaper article about how shaving one's pubic hair increases one's risk by 400+%.    I had shaved/trimmed mine about the groin and testicle area approximately 12 hours prior to the encounter.  

Out of precaution, I've already taken a Chlamydia/Gonorrhea test at 6 days (awaiting results)

So, my questions are:

1.   Should I be concerned about an "increased risk" of STI due to the trimming/shaving?
2.  Would you recommend an HIV test?
3.  If so, what would the accuracy of a 4th generation test be at 2.5 weeks?
4.  Is it safe to resume sexual relations with my Significant Other?

The irritation around the groin area could be attributable to the fact that the hair is growing back.  

Thank you for your help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Welcome to the forum. Thanks for your question and for reviewing other discussions on the topic.

It sounds like your partner is unlikely to be infected with HIV or STDs. Even if she was, you went about the event with maximum sexual safety. It is virtually impossible you have HIV, and your symptoms don't sound like it. Directly to your questions:

1) I'm unaware of any scientifically credible reports of HIV transmission because of recent shaving. This is one of those theoretical risks people speak about that seems to have little actuality in the real world, and I cannot imagine how someone could caluculate a four-fold increased risk from pubic area shaving. I doubt it is from a scientifically valid source. But let's say it's true. The average risk of HIV from a single episode of unprotected vaginal sex with an infected women has been calcuated at 1 chance in 2,000. Let's further assume condoms are 99% protective. If your partner has HIV (probably she does not), that puts your risk at 1 chance in 200,000. If that risk is 4 times (400%) greater, the risk becomes one chance in 50,000. So one of the take-home messages here is to be careful when you read news story citing statistics and probabilities and think through what they really mean. As for other STDs, I wouldn't worry there either. I can envision a possible increased risk of herpes or HPV due to shaving, but the same concepts apply:  the actual risk remains miniscule.

2,4) From a strictly medical standpoint, I don't recommend HIV testing after any single exposure, and certainly not for you at this time. OTOH, some people will get greater reassurance from a negative test than from probabilities and statistics. If that applies to you, feel free. But if somehow I were in your circumstance, knowing what I know, I would not be tested and would be continuing unprotected sex at home without worry. 

4) A fourth gen test probably detects ~90% of new HIV infections at 2.5 weeks. If you're going to do it at all, I recommend waiting until 4 weeks for a conclusive result.

I hope this has helped. Best wishes and stay safe--  HHH, MD

---
47 months ago
Thanks Dr. Mansfield.  


Follow up question.

What are your thoughts on the RNA test at 10 - 11 days?   I don't see it discussed as an option much here.  

Thanks


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
RNA testing is primarily recommended and used to asses possible people with symptoms suggesting acute HIV infection, and as part of programs of testing blood transfusion specimens to detect early infection. It is rarely if ever recommended for testing people merely on the basis of exposure and I don't recommend it in your situation. But it could be done. If negative at 10-11 days, it would be about 90% reliable. But good grief, you're speaking of a zero risk situation for all practical purposes. It isn't worth the money, in my opinion.


---
47 months ago
Thanks Doc.  Last follow-up and I know what you're going to say, but still, it gives me comfort to hear it directly from you.

FYI, I haven't thought about gonorrhea or chlamydia lately and surprise surprise, those penile & groin symptoms/sensations have subsided to a great extent.   

Now - I will go ahead and take your advice to forgo the RNA test.   I will go ahead and take the regular 4th generation test.  Its about 10 days since my encounter.     I have developed canker sores - anything to worry about?

FYI, I do tend to get them quite often.   I've also been battling a cold of some sort.   Felt congestion at 2 days post encounter - Never thought that the cold symptoms were related.  

I'm guessing the canker sores at day 10 are from stress that I am causing myself and/or combination of my cold?   Your thoughts?



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Neither canker sores nor cold symptoms are of concern in relation to HIV or this sexual exposure. Also, cold symptoms like nasal discharge, sinus congetsion, or cough are not common symptoms of new HIV infection; sore throat is really the only upper respiratory or oral manifestation of new HIV. Cankers often occur in presence of other infections like common colds. But you certainly aren't causing them yourself; it's probably an immunologic issue over which you have no control.

You definitely can expect negative results on your HIV testing.

---
47 months ago
Can you clarify 1 last thing re: sore throat.

I'm assuming that you're talking about a severe sore throat, not the slight run of the mill ones that one often gets with a common cold?

And that if it (sore throat) appears within 7 to 10 days of an encounter, its too early to be HIV related?

Thanks

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Sore throat could be mild in HIV, and acute HIV symptoms typically start 1-2 weeks after exposure. But sore throat alone is almost never the only symptom of a new HIV infection anyway. Trust me on this:  you simply are not at measurable risk for HIV from this exposure. Do your best to believe it and move on!

That concludes this thread. Best wishes and stay safe.

---