[Question #151] Brief Unprotected with CSW

108 months ago

Nearly a week ago I had unprotected vaginal insertive sex with a CSW in a shower that lasted for about 20-30 seconds in an upscale area of seattle. It was incredibly stupid I know; she told me she was teasing me, and it happened about as fast as it was over. I was barely inside her (just the tip really), did not ejaculate, and have been wrought with anxiety ever since.

She was a high end escort, the picture of health at 22, and insisted we use a condom for the remainder of our encounter (not that I argued). When I wrote the agency's booker to ask if his girls are tested frequently he told me 'yes, of course they are'.

Should I be concerned about a possible HIV infection? Should I get tested? If so what is the soonest I can test and with what test?

What would you asses my risk levels to be? Would a duo at 14 days offer any valuable information or is that way too soon? Would I be correct in assuming that my risk is (1/100)*(1/2500)= .000004? This is assuming 1/100 CSW are HIV + and 1/2500 receptive intercourses would result in a transmission or am I being super optimistic?

Edward W. Hook M.D.

108 months ago

Welcome to our Forum. I'll be pleased to provide some perspective. In general any single episode of sexual intercourse with a new partner of unknown HIV status is relatively low risk for statistical reasons. Your estimate of acquisition of infection about once in every 2500 exposures is within the range of estimated risks- I tend to use a risk of 1 in 1000 to be conservative. Further, as you know, most people, including most CSWs do not have HIV and your estimate of a 1% likelihood of HIV in your partner is, if anything, probably a bit on the high end, particularly since you asked her and since she was a relatively "high end" commercial sex worker. Thus your risk for infection is no greater than 1 in 10,000 and probably substantially lower (that's about the same as your lifetime risk of being struck by lightning).

As for testing, you can test at t his time for the most common STIs (gonorrhea, chlamydia) but it is a little early for HIV testing. In general, we suggest testing at 4 weeks using a 4th generation, combination HIV antigen/antibody test. Such tests give completely reliable test results at that time (4 weeks)

I hope these comments are helpful to you and will help to ease your concerns. EWH

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108 months ago

Thank you for the super fast response! Would a PCR RNA test at 7 days be fairly conclusive?

Edward W. Hook M.D.

108 months ago

Despite what the people who advertise them say (and they do claim that PCR tests for HIV are conclusive at 7 days), there are no good data on precisely how quickly PCR tests become positive in infected persons. They probably do become positive a few days earlier than a 4th generation HIV test but not much. they are not recommended for HIV diagnosis in situations such as yours. It would be a waste of money for you to test using PCR. EWH
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108 months ago

At 5 days since exposure would the onset of a sore throat and a cold sore on my tongue most likely be the result of incredible anxiety, or could it be a possible symptom this early?

Edward W. Hook M.D.

108 months ago

This is unlikely to be acute HIV, both because of the brief interval since your exposure and, perhaps more importantly, the fact that, even in at risk persons, most such symptoms are due to the far, far more common, "everyday" viral infections that most people get from time to time. If this were acute HIV, your 4th generation HIV test would likely be positive even at this early time. eWH
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