[Question #1631] CSW Protected vaginal & oral intercourse

45 months ago
Dear Doctors, 

Over the past year I have had several protected vaginal encounters with CSWs in Toronto, Ontario, Canada. I had a full HIV and STD test on January 3rd, 2017. The results all came back negative. However, this panel of tests did not a capture a more recent encounter where I had protected vaginal and protected oral sex with a relatively inexpensive ($60) and likely drug using CSW. The encounter occurred on December 25, 2016. I wore a condom throughout and inspected the condom after the encounter with a water test and it remained intact. Though the reason I am worried is six days after this possible exposure, I developed a minor cough, which eventually transitioned into a full out flu-like illness. I had a fever, productive cough with phlegm, chills, and night sweats. On January 5th, I was diagnosed with pneumonia through a chest x-ray. I have since taken antibiotics and steroids and feel much better. 

Additional information on this CSW: cheap ($60), drug using (oddly grinds her teeth during intercourse). On a more positive note, I called her today and asked her if she offered unprotected vaginal intercourse and she angrily responded that she does not. I then asked her the last time she had been tested, and she, sounding upset, asked that I not call her again. 

1. What are the odds of me being infected? Do I need an additional test? What do you think about my estimation: (1/1000 chance of transmission) * (1/100 chance of unknown condom failure) * (1/10 chance she is infected since she is a CSW and drug user) = one in a million chance of infection. 

2. Does the January 3rd 4th generation test (9 days) in anyway suggest that I was not infected? I understand it would not be conclusive, but just wondering if it further reduces my overall likelihood of infection. 

3. Would the 9 day test, which was taken after the onset of my symptoms, at least suggest that those symptoms are not related to early HIV or ARS?
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
Welcome to our Forum.  I'll go straight to your questions.

1.  As implied from the way you write your question, there is very little chance that you acquired any STI, including HIV from the encounter you describe.  The chance of undetected condom failure is far lower than the 1% chance you mention.  The issue of the need for repeat testing at this time depends on your level,of confidence.  While I am confident that your recent illness was not HIV based on the considerations you mention, if you have lingering concerns concerns a repeat test at4 weeks is easy and reasonable.

2.  Typically, when persons are experiencing the acute retro viral syndrome symptoms the 4th generation tests are positive.  The fact that your test was negative while you were symptomatic is strong evidence that your flu-like illness was NOT due to HIV.

3.  See my comments above.  I would add, a number of the recent symptoms you describe such as cough and pneumonia are not suggestive of the ARS.  

I hope these comments are helpful.  If there are further questions, please feel free to ask.  EWH 
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45 months ago
Thank you for the response. So, overall, from a risk based assessment, what would my odds of infection be? Also, would you recommend additional testing when considering my risk level from a medical standpoint? 

I have particular interest in this as it has caused me a great deal of stress and anxiety over the past few days. Thank you for your understanding. 
45 months ago
I just wanted to add that my main concern here is HIV.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
I would estimate your risk for HIV would be far less than 1 in a million and likely lower still.  There has never been a case of HIV acquired  from receipt of oral sex, condoms are more than 99% affective, and far less than 5% (probably in the neighborhood of 1%) of CSWs have HIV.  I really would not worry.  EWH
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45 months ago
Thank you Doctor, last question. So, in your opinion, with all things considered, I do not need another test for HIV? 
45 months ago
Hi, sorry, but I forgot to also ask: is "far less than 1 million" equivalent to a no risk situation (essentially zero risk)? And as I asked earlier, all things considered, do I need to be tested again for hiv for medical purposes? These are my final questions. I apologize, just very concerned and having trouble coping at the moment.
Edward W. Hook M.D.
Edward W. Hook M.D.
45 months ago
 Yes, all things considered, there is no reason for you to test further for HIV. I urge you to consider your test results conclusive.  Test results with a risk of infection being less than one in 1 million are essentially and effectively zero. 

 I hope my replies to you have been reassuring. As you know our forum guidelines call for up to three replies to questions from clients. This is your third reply. This thread will be closed it a few hours. Take care .  EWH
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