[Question #236] Worried - sex with prostitues

36 months ago
In the past two month I had 2 incidents that make me really worried. The first was before 2 month and the second before 22 days.  In the 2 cases I had vaginal and oral sex with prostitutes- one in Israel (Russian girl) and the second in Prague (with local girl). 
In the 2 incidents I used condom (for oral and vaginal penetration) and I didn't noticed any broke or... 
The first girl licked my anus to.... 
Before a week I had some sickness - green nasal , headache but the body temperature was normal, it go after 4-5 days.
I'm really worried about hic from those incidents and feel like I'm going to lose my mind...
I read a lot of information about hiv, and find some researchers who claimed that condoms give just 80% protection even when they use correctly and didn't damaged.
Stated with bad feelings that maybe the condom broke and I didn't noticed or I catch hiv even I used condom.
My questions:
Do you think I need to test for hiv?
Do you think I can make love with my wife without protection?
If I will test with 4th generation (combo) test at 22-23 days after the second incident will it be reliable enough?
Thanks a lot and sorry for y poor English...
Hope to feel better soon.
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago

Welcome to the Forum.  I will try to help.  You report two exposures to commercial sex workers who may have had an STI, including HIV and are concerned about this.  I congratulate you on your use of condoms for all exposures- the fact that you used condoms for these exposures will greatly reduce your risk for acquiring any STI. Condoms are the most effect way to prevent acquisition of most STIs and although they are not perfect, they are very good.  Currently, with regard to HIV, it is estimated that IF one of your partners had HIV (you do not know that they were and it is statistically unlikely that they were), the risk for HIV would be less than 1 exposure in 1000 unprotected genital sexual exposures.  Using a condom reduces that risk more than 99% more (the statement that they only provide 80% protection when used correctly is wrong), making the risk for HIV from a single condom protected exposure to an infected sex partner somewhere between 1 in 1 million to 100,000.  This is not something to be too worried about.


As for your specific questions:

Do you think I need to test for hiv?
I would suggest testing for HIV and other, more common STIs (gonorrhea and chlamydia) and perhaps syphilis.  I do not see a need to test for herpes and would advise against it.  The tests for gonorrhea and chlamydia would be accurate at this time.  A 4th generation HIV test at this time, 22 days after you last exposure would detect most but not all recent HIV infections.  The 4th generation tests are completely accurate for testing after 28 days or more.

Do you think I can make love with my wife without protection?
See above. The risk that you are infected is low but it is probably best to be tested for the common STIs first.  I would not feel the need to wait for an HIV test before engaging in unprotected sex however.

If I will test with 4th generation (combo) test at 22-23 days after the second incident will it be reliable enough?
A 4th generation HIV test at this time, 22 days after you last exposure would detect most but not all recent HIV infections.  The 4th generation tests are completely accurate for testing after 28 days or more.  Thus given your low risk a negative test at this time will be very strong but not perfect reassrrance that you did not get HIV from the exposure you have described.

I hope these comments are helpful.  EWH
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36 months ago
Ty 
But now I'm little confused. You saying that I should not worry about hic cause I used condom, but you think I need to done test.
Do you see medical perspective for test or you recommend it for my piece of mind?
You mentioned other sti tests, I don't have any symptoms of sti, is it still necessary?
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago

Sorry if I was confusing.  I recommended the test for your peace of mind, not because I am concerned that you acquired HIV from your condom protected exposures. 


Unfortunately, some of the other infections (chlamydia in particular) can be asymptomatic so, if you want to be completely confident, I would test for the others.  Hope this helps.  .  EWH

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36 months ago
That's help thank you very much!
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
Great, so pleased that you found my comments helpful.  EWH
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