[Question #2386] Advice Please
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98 months ago
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I am in a bit of a panic so would appreciate some advice.
Last night I was very drunk and I had unprotected oral and protected vaginal sex with a sex worker.
To be descriptive, I received oral then she proceeded to put a condom on me and we had sex. I did lose my erection during for a while but the condom remained on that I recall. She seemed quite conscious that it remained on. She was quite wet so there was a fair amount of vaginal fluid on my hands and I touched masturbated my penis after. I don't recall seeing any sores anywhere on her.
Problem is I have a girlfriend... I regret it massively. We are going away in a couple of months so need some advice on how long I should steer clear from sexual intercourse..
I am very tempted to go get the 10 day HIV test and I am scared of everything else too, like Hep B etc..
To calm my sanity, realistically what do I need to look out for in the coming weeks/months before I can feel safe to resume unprotected sex with my regular partner? Or should I wait the 3 months for everything to be tested? Chances are doing that I will need to confess all.
How risky is what I did % wise? If I see no symptoms in a week should I feel more comfortable? I am such a mess right now..
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Edward W. Hook M.D.
98 months ago
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Welcome to our Forum. I'll be pleased to comment. The exposure you describe was no risk for HIV nd very low risk for other STIs. It sounds as though your partner was careful and used the condom appropriately. As it turns out, while rates are a bit higher among commercial sex workers than the general population, most CSWs do not have STIs. Your vaginal exposure was condom protected and thus virtually no risk. Contact of your skin with her vaginal secretions is likewise not a risk for STI or HIV. Thus your only exposure associated with meaningful risk for STI is oral sex and oral sex only relatively rarely
leads to infection. When it does, the most common problems are either
gonorrhea of non-gonococcal urethritis NGU) caused by mouth organisms
introduced in to the urethra during sex or, very rarely chlamydial infection. Gonorrhea and chlamydia can be reliably ruled out with a urine test taken any time 2-3 days or more after sex .Non-chlamydial NGU
is not clearly and STI in the traditional sense, is not readily transmitted to
sex partners like other STIs, and in not associated with complications.
In terms of viral infections, neither HIV nor hepatitis B is not transmitted by oral sex. I am unaware of any reported cases acquired in this way. If you do not already have HSV-1, the virus that causes cold sores, there is a very small risk of this and HSV-2 is almost never transmitted by receipt of oral sex. Blood tests for herpes are not recommended so the thing to do is watch. In the unlikely circumstance that you acquired herpes, you would most likely experience an outbreak at the site of exposure (your penis) in the next 7-10 days.
Thus I would watch for symptoms but feel they are unlikely to occur. Get a urine test for gonorrhea and chlamydia, as much to reassure yourself as anything else. If you do not develop lesions in the next two weeks you did not get herpes and syphilis while very, very unlikely, can be reliably proven to not be present (I said it this way rather than say it could be "ruled out" because it is so unlikely following the exposure you describe).
I hope my comments are helpful. EWH
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98 months ago
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Thank you very much for taking the time to reply on a Sunday :)
That has made me feel a lot better, so my plan should be to take a test after a few days to rule out Gonorrhoea and Chlamydia which seems highest risk from the Oral? I should completely relax about HIV and any other Viral but keep an eye out for lesions in the unlikely case I see Herpes or Syphilis? If I didn't see any sores, assume Herpes risk is even lower?
Would you say that after 2 weeks if I see no symptoms of anything, I should be safe to resume unprotected sex with my partner? Probably a bit out of order but I did text the worker afterwards and said I was nervous about the Oral and she said she was clean, so hopefully that is a good sign too.. Is there any benefit at all in getting Hiv tests etc, or would it just fuel my anxiety?
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Edward W. Hook M.D.
98 months ago
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Your summary of my recommendations is right on target.
If your test is negative (I am confident it will be) and you have not had symptoms after two weeks, I would not hesitate to have unprotected sex with your regular partner.
Personally, I do not see any reason for testing for HIV but, obviously, if it gives you comfort, there is no reason no to do it. If you do choose to test, I would wait until 4-6 weeks after your exposure and then request a combination HIV antigen/antibody test. Once again, I am confident that you are not at risk for HIV from the exposure you have described. EWH
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98 months ago
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Appreciate this is my last post I can do, so saying thank you for your advice in advance. Last couple of queries if ok.
If I decide to go with the HIV test in the UK I can get a 10-14 day test privately, is that not worth doing against the 28 day one you mentioned?
If I did contract gonorrhea or chlamydia, assume I can take medicine then wait for it to clear and then be safe again with partner afterwards? If so, I guess my nervous wait is to hope I dont get Herpes? Is it the Urine test or swab that works within 2-3 days or both? When going private they ask for 14 days wait.
I keep playing the night in my mind and I feel that the condom covered the head the whole time. I do feel quite irritated on my penis today but I read that in under 24 hours this cannot be an STI, is that true? I hope it is just anxiety related?
Again thanks for your advice.
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Edward W. Hook M.D.
98 months ago
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At 10-14 days you could have an HIV PCR type tests which would provide proof of infection by that time however these test are more expensive and have more false positive test results than the 4-6 week combination HIV test I mention above. I would not recommend the PCR test. In your case your risk for having a false positive result is higher than your risk of infection from the encounter you have described.
Yes, gonorrhea and chlamydia are completely treatable, in the unlikely circumstance that you were infected. If you were infected, (again, unlikely) you could safely resume unprotected sex after treatment. Gonorrhea can be accurately diagnosed using either a urine test or a swab taken from the penis. Not sure why anyone would suggest waiting for 14 days until testing- this is just not needed.
You are correct, STD symptoms do not begin within 24 hours of exposure. The irritation you are experiencing are not an infection and have some other cause, perhaps increased in intensity by anxiety and/or hypervigilance.
As you point out, this will complete the responses provided as part of this thread. I hope my comments have been helpful. Take care and try not to worry. EWH
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