Hi Doctors;

18 days ago, I had an encounter with a CSW in Beirut, Lebanon. She said that she is Syrian and has been working in this for only 2 months and she don't take drugs,alcohol, or smoking and she doesn’t have anal sex. I brought her through agency on internet for 200$.

  Most of the times I was kissing, sucking nipples. Then I did brief cunnilingus, I think only my lips were involved in it but I will assume that my tongue was involved too. Then I proceeded to rub my penis on her vagina. Here, when I approached to start the she stopped me as she thought I wanted to penetrate but I told no penetration. Throughout the whole act my penis didn't get full erection. I rubbed the head of my penis against her vagina (in the middle of her outer labia) up and down, so urethra was exposed. After many trials to get my penis erect I put the condom and tried to have vaginal intercourse but I failed because hard erection lasted in seconds. Before I put the condom I noticed some vaginal fluids on my penis head. I am 85% sure that no penetration occurred, the 15% doubt is due to the following reasons: 1st I wasn't looking down on our genitals the whole time, 2nd I used procomil spray that decrease the sensation on penis to last long during the relation so if minimal penetration occurred I may not feel it, and 3rd anxiety.

I also used my finger to rub her vagina but I didn't insert it in her vagina, in the same week I noticed dead-like skin on that finger but it is not peeling. It is small (1 cm L and 2 mm W) it only has rough sensation and it never bled. The problem is that I can’t remember if it were present before the encounter. I had no meaningful symptoms (no rash or fever or severe sore throat) but on day 10-11 I had salty phlegm and mucus and salty throat that lasted in 2 days. No visible enlargement in my lymph but I feel mild burn sensation on different areas of my neck and beard. But when I wake at morning I feel nothing, maybe these sensations come and when I start thinking about the encounter.

1-      What was the risk of HIV from this act?

2-      I am very worried and anxious and planning to test (4^th generation) on days 21, 28 and 42, how reassuring would be 21 days? Have you ever seen a negative at 3 weeks change later?

3-      For many years you were assuring that that a 4 weeks 4^th generation negative is conclusive, I noticed that you changed to 6 weeks. Did you see a negative changed after 4 weeks? All the people who considered their 4 weeks negative conclusive before should test again? 

3-      For many years you were assuring that that a 4 weeks 4^th generation negative is conclusive, I noticed that you changed to 6 weeks. Did you see a negative changed after 4 weeks? All the people who considered their 4 weeks negative conclusive before should test again?

I have never seen a test which was not detected by 4th generation tests at 4 weeks HOWEVER there are, apparently, a very small number of cases which have been detected in the interval between 4 and 6 weeks. The proportion of such cases is very low.  This statement reflects recent data from the U.C. CDC. 

I hope that they are helpful to you.  EWH