[Question #2683] Very Worried and Anxious

43 months ago
Hi Doctor,

Appreciate your help:

18 days ago I had protected vag +oral with csw.  She had long nails and broke first condom whilst trying to put on. I put on second myself. During she used her hand to prevent me going too deep. 

After sex she removed with tissue. Few days later I became worried she may have pierced condom without us noticing. Possible?

Since I have had so many symtoms:
- first nausea/constipation/upset stomach 
- recently back ache 
- headaches at different times 
- hives 

Took 14 day duo during symptoms. Negative. Is this any good?

Many Thanks 
Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Welcome to our Forum.  I'll be glad to tell you  the several reasons that you should not worry about your risk for HIV form the encounter you describe.  They include:

1.  First, it is statisticaly unlikely that your partner had HIV.  Most commercial sex workers do not.
2.  Your condom almost certainly did not break.  CSWs most often use condoms to protect themselves from their clients, not the other way around.  Further had the condom broken, it would have been apparent.  Just as was the case with the first condom, when a condom breaks, it breaks wide open leaving no doubt that it has broken.
3. Even if the condom had brok3en and your partner had HIV (both unlikely) the risk of acquiring HIV form a single, unprotected act of vaginal intercourse (and you were protected) is less than 1 infection per 1000 sex acts. 
4.  While your HIV test is not definitive at this time, if the symptoms you describe had been due to HIV, your combination HIV antigen/antibody test taken at the time symptoms were present would have been positive. The symptoms of the ARS are correlated with very high viral loads which are easily detected by a DUO test.

While you test results will not be definitive until 6 weeks after your exposure, for each of the reasons I have mentions, there is really no reason to worry.  I hope my comments will be helpful to you.  EWH
43 months ago
Thank you very much doctor. That is immensely helpful and reassuring. 

My last  questions are:

- given my circumstances, had I have come to see you, would you have advised me to test in the first place? I have seen feedback for unconfirmed condom breakages to not test due to it being so obvious and hard to miss. 

- given where I am now. Do you advise further testing? If so, for medical reasons or to ease anxiety? 

- the symptoms I describe, are they even ARS symptoms associated with ARS?

- what % accuracy would you attach to my test?

Thank you!

Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Testing in your situation is a personal choice.  I would not be worried about HIV from a medical/scientific perspective but it appears that you are somewhat anxious.  If this is the case, testing may be reassuring. 

Your symptoms do not match up perfectly with the symptoms of the ARS. The symptoms of the ARS are associated with high fevers, sore throat, and rather severe muscle or joint aches.  A headache which comes and goes does not suggest the ARS.  Any of the sorts of symptoms you report could be due to any number of the sorts of community -acquired, non-STI viral infections that most people get from time to time and, as I mentioned, your tests PROVE that your symptoms are not due to the ARS. 

Your current test results prove that your symptoms were not due to HIV but overall, the test you took would not detect all recent HIV infections - certainly more than half but it is difficult to give you an estimate beyond this.  EWH
43 months ago
Thank you again Doctor, 

Conscious of this being my last message, so want to ask the following:

- I know that testing can cause and heighten anxiety - especially during the period between testing and receiving results which can be days - and so I am keen to avoid testing where not necessary. Do you agree I am ok to not test again?
- Am I able to resume unprotected sex with my partner?
- I am experiencing upper and lower back aches and pains, can I disregard these as being unrelated?
- I found out today that I did not contract anything else from her - does this support the lack of need to test?

any last insight or advice you have for me on this would be great, so save me posting again. In particular, it would be helpful to get your thoughts on my situation and steps forward etc.

Once again, I appreciate your help and want to say how honoured I am to have your thoughts. I have read 100's of yours and Dr HHH's posts and they have helped through the last few weeks! Once I am over this, I hope to contribute some of my time to help others as you have with me!

Best Regards!

Edward W. Hook M.D.
Edward W. Hook M.D.
43 months ago
Each of your questions has more to do with your level of comfort than mine.  I would not feel the need for additional testing if I were you.  Obviously, answers to questions about topics such as resuming sex with your regular partner will be influenced by your decision to test or not. If you are so nervous that you feel you need to test again, then, logically, you probably should wait until that test result to resume unprotected sex. 

I have already told you that your tests prove that your symptoms are not due to HIV.

The absence of other STIs, is, of course, likewise a good sign. 

I hope my comments have helped.  I would encourage you to move forward without concern.  As you point out, as per Forum guidelines, this thread will be closed later today.  Take care.  EWH