[Question #3033] HIV

41 months ago
Dear Doctors,

First of all thank you all for taking your time to answering people.

5 weeks ago i was together with a girl (prostitute) from Cambodja in Dubai. We had sex and i was wearing a condom all the time. During our intercourse i discovered that she was bleeding a bit, but we continued (total 10 min) After our intercourse i pulled my penis out and removed the condom and she finished me with normal oral sex. 
5 days after i became a little sick and during the night and on the 6 and 7 day i was home with fattigue, sneezing and some irritation in my throat and minor headache. I also discovered some pimples on my left shoulder which dissapeared after 2 days.  During the nights between 6/7 & 7/8 i had heavy night sweats, which means i probably also had fever? On the 8 day is was fresh again but still had some irritation in my throat and minor pain in my right ear and not feeling super hungry.
I have been extremly nervous the last month and probably read everything about HIV actute phase a hundred times, which probably also have effected my judgement. However this week i went to the doctor with a burning sensation on my cheeks and the doctors told me that i had a mild rosacea in my face. I Have been to 3 dermatologist this week. I have also felt a burning sensation on my skin, but this is maybe due to paranoia because of the rosacea.

Here are my concerns:
1) Can a condom have a litle hole where the blood could come in and infect me? or would you not be in any doubt if the condom breaks?
2) How long does the HIV Actute phase last? (some sites is writing two days others up to 4 weeks)
3) how soon after infection will the fever and acute phase take place? (mine started 5 days after)
4)Does my symptoms sounds like HIV?
5)Is rosacea a rash that comes together with HIV?
6) could the rosacea be dermatitis or herpes instead and the doctors made an error?

I Look forward to your reply and wish you all a great day.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Welcome to the forum. Thanks for your qeustion.

I understand your concerns; it's common to second guess sexual safety after such a sexual exposure and to be concerned about symptoms afterward. However, you really needn't worry. You describe a low risk exposure and symptoms that are not typical for a new HIV infection. I am very confident you don't have it. To your spoecific quesitons:

1) Sex with infected women while menstruating does not elevate HIV risk, even without a condom -- that is, blood exposure is no more risky than exposure to non-bloody vaginal fluids. And small holes in condoms, or microscopic ones, are rare. If a condom doesn't break wide open, which for sure you would have noticed, protection is complete.

2) The medical term for the syndrome caused by initial HIV infection is acute retroviral syndrome, or ARS. The information you found online is pretty accurate:  ARS symptoms typically last 10-20 days, although in mild cases it could be as short as 2-3 days, and 4 weeks also is possible.

3) The incubation period of ARS is usually 10-15 days, probably always at least a week. Five days is too soon.

4-6) Although some of the individual symptoms can occur with ARS, most are not suggetive at all. Fatigue, fever or night sweats, and appetite loss are common, but of course also occur in hundreds of other medical conditions. The rash in ARS is body wide, not appearing as pimples or rosacea. And ARS does not cause nasal congestion, cough, or sneezing, and not likely to cause localized ear pain. It sounds like you caught a garden variety cold virus -- given the timing, perhaps from the sex worker -- but not HIV.

You should have an HIV test. Not because I believe you were infected -- I do not. (In the 14+ years I have been doing this and a previous forum, with thousands of questions like yours, not one person ever posted later that they had caught HIV. You're not going to be the first:  if and when it happens, it will be a truly high risk exposure, not condom protected sex with a partner who, statistically, is very unlikely to have HIV. Still, since you're nervous enough to have come to the forum, testing is needed for the reassurance you will get from the negative result. Enough time has almost passed for a conclusive test:  wait to the 6 week mark, then have a standard HIV antigen-antibody ("duo", formerly called "4th generation") blood test. But stay mellow in the meantime. You definitely can expect a negative result.

I hope this information is helpful. Let me know if anything isn't clear.


41 months ago
Dear Doctor Handsfield,

Thanks for your reply.

I will definitely go get tested! I just have a follow up questions

1) I only felt really bad one day and that was exactly 7 days after. However this was over the day after and i have been working since without any problems. So a fever periode of maybe 36 hours shouldnt be coursed by ARS?
2) The worst day with the fattigue and fever started on the 7th day, but i was starting to fell uncomfortable after 5 days. Does ARS starts mild or does it comes with full power?
3) i have had some irritation on my collarbone the last week. No major - just some discomfort. Could this be cought from the lymph? I havent got any other lymph problem beside small irritation under my right jar below the ear with the minor pain.  However i went to an ENT doctor to get examed and he told me i had REFLUX which caused the discomfort in my throat and could also affect my ear.
4) is there any numbers on infected workers in the country i went to?

Once again thank you.

41 months ago
Additional question. Sorry Doctor

5) how there ever been a case where someone got HIV from wearing a condom? By this i mean where the blood og fluid went into a small hole in the condom. I am positive i pulled it of intact, but then i started thinking there might be a small hole that i didnt see or maybe a small drop of blood hit my penis head after i pulled the condom of.  I am circumcised which makes my penis head easy to it 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
I would say you're overthinking all this. Can there be rare exceptions to typical onset, duration, and types of symptoms? Or to judgments about condom use, likelihood a partner is infected, or other aspects of sexual safety? Yes, of course. Few things in human biology or medicine are absolute. But for you to have HIV, a whole bunch of these considerations ALL have to be atypical. The odds against it are astronomically high.

1) Correct:  24-36 hours is definitely too brief a duraction for ARS, but typical for any number of less serious viral infection.
2) I suppose both sudden and gradual onset of symptoms could occur.
3) These symptoms still don't sound like ARS, and I see no reason to doubt the ENT doctor's explanation.
4) Not long ago (a couple years) I exchanged emails with the director an STD/HIV clinic in Dubai. (There are several:  google "STD clinic Dubai".) At that time, he was unaware of even a single case of HIV acquired by an ex-pat in Dubai following sex with a local sex worker, of any nationality. That's not to say it can't occur, but it appears to be rare.
5) I'm sure HIV has sometimes been acquired despite condom use. But it is extremely rare; and when it happens, it is almost always from overt rupture, which you would not notice. The notion of small or microscopic pores that allow HIV transmission is an urban myth.

But now I think I understand the reason you haven't been tested. However, you really needn't fear being tested in Dubai. First, just being tested will not mark you as at special risk; the clinic mentioned does hundreds of HIV tests a year, mostly in ex-pats. I'm confident they don't report the fact that someone is tested, only positive results. Second, perhaps you fear deportation if positive. However, if you have HIV, you have to get prompt care in order to extent your life and protect partners, and that care won't be provided to foreigners in UAE. So you would have to leave anyway. So just do it -- or at least contact the clinic for phone advice about it.

41 months ago
Dear Doctor,

Once again thanks for your answer. I took a test today bought at the pharmacy and it was NEGATIVE :) I can now focus on working and living instead of worry. 

Thanks for everything and your come guidance

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
I'm glad to have helped. Take care and stay safe.---