[Question #3182] HIV Exposure

37 months ago
Hi,

Few months back I had protected sex with a CSW. During intercourse I realized she was on her period. When I pulled out the condom was covered with blood. I also saw blood on my groin and noticed that some of the blood was covering a herpes lesion which was not fully healed. 

6 weeks after that, I developed fever for 2 days, enlarged lymph nodes, fatigue and a congested nose with a green and bloody discharge . Dr said it’s a viral infection but I didn’t share with him my Exposure 

I need your advice on whether my symptoms are related to ARS and whether my Exposure was risky

The other question is whether you can develop ARS symptoms and cold at the same time. So get the ARS symptoms and at the same time have a cold with congested nose 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Welcome to the forum. I was logged in when it arrived:  most users should not expect replies within half an hour!

The important thing is that you used a condom. That the CSW was menstruating does't change anything:  even without condoms, sex with an HIV infected woman during her period does not elevate the chance of transmission to her male partner. The amount of HIV in menstrual blood usually is no higher than in cervical or vaginal fluid. In addition, the large majority of female sex workers do not have HIV:  depending on the setting (city, country, escort vs brothel worker, etc), the chance she had HIV probably was under 1% and perhaps as low as 1 in a thousand. And when a woman is infected, the average transmission risk for unprotected vaginal sex has been estimated (by CDC) to be around 1 in 2,500 -- and that's without a condom.

As for your symptoms, they started too late to be due to HIV from that exposure. ARS symptoms start 1-2 weeks after infection. And you seem to know that ARS symptoms don't include nasal congestion or discharge (presumably that's why you ask about simultaneous cold plus ARS). Of course that could occur, but not with this timing; and anyway, the only symptoms that could imply ARS (lymph nodes, fatigue, fever) also occur with upper respiratory viral infections.

I would encourage you to discuss your sexual lifestyle and exposure with your physician, then follow his advice. Mine is that you should be tested for HIV, not because the risk is high or your symptoms likely due to ARS, but strictly for reassurance. I'm pretty sure your worry about it will continue, despite my reassuring assessment, until you prove it to yourself with a negative test. Plenty of time has passed (more than 6 weeks) for a conclusive antigen-antibody ("combo", "4th generation") HIV blood test. You can count on a negative result.

I hope this information has been helpful, but let me know if anything isn't clear.

HHH, MD
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37 months ago
Thanks Dr

Sorry for not making it clear. The symptoms occurred around 6 weeks after exposure

Having said that are you still comfortable with a negative outcome ?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Your question was clear and I understood the timing. I'm comfortable with what I said above and confident that if you test now, the result will be conclusive and negative.

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37 months ago
Last reply before I close the thread. You did not comment on the herpes lesion. I read a lot of articles stating that cells that help herpes heal are the ones hiv gets attached to. With that in mind and blood touching the sore will that be a high risk for transmission 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Sorry, I missed the "herpes lesion" business. Are you sure you had a herpes lesion? Have you been diagnosed with genital herpes and was this a typical outbreak like previous ones? Where exactly was the lesion that came into contact with your partner's blood?

Having genital herpes due to HSV2 increases the risk of HIV if exposed. But first you have to be exposed, and I have given you some reasons why it is unlikely your partner had HIV. If she did, I have already explained that exposure to menstrual blood does not raise the risk. If the lesion was in a location that had blood contact, it also would have had contact with genital fluids, whether or not she was menstruating. Also, the effect of herpes on HIV risk is to roughly double the transmission risk. As noted above, the baseline risk for vaginal sex, female to male (if the woman has HIV) is 1 in 2,500. Double risk would mean one chance in 1,250. In other words, even with herpes, this is equivalent to having unprotected sex with HIV infected partners once daily for 3.4 years (1,250 divided by 365) before transmission might be likely. And by the way, if your genital herpes is due to HSV1 and not HSV2, there is no elevated HIV risk.

So to summarize, you having genital herpes slightly raises the chance you could have acquired HIV, but only slightly. Your overall risk remains extremely low, probably under 1 chance in 100,000 or even 1 in a million.

My final comment is that the main STD transmission risk raised by this information is that you could have transmitted herpes to your CSW partner. Although it is unlikely you were infectious if the lesion indeed was healing, there was some risk -- and CSWs should be informed of potential STD risks just as any partner. Most CSWs don't have herpes and really want to avoid it! So if you are able to contact your CSW partner, you would be doing her a favor by telling her about it, so she can be on the lookout for symptoms (or in case she had symptoms of new herpes in the 1-2 weeks after your contact with her). And in the future, you should wait to have sex until any recent herpes outbreak has entirely healed.

I'll leave this thread open for on more round of any comments you may have.

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37 months ago
Thanks for your answer. The lesion was on the groin and not covered by condom. The CSW is from Egypt. Yes it was a typical outbreak. When I noticed blood I went to shower and noticed dry blood on the groin area where the lesion is. My concern is mainly from the symptoms as I had a lesion in contact with a possible infected blood
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
OK. My understanding is that HIV is rare in Egypt, including in sex workers.

The groin is an atypical location for recurrent GH outbreaks. If the diagnosis has not been confirmed by lab testing, that's something for you to consider.

For the reasons above, this information does not materially increase your low risk of HIV from the sexual encounter a few months ago. But if you remain concerned, have an HIV test. I am confident it will be negative.

That concludes this thread. I hope the discussion has been helfpul. Best wishes and stay safe.

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