[Question #3286] Repeated mistakes, I am finally getting help

38 months ago
Doctor Handsfield & Dr. Hook

Good morning.  The past couple years have been tough,  I have been in and out on counseling due to PTSD (from assault).  I think its finally time to stop making excuses and take ownership of my life.  With that said I began a new inpatient and outpatient counseling program.  

To my incident of concern which took place in central NJ:

On January 8th 2018 I went to my dermatologist where he froze off what appear to be two hpv warts towards the head of my penis.  This happened at lunch time,  I then returned to work for the remainder of the day.  After work I got a bite to eat and went for a massage.  During this session the girl offered "extras".  I weakly excepted.  She went and got a condom.  I did not see her open it nor did I see what kind it was (latex, lambskin, etc).  She placed the condom on me and began to give me oral sex.  The women was of Chinese decent.  During the oral sex I asked if I could insert my penis inside her.  I took two pumps and decided this was a bad idea.  She then finished me orally.  It appeared the entire time the condom was on. (for both the oral and very brief vaginal)  I may also have fingered her briefly with a small nick on my finger.

My questions are:

  1. Did I put myself at risk for hiv?
  2. How bad is it that I had warts frozen earlier in the day prior to this event?  Did this increase my risk even though a condom was on?
  3. What if the condom slid down and the warts were exposed (I am pretty sure this didnt happen during my two pumps)
  4. Did I put myself at risk for hepatitis or any other std?
  5. Any thoughts considering that I have no idea what type of condom it was (it didnt appear to have lubricant)?
  6. Is fingering with an open cut a risk or must it be bleeding?
  7. Do I need testing of any sorts?
  8. Can I sleep with my ex safely?


Thanks for your time and patience

K







H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome back, but sorry you found it necessary. I'm also glad you're in treatment for your PTSD (with a component of OCD, I would guess). This question is sufficiently different from your others that we are letting it stand and will respond, despite the warning of deletion wtihout response. On the other hand, this still reflects an inflated perception of HIV risks and is mostly your OCD speaking yet again. 

1) This was a very low risk exposure. Such a partner is unlikely to have HIV and, the brief vaginal sex was condom protected, and oral sex, massage, fingering, etc all are no risk in regard to HIV.

2,3) No, recently treated warts would ot elevate the risk, even if those spots were exposed to your partner's vaginal fluids.

4) Condoms are somewhat less protective for infections transmitted skin to skin, like herpes, HPV, and syphilis. Still, the chance of infection during any such encounter is very low.

5) The "type of condom" doesn't matter. Cheap condoms rupture more readily, but if it remained intact, protection was complete. Even natural membrane condoms provide excellent protection.

6) It is generally beleived that without active bleeding, there is no risk.

7) From a medical or risk standpoint, there is no need for testing on account of the exposure described. However, you might find negative test results more reassuring than my opinion and advice, so testing is up to you. If you feel you need that additoinal reassurance, have a urine gonorrhea/chlamydia test any time more than 4-5 days after the event, and blood tests for HIV and syphilis at 6 weeks (or a 4th generation HIV test at 4 weeks, which is almost conclusive at that time).

8) Here too, your judgment must prevail. If somehow I were in your situation, I would not be tested for anything and would continue unprotected sex with my regular partner, without worry.

Best wishes--  HHH, MD

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38 months ago
Thanks for your response Doctor.

My series of followup questions are as follows:

On February 2nd I got a rash on my upper chest.   I sent a picture to my dermatologist whom said it was not the ARS rash.  It kinda came and went as I got hot or cold.   I followed it up with several pictures over the next three days and he said it was nothing.  By Monday it was gone.

On February 5th I had the alere rapid duo.  It was negative.  This was 29 days post exposure.

On either February 4th 5th or 6th(not sure of exact date)I had a small white thing on my cheek next to my bottom teeth.  I used my finger and it peeled off.  It looked like a piece of skin.

1.  How long does the ARS rash last?

2.  If it truly was the ARS rash would I have tested positive on the 5th?

3.  Would the rash come all by itself along with one sore like I desribed?

4.  Does what I described sound like thrush?

5.  Do I need more hiv testing?

6.  Do I need hepatitis testing?

7.  Can I sleep with my regular partner unprotected?

Thanks.  I continue my intensive counseling





H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
You should have told me in your initial question you had been tested for HIV at 29 days with negative results. My reassurance you don't have HIV would have been even stronger. Even though it can rarely take up to 6 weeks for conclusive results with the HIV Ag/Ab (combo) tests, such as Alere, almost all newly infected people are positive by 4 weeks. Equally important, the negative results prove for sure that your symptoms are not due to HIV. Everyone with ARS symptoms has positive antibody tests. There are few if any exceptions.

1-3) These are irrelevant questions. As just implied, negative test results always overrule symptoms in judging whether someone has HIV. Your negative test result proves your rash and any other symptoms you have now or may develop in the future are not due to HIV (assuming no new risky exposures). In addition, rash would never be the only symptom of ARS, and your dermatologist's opinion also is important evidence against ARS. And an ARS rash would not clear up so quickly.

4)  Yeast infection (thrush) would not cause such a rash.

5,6) You do not need testing for viral hepatitis or any more HIV tests.

7) You can safely have unprotected sex with your regular partner.
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38 months ago
Dr.  

I am sorry I don't understand the beginning of your most recent reply.  You stated:

"You should have told me in your initial question you had been tested for HIV at 29 days with negative results. My reassurance you don't have HIV would have been even stronger."

Doctor when I first posted my question I described my risk that happened on January 8, 2018.  I had not yet been tested when I posted my question.

My rash appeared on February 2, 2018.  The mouth  sore or thrush appeared on February 4, 5, or 6th.(not sure of exact date)  

I then tested negative on February 5, 2018.

Could you please explain and ammend your response if necessary.

Respectfully, k
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Sorry, I misunderstood the timing. I didn't realize you were tested after my first reply. However, this does not change my evaluation and advice. The negative test 4 weeks after exposure is very strong evidence you were not infected on January 8, and is 100% proof that the rash and any other symptoms were not caused by HIV from that exposure. In addition, in my first reply I told you why the exposure itself was low risk.

Contrary to common belief, oral yeast infections (thrush) are not very common in ARS. Also, self diagnosis of oral yeast is highly unreliable:  if a doctor did not diagnose a yeast infection, my guess is you don't have one. (White coated tongue, for example, is no the same as thrush and occurs all the time with minor viral infections.

Presumably you came here for reassurance that you don't have HIV. I've tried to give you that reassurance. Clearly you do not have it. But in order to help you believe it, I suggest one more HIV Ag/Ab (4th generation, combo) test 6 weeks after the exposure. Stay relaxed in the meantime:  you definitely can expect it to remain negative.

Normally threads are closed after two follow-up comments or questions and replies. However, I'll keep this open so you can post the result of one more HIV test at 6 weeks, i.e. around Feb 12. I won't have any more comments until then.


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38 months ago
Thank you doctor.  I will do my best to remain mellow.  Six weeks will actually be on February 19th (not the 12th).  I'll return to the forumn at that time.  Have a nice weekend.
37 months ago
Dr. 

I am very worried again.  I got a cold sore / herpy leision on my bottom lip.  It is painful and swollen

Is this an ARS symptom?

I will get my 6 week test on Tuesday and report the results.  Thanks and happy Valentine's Day!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
If you have a history of recurrent oral herpes, there is nothing about this outbreak that should concern you. But if you have not previously been diagnosed with oral herpes, I suggest you see a doctor to confirm the diagnosis and prescribe symptoms. As you may know, effective treatment is available for cold sore outbreaks:  you just need a single 2 gram dose of valacyclovir and it will quickly heal. This is not an ARS symptoms.

Threads are closed after two follow-up comments and replies, and you've had three -- so that ends this discussion. There is no need for you to post your negative HIV result next week; I would just agree and confirm my lack of suprise at the result. And this should be your last question on the forum that concerns similar exposures, symptoms, and STD/HIV risks. Future similar ones will receive minimal or no reply.

Best wishes and stay safe.

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