Dear Dr , i am back with a new question , althoughi have and old experience with hiv fears but looks like this didn't prevent me of having sex with a csw for a second time and this is something i realy regret and i think i need to find somehow to stop that . to my exposure : Friday  9 FEB i met a csw in a bar in Dubai i was little drunk , she was from Cambodia , she performed oral sex( unprotected ) on me and me also performed the same to her, after that i had a condom and we tried to make vaginal  penetration but the problem was that her vagina was very tight , we couldn't have a full penetration only around 1 inch from my penis was inside her, after that we tried anal but it was the same because she was also tight ,i was very depressed for that but  she asked me to try for one more time anal but with strong pushes , we did this already and it didn't work also , after that i removed condom and we made some anal frottage for around 1 minute ,  the problem is after that act we found some blood drops on the bed where she was sitting ( most likely because of the last strong try of penetration and i was condom protected in this moment ) , she discovered that she had anal cut and she was bleeding , my fears is that i was little drunk as i said before and i don't remember if i tried little dipping while frottage or not but this may happened ( i realy don't remember and i am not sure ) . my symptoms : Tuesday 20 Feb night  i started to have swollen uvula , very little fever for some hours ,minor runny nose for 1 day . Wed 21 Feb in the morning there was no fever but only the swollen uvula continued , in this day night ( 11 days since exposure and 1 day after swollen Uvula )  i had a DUO Combi test and it was negative . i still have the swollen uvula until now and also i was seen by a doctor yesterday and he confirmed that i have viral infection ,my symptoms now is swollen uvula and throat , headache on / off , also i feel my lymph nodes in the neck larger than usual . no r 

1- how much was the risk from an exposure like that ? 

2- i can't confirm if i did little dipping while she was bleeding ( i didnt see any blood while frottage ) but if this was hapend how much was the risk ? 

3- could the sinus or normal viral infections ( not hiv )  happens without runny nose ? 

4- is it true that Cambodia have high rates of hiv transmission specially between csw/s ? ( i read this online)

5- how reliable is the duo test 11 days after the exposure and 1 day after my symptoms ? 

6- in your old experience , have you ever seen some one turned positive after an exposure like mine ? 

7- do i need any more tests ? 

i am realy scared because i had sex with my wife after that exposure for 2 times ( before my symptoms appears) and i don't want to infect her with anything .

Over the years, from time to time I have been in touch with physicians who provide STD/HIV services in Dubai, in part because of the many questions we get like yours -- i.e. ex-pats in UAE having contact with Dubai sex workers. Last I heard, there had never been a well documented HIV infection from such contact. In any case, when a woman has HIV, the average transmission risk for her male partner for a single epsiode of unprotected vaingl sex is around 1 in 2,500; and oral sex has never been proved to result in HIV transmssion mouth to penis, or by oral-vaginal contact. Finally, a swollen uvula is not a likely symptom of HIV. This and your other symptoms are more like a minor viral infection, or perhaps anxiety magnifying meaningless minor symptoms or even normal body sensation.

Those comments start to answer your specific questions, but to be sure there is no misunderstanding:

1) There was little if any risk for HIV from these events.

2) Blood exposure during sex does not significantly increase the risk of HIV. For example, the risk is not significantly different from vaginal sex with an infected woman who is or is not menstruating.

3) Yes, see my comment above.

4) Heterosexually transmitted HIV from sex workers is more common in SE Asia than in, say, Europe or North America, but I don't know the data for Cambodia. However, the data in that country don't necessarily apply to Cambodian women now doing sex work in Dubai.

5) Your negative duo test is only slightly reassuring. At 11 days it would pick up around 30-50% of new HIV infections.

6) No, I have not seen anyone ever infected after an exposure like this. Perhaps you would also like to know that in the 14 years I have been answering forum questions, with thousands of questions about HIV risks, nobody has ever turned out to have caught HIV from an exposure they asked about. You won't be the first. If and when that happens, I expect it to be a truly high risk situation, such as anal sex between men, unprotected sex with a known infected partner, etc.

7) Have another duo test at 4 weeks and a final one 6 weeks after the exposure. At 4 weeks, your negative result will be almost conclusive -- and truly conclusive at 6 weeks. In the meantime, stay relaxed. Almost certainly you do not have HIV.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

what worries me in the exposure is the anal frottage with little dipping while she was bleeding .

as what I understood from your appreciated reply is only the transmission average for vaginal exposure but not the anal .

I hope this will not be counted as my 2 nd reply .