[Question #3451] HIV and STI testing after sex with sex worker

36 months ago
hi, 
about a month ago I had visited a sex worker in Amsterdam while stopping on the trip from North America to South east Asia. it was a window sex worker in red light district in Amsterdam.  I had PROTECTED oral and vaginal sex with her and used the same condom the whole time. There was a a lot of skin to skin contact, and when I finished I took the condom off, but didnt check if it had broken or not. I am not too sure what it feels like when the condom breaks. After I got to South east Asia, I got tested for HIV and Herpes, and it was negative, but this was only 5 days after the incident. 

I know sex workers in Amsterdam are regulated but not tested. The one I had sex with said to me that "she wouldnt have sex with anyone without a condom for any amount of money" and said she got tested 3 months ago. 

Since then I have had a lot a anxiety thinking that I caught something. I have always thought that condoms protect but reading on the internet says they are always not safe. I just dont know if the condom broke or not, I never check. it was still on my penis when I took it off. 
I have also had some symptoms, which may or may not  be HIV or herpes related, they are 

I had Diarrhea when I returned after two week, but it would only occur I ate big meal, the Dr said it could be viral or parasite. its gone now.  I  didn't have fever or sore throat
My pubic and groin muscle has been irritated or sore since the incident, and I do have a tingling or burning sensation in my inner thigh, I don't see any blisters or lesions anywhere.  I had the Drs in Asia and back home check for Lymph nodes and they said they couldn't feel any. 

My questions or concerns are:

What are the chances I caught HIV or Herpes? When would I see symptoms for them? What should I keep any eye out for?
Should I get tested for these or any other STIs? 
I have had a lot of anxiety due to this and I don't know if I should go for the test,  fearing I will be positive for something. 

Thank you and much appreciate your re

Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
Welcome to our Forum. I will be happy to comment and hopefully help relieve your anxiety over the event you describe. This was a low risk event.  First and importantly, most commercial sex workers do not have STIs or HIV.  As a matter of professionalism, they get checked regularly and typically take precautions as your partner described.  Further, even if your partner happened to be infected, most exposures to infected partners do NOT lead to infection.

Condom protected sex is typically safe sex.  As long as the condom is used throughout the exposure and do not break, they virtually eliminate risk for the most common STIs (gonorrhea, chlamydia) and HIV and markedly reduce the risk for herpes.  When condoms break, it is obvious as they break wide open leaving no doubt that they have broken. 

Neither the isolated, self-limited diarrhea you describe, nor your groin discomfort are symptoms that suggest any STI.

In my opinion, the exposure you describe was very low risk and there is not a need for testing.  If testing would help your anxiety, I would suggest testing for gonorrhea, chlamydia, HIV and perhaps syphilis.  All of which can be reliable diagnosed with routine testing.  I would not recommend testing for herpes however.  Currently available blood tests for herpes have problems with false positive test results and are not highly sensitive. 

My other recommendation for you is to stay of the internet for assessing your risk.  Much of what is said there is incorrect, taken out of context or just plain wrong. 

I hope this information is helpful to you. Take care.  EWH
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36 months ago
Thank you Dr. Hook for your response. I did go get tested today for my peace of mind., they said that they can test for everything except HIV as I have to wait for 3 months to get correct results and its only been 28 days. I am hoping everything turns out fine, and I can put this behind me and move on. 
I have a question about Herpes, how would I know that I Herpes? I did do an IGG test in Asia and it showed that I didnt have it. how do I know for sure that I dont have it and I wont pass it on to my partner?  I did have some sort of dry skin on my penis after the exposure and got it checked by two Drs and they said just to apply moisturizer. Would dry skin or dermatitis be a sign or symptoms of Herpes or confused with it?  I do have itching in my groin and inner thighs, do not know if its Herpes. there are no blisters, just dry skin. 
In this situation , is there a way I can get tested or know for sure I didnt get it, as condoms dont always protect against it, as I can get it skin to skin contact. 

thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
Regarding your HIV test, currently used HIV antigen/antibody tests would detect about 99% of recent HIV infections at 28 days.  Please have confidence in your results.

Your questions about HSV are a bit paranoid. This was a low risk event and you have not had any manifestations which might indicate that you acquired herpes from the exposure you mentioned.  Dry skin is not a sign of herpes.  As I said above, testing for HSV in this situations is NOT recommended because the tests are just not good enough - the miss some infections and have relatively frequent false positive results. 

I urge you not to worry about HSV from the exposure you describe and to move forward without concern.  Remember, HSV is just not that easy to spread.  Even with direct contact to an infected lesions (something you did not have) the majority of exposures do not lead to acquisition of infection.  EWH
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36 months ago
This will be my last post and follow up. I am writing to share my results, which hopefully will give some people and me peace of mind to move on with similar instances like mine. My results at 4 weeks came  back negative, I never heard from the clinic and I went to inquire and they said I was good nothing positive. What a relief. But I do have some follow ups. 

Do you think I need to go back and get tested again at 3 months for HIV and herpes? I am ready to move on with just 4 weeks test, i just wanted your opinion? 
I do have a concern about Herpes, I know you said last time that I have low risk of exposure in my situation. But I have been dealing with a groin rash/dry skin for the last 5 weeks, it went away and came back. I went to my GP and he said that it was a bacterial infection, he gave me a antifungal cream for it. I read somewhere the Herpes symptoms can be mistaken as bacterial infection, is this true? The rash is mostly on my scrotum, no blisters, just red and inflammation, its not itchy just irritated. Do you think it could mistaken for herpes? 

Sorry if I sound a little paranoid but this has never happened to me. I am hoping to take your answers as conclusive results as move on with it if there not testing required for any STDs any more. thank you for all your help. 
Edward W. Hook M.D.
Edward W. Hook M.D.
36 months ago
I absolutely recommend against testing for herpes (as I did earlier above). The test has too many false positives and you are not at meaningful risk.  Don't be paranoid.

As for HIV, again, your risk is virtually non-existent and see no reason for additional testing.  At least this test does not have the problems of false positives that the herpes tests have so if you must act on your unwarranted paranoia, feel free to get tested for HIV although I am confident that this is not needed and that if you choose to test the test will be negative, again. 

I personally would not test more if I were you.

this thread will be closed shortly and there will be no further answers from me.  EWH
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