[Question #3539] Sex w/ csw

35 months ago
Hello Doctor. I am a male college student and in early January of this year I had sex for the first time w/ a female Romanian CSW in a brothel in Munich, Germany. Condoms are mandatory in German brothels so I wore protection for oral and vaginal sex. I ejaculated twice thru the whole encounter. After the first time I ejaculated, we had sex again but had trouble getting an erection. Thus, I believe there was a big gap between the head of my penis and the tip of the condom. However, the condom never broke. I am now worried about HIV and would like your assessment on the situation.I am very worried about this rash that I have had for about 2 months now. The rash comes and goes. There is like little tiny red dots in the upper portion of both the palms of my hands. Also, the same type of rash was in the upper part of my left foot (kind of like below all the fingers). Now the rash in the foot seemed to leave but if you look closely you can see that it left some spots. Some days the rash in the palms is hard to even notice, and other days the tiny red dots are easier to notice. The rash seems very strange to me and I have never had it in my life to my knowledge. I have been browsing thru the Internet and the closest thing I could find that looks like the rash is called petachiae. Does my rash sound like HIV?Another  symptoms that I have had is sore throat that only comes in the morning (although I remember the sore throat persisted for about 2 days once). Also, I have an enlarged lymph node in the left part of my neck. I have been feeling lightheaded as well. The only symptom that I have not had is fever. Some of my muscles ache as well sometimes. Does my rash sound like HIV?  Do my symptoms in general sound like HIV? What is the chance that I have it? Should I test? I am very nervous about HIV, to the point where it is affecting my studies and social life. I have been browsing incessantly thru the web about HIV, and decided that I would like expert advice on my situation.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
Welcome to the forum. Thanks for your question.

Condoms work:  that it was loose on one occasion makes no difference. If the head of your penis and the meatus (urethral opening) were covered, protection against HIV was complete. Second, the large majority of CSWs in Germany, including those from further east, do not have HIV. The chance of catching HIV from the encounter described was under on in many thousand.

You misunderstand the symtpoms ave acute retroviral syndrome (ARS, i.e. initial HIV infection). Your symptoms do not suggest it. As you seem to know, absence of fever is strong evidence against itl the timing of all your symptoms is wrong; and your description of your rash also is not at all like the rash of ARS. All things considered, the chance you have HIV is low enough that from a medical standpoint, you don't even need testing.

Nevertheless, you should be tested:  not because there is real risk, but because the negative result probably will reassure you much more effectively than my professional advice. I don't take it personally:  that's human nature. Anyway, enough time has passed for a conclusive antigen-antibody ("4th generation") HIV blood test, which is 100% valid any time 6 or more weeks after exposure. So I suggest you be tested. I hope you will do it and return and let me know the result. Stay relaxed in the meantime:  I'm confident it will be negative.

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

HHH, MD

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35 months ago
Thank you for the response. I have a few follow up questions:
1.) When you say the chances from this situation are under one in many thousands, are you saying there still a chance? 
2.)From your medical experience, have you ever known of someone to contract HIV this way? 
3.) I had a red bump in my penis that was healing. Does this affect the chances?
4.) I am also uncircumcised. Would this also affect my chances? 
5.) I forgot to mention that the rash I described in my palms and feet was also not itchy. Does this sound like an STD or HIV rash?
6.)Also, since it takes some time to make an appointment for a blood-test, would Oraquick be as reliable? Should I follow up with a 4th generation test after Oraquick just to be sure?
7.) Since you have a lot of experience in this field, do you think there will be a cure for HIV in the next 10-20 years?
Thanks again

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
1) Yes, there is still a chance. There is also a chance you'll be killed by lightning. The odds probably are about the same.
2) Not only have I never seen such a patient in my clinic, there's never been one on this forum. In the almost exactly 14 years since I started doing online forums (April 2004), with tens of thousands of questions about HIV risk after various exposures, not one person has turned out to have caught HIV from the exposure they asked about. You will not be the first. If and when that happens, it will be someone with a real risk (e.g. unprotected anal with a known infected partner), not a near-zero-risk event like yours.
3) This makes no difference.
4) Being uncircumcised doubles the risk of HIV if exposed. So if your risk started at 1 chance in a million, this raises the risk to 1 500,000. Still zero for practical purposes.
5) ARS rash does not occur without also causing fever and multiple other symptoms. Rash alone is never the main symptom.
6) The oral fluids test is the least reliable of all tests and takes longest (3 months) for conclusive results. Most likely you can find either a clinic or a freestanding lab that can do a blood test.
7) Even now, proper treatment gives HIV infected persons essentially normal life spans. There's probably a pretty fair chance that a true cure will be available someday, but I cannot estimate a timeframe for that.

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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
I just realized that 3 months have passed since the exposure you are concerned about. The oral fluids test would be OK.---
35 months ago
Hello Dr. Handsfield. I just took an Oraquick test (I cant believe I had the courage to do so) and I didnt see any line on T. So I guess the result was negative. When I opened the test tube to begin my test, a little bit of liquid got into my finger. Also, when I swabbed the stick in my gums, it touched one of my teeth. However, the test still ran. Would this affect the result? Should I go to the clinic in my university and have another test. Or am I conclusively negative? Should I also get tested for all STDs? Also, what could the rash in my palms be? Thank you! You have been great help. I have been reading a lot of your past responses and you have been a massive help for me to get through this difficult time. 
35 months ago
35 months ago
Also, forgot to ask, how likely is a false negative in Oraquick?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
35 months ago
The test is designed to be more or less idiot proof, otherwise the manufacturer could have have gained FDA approval to put it on the market. After 3 months, the false negative rate probably is around 1%. That doesn't mean there is a 2% chance you have HIV. If based on the exposure we assume you had, say, 1 chance in 100,000 of having HIV, after a 99% valid test the chance you are infected would be 1 in 10 million. That's zero for all practical purposes. So no more worries and no more tests.

That completes the two follow-up questions and replies included with each thread and so concludes this discussion. I hope it has been helpful. Best wishes and stay safe.

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