[Question #445] His transmission and neuropathy

34 months ago
i, I saw a sex worker in Australia 12 months ago. At the time I received protected oral sex on me (male) by a female Asian sex worker in Sydney, and she also finger/fisted my anus i.e. She inserted all her fingers and eventually her hand in my anus for a period then removed it. And then reinserted twice more, always wearing a glove. 3 weeks after that I had a brief two day flu, then another two week later a major head cold,. At week six (already stressed by the incident) I had a a fever (never over 38c) for about two weeks, myalgias and a stiff neck and fatigue which lasted a few weeks. I contacted the local sexual health clinic who advised I could not have got HIV (as it was effectively masturbation on me)  and testing was really warranted. I continued sex with my wife who subsequently, developed a mouth ulcer, bad facial rash, (but  no rash elsewjere) and also stiff neck and headache. This eventually disappated. Since that time my wife has continued to get facial lumps pea size that come and go daily ( treated with either allergie tablets or cortisone cream). Both my wife and My stomach and stools have  not been normal since that time, and we continue to get periodic sore neck (at base of neck on the spinal area). At month eight I developed numb and stiff toes on several toes of each foot, which continue to this day, a year later,mouth intensity is relieved by massage sometimes. I have not tested for HIV yet because I am working in a remote part of Asia but intend to when I get back to Australia in two months time. My brain tells me I practiced safe sex and the was no risk but both my and my wife's ongoing symptoms alarm me. Particularly my wife's facial allergies and my neuropathy like numb toes and foot pain. I am 52 and my wife late 40s. It is possibly HIV (if the glove was damaged and the sex worker bled in my anus, but I saw n open wounds on her hand)  and would the facial allergies of my wife be related. Moreover, would. I have such rapidly developing neuropa

Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

Welcome to the Forum.  I will try to help.  I agree with the advice provided to you at the sexual health clinic- receipt of oral sex and fisting by your partner (protected or not) were no risk activities not associated with risk for HIV.  Testing at this time is something I would recommend, not because I think that there is any risk for HIV but, rather, for the peace of mind that it will provide to you.  Assuming that your commercial sex worker partner in Australia was working at a licensed brothel, you can be further confident that she had been regularly checked, as is required in Australia making your exposure all the safer.

My sense is that you (and your wife) are experiencing the sorts of problems that many people, and particularly travelers, experience and then linking them to your exposure.  Try to resist this.  It would not surprise me if you had coincidentally caught a flu-like illness six after your exposure to the  CSW and then transmitted it to your wife but I doubt that the two events were related.  If she is not already doing it (my sense is that she may be), I would suggest that your wife see a health care provider to address her recurring facial rash (which does not sound like an HIV-related problem anyway).  As for your neuropathy, similarly, I would suggest you see a trained health care provider to explore which of the many, many possible non-HIV  causes of neuropathy may be causing your problems- these include diseases like diabetes, environmental toxins, and much, much more.  (Incidentally, the neuropathy associate with HIV typically does not occur until many years after infection, not within a year of acquiring infection).

I hope my comments are helpful.  I do not know where you are in Asia but I do know that accurate, high quality HIV testing is available just about everywhere.  I suggest you go on and get tested to put your concerns (perhaps guilt driven) behind you so that you can concentrate on what may be causing these problems.   EWH

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34 months ago
Dear Dr Hook, thank you for yr prompt reply. Apologies also for the many typing errors in my question but I experienced  a few challenges writing my question on a tablet.  A few follow up questions if I may.  I am not sure whether it was a registered brothel,and I guess part of my paranoia is driven by the fact the CSW offered me unprotected oral sex twice (I refused). But If I understand you correctly even if I was fisted without a glove I was not at risk from Hiv? Secondly, my neuropathy if it is that, is also affecting my arms on occasions, as I sometimes  getting tingling in my hands or arms if I sleep or lie too long  in one position beyond normal occurrence prior to the incident.  I guess that further mitigates against it being HIV PN, and particularly noting what you said about the time that HIV PN occurs i.e. Many years down the track. Guilt is certainly a big driver for me, as I have always prided myself on safe sex (less pride of course about having seen the CSW in the first place) us it has been on my mind for the last year. Final question, would syphlllis be a possibility when she rubbed around my perineum without gloves prior to the fiat get? Or should I just move on, get a test for sanity's sake and see my doctor re my other health issue? Many thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

For clarification of not- there are no cases of HIV which can be attributed to the receipt of unprotected oral sex from an HIV infected partner or from fisting per se.  Your exposure was safe sex.

Correct as well about your neuropathic complaints.  I would discuss these problems with a neurologist, particularly if they are progressing.

Nothing you have described suggests syphilis either. The timing is wrong for these neuropathic problems to be due to syphilis which, like HIV takes years to cause the sort of neuropathic symptoms you describe. 

As you suggest, my advice is to see a doctor to work on the cause of these problems but not to worry that they are related to any sort in infection acquired through the exposure you described.  EWH

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34 months ago
Thank you Dr Hook. I appreciate your time and being able to access your extensive expertise. Much appreciated.
33 months ago
Dr Hook, a final question in closing if I may. Rationally, I accept and appreciate your advice and acknowledge your expertise but of course still struggle with the 'what if' mind games since the event. Of course this just reinforces your point to get tested not because of risk but to ease my mind. I have to say my worried well stress levels have been reducing markedly since your response, (big thank you!).  In the interim, as I am in Laos and medical,care is poor quality and the nearest quality medical,facility is Singapore which I hope to visit in the next two months, can you indulge one final query. Given the base of my neck at the spine tends to be sore on a regular basis, and has been since my (non) risk exposure where I had a headache and stuff neck, can I attribute this to that illness or some other viral illness? Just odd my wife seems to suffer the same problem, many thanks. 
Edward W. Hook M.D.
Edward W. Hook M.D.
33 months ago

I'm pleased that you found my response helpful.  As an FYI, I am confident that accurate HIV testing, using WHO-approved tests which will provide reliable results are available in Laos.

A non-STI, non-HIV illness could certainly account for your neck soreness, stiff neck and headache.  Before I presume that however, I would also explore the possibility that this could be due to muscle tension related to stress.  If it improves with a massage of the area or medications like ibuprofen or Naprosyn (if it is OK for you to take these widely available non-steroidal anti-inflammatory medications), that may well be the cause.  I realize that this may not be what is occurring with your wife who may have something entirely different going on.

Take care.  As per Forum policy, this thread will be closed later today.  EWH

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