[Question #5155] Risk

76 months ago

My situation - last Friday had an encounter with a female CSW who works for an agency in one of the largest cities in America. Upon completion, we discovered the condom had broken, to which her response was basically ‘it’s okay, we can do it without one next time, I do both’. I was freaking out and her response was less than reassuring. Fast forward to this Friday, one week to the date after the encounter and I am unable to eat, get a massive headache and need to sleep. Same thing on Saturday. I felt swollen glands, but it’s almost like my nasal area hurts more when I swallow. Also I’ve got a constant cough and nasal build up. I’ve been taking medicine and feeling better, until I freaked out last night. My arms were covered in rashes with rashes very few other places (maybe a little on the top of my feet). Obviously I’m going to get tested, but my question is when’s the soonest that I can accurately obtain a difinitive test and can you please provide a risk assessment based upon my description of events. The rashes last night really freaked me out more than I was already. Also, they appeared about 12 hours ago and are absolutely going away. Already nonexistent on one arm and just big blotchy messes on the other that are fading. Thanks.

76 months ago

Oh, also, absolutely the worst thing in the process was the diarrhea and stomach issues. They are gone and I’m

Back to eating, but they were horrible Friday and Saturday into Sunday morning

H. Hunter Handsfield, MD

76 months ago

Welcome to the forum. Thanks for your confidence in our services.

I understand your concern, and agree that your CSW partner's inconsistent condom use implies a higher risk of HIV and other STDs. But even in this circumstance, at any point in time most CSWs do not have HIV or other active STDs. And your symptoms are not suggestive of HIV, which doesn't cause nasal congestion, drip, or cough, and usually no diarrhea or "stomach issues". And "felt" swollen glands (e.g. neck discomfort) is not significant if the nodes are not visibly enlarged -- and even then, all these symptoms started too soon to be caused byHIV from the exposure a few days earlier; acute HIV symptoms cannot start sooner than 7-8 days after exposure. The same is true of the skin rash associated with new HIV infections; and a rash that clears up within a day or two also cannot be HIV or any other STD. All your symptoms are typical for any number of garden variety respiratory/cold viruses. The timing is right for perhaps catching your cold from your CSW partner, but they are not due to HIV or STD.

You could have a nucleic acid amplification test (NAAT) to detect HIV RNA/DNA in your blood about 2 weeks after exposure; a negative result would be ~95% reliable, followed by an antigen-antibody (AgAb, "duo", "4th generation") HIV blood test at 4 weeks. The combination of those results would be 100% conclusive. Or just have an AgAb test at 6 weeks, also 100% conclusive. That said, the chance of HIV is so low that you really shouldbn't be worried. As for other STDs, you could have a urine test for gonorrhea and chlamydia now (valid any time 4-5 days after exposure) and a syphilis blood test at 6 weeks. But all these unlikely. If somehow I were in your situation, I would get tested for gonorrhea and chlamydia, and then have an HIV AgAb test and syphils blood test at 6 weeks. But the last two are so unlikely that I would resume unprotected sex with my wife once the urine tests returned negative.

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

HHH, MD

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76 months ago

Thanks so much for your very helpful reply. The rash began about midnight last night and is almost totally gone at this moment. However, one point of clarification and my apologies if my original post was worded poorly - my illnesses occurred exactly 7 days to the day of my encounter. I’m not sure if that changes your thinking and it’s entirely possible that I could have gotten I’ll in the subway or while out at a bar or whatever, but I wanted to throw that point of clarification there.....appreciate the help and I’ll get the other tests

H. Hunter Handsfield, MD

76 months ago

Thanks for clarifying the timing, but it doesn't change my opinion or advice. Your symptoms still fit far better with a garden variety respiratory virus infection than with HIV.---

76 months ago

Thanks for the advice. Cheers.

H. Hunter Handsfield, MD

76 months ago

Thanks for the thanks. I'm glad to have helped.---