[Question #5759] HIV worry

21 months ago
Good day doctors,

Firstly thank you for this valuable service you provide. 3 weeks ago I visited a female CSW (was from SE Asia but we're not in that region) after a heavy days drinking. Visit was in  a private appt. 

I cannot remember much about the visit but know that I received unprotected oral sex. Following that we had full intercourse. I remember a condom being prepared but honestly cannot remember if it was used during intercourse.

Since then  I have been wracked by guilt and worry about my risk from this visit. I am suffering from a number of health related issues since this event and I don't know if this is related to anxiety or to possible infection.  

Last weekend due to the worry I returned to see the same CSW and ask about events.  She remembered who I was and said yes we used a condom, that I shouldn't worry and she was also good (which I took to mean she did not have any infection)

What are your thoughts on my risks from this episode?

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
 Welcome to our forum. Thanks for your question. I'll do my best to help. Your questions relates in part to whether or not you believe that a condom was used during your encounter as well as to whether or not your partner has HIV or other STIs.   Most commercial sex workers do not have HIV and even when they do HIV is rarely transmitted during a single sexual encounter. There is no risk of HIV from receipt of oral sex ( there are no proven cases of HIV due to receipt of oral sex) and the risk of acquiring infection  during unprotected vaginal sex is less than one infection for every 1200 sexual encounters.  If a condom was worn during the encounter that wrist drops much much more to close to zero. 

 Your risk for the most common bacterial sexually transmitted infections such as gonorrhea and chlamydia is also relatively low, even if a condom was not worn. Typically these infections would cause symptoms within 5 to 10 days  of exposure. 

 As you indicated in your question however, that this exposure and your inability to remember it has made you anxious. That being the case, it may be worthwhile for you to get tested for the purpose of relieving your anxiety even though your risk  is most probably very, very low. At three weeks following exposure testing for common STI's like gonorrhea and chlamydia will be totally reliable. Testing for HIV using a modern fourth generation test however would detect only about 90% of infections. At  four weeks HIV testing will detect well over 99% of recent infections and at six weeks testing will be entirely inclusive. 

 Personally, I probably would not worry. I suspect your partner was telling the truth. However, should you wish to test I have provided information regarding the reliability of testing. I hope that you find it helpful. EWH 
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21 months ago
Thank you Dr Hook for your reply.  I will try not to repeat anything I wrote earlier. Had a few more questions now I've read your reply (a few times!) 

I don't believe that I've got chlamdyia or gonerhea as I haven't had any discharge or other symptoms (realize that a test would be conclusive). It's going to be another week before I am able to go get a test and that's what's really killing me. 

There's a number of health issues that I am now having ... Increased heart rate, shortness of breath, hot flushes, swollen glands in throat, dull headache and I that I am completely obsessing over every aspect of this episode. Does this all come with extreme anxiety? It's pretty heavy duty and very hard to rationalise.

if I just look at the facts you mentioned ... low HIV rates amongst CSW,  getting HIV is 1/1200, the fact that I probably did wear a condom all means it is very very unlikely I have anything but that clearing the anxiety (which is real) is going to mean I need to go get tested?

Great site and service provided to all those that submit questions Dr Hook, You've  probably heard my story a 1000 times before.
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Thanks for your follow-up.  Your symptoms could well be due to your anxiety, combined with an anxiety-related hyperawareness of sensations that have been there is the past but went unnoticed because you were not looking for them.  If you choose to test, you are doing it for anxiety relief and there is no scientific reason you need testing at this time.  EWH---
20 months ago
Dr Hook your advice and use of the right words and giving the right guidance was very much appreciated. Appreciate that you do this every day to what must seem like the same set of questions over and over but it is a very reassuring option to have during some difficult days. I took a HIV I / II test at 40 days and it came back negative. time to move on now. But wanted to say thank you and keep up the good work that you all do. Kind Regards.
Edward W. Hook M.D.
Edward W. Hook M.D.
20 months ago
Thanks so much for the follow-up information.  I'm sure that now having a conclusive negative test for HIV is a relief, although not unexpected.  Thanks as well for your kind words.  Take care.  Closing this thread now.  EWH---