[Question #6088] HIV Risk from CSW ?

17 months ago
The specifics of the incident; female CSW visiting New Zealand from mainland China.  Protected vaginal sex, protected oral on me and unprotected oral on her. After stopping vaginal, removed the condom. She then masturbated me and inserted her finger into my anus.  This continued for 3 or 4 minutes, then put a condom on her finger and continued for 2 or 3 minutes. In cleaning up the room later, I was horrified to discover 2 things; the same condom that had been used to have vaginal sex had been used to cover her finger and, I also spotted a tissue she had used to clean up with which had on it a reasonable amount of blood (suspect this was from my anus as I had some bad hemorrhoids and the fingering was vigorous, but am not sure).  

Day 10 - The start of a slight irritation in the throat (no redness); Day 16 – Red and sore throat (but not too sore to swallow) which persists; Day 16 - the appearance of a raised (lots of small individual bumps, slightly colored) on both sides of my trunk (below the chest) which persists. I have had a 4th GenTest at 19 days which came back negative.  I have not had a fever at all (although woke up with a very minor sweat 1 night around day 10), no swollen nodes or aches and pain.  Very fatigued (although very stressed).  

I would appreciate your assessment of my risk in this situation; do I have cause for concern and also to what extent can I rely on the recent 4th Gen test to rule out that the “symptoms” are ARS?
Edward W. Hook M.D.
Edward W. Hook M.D.
17 months ago
Welcome to the Forum.  Thanks for your question.  I'll do my best to answer your questions.  Of the sex acts you describe, there is virtually no risk for acquisition of STI from condom-protected genital-genital sex, from receipt of oral sex (protected or otherwise), or receipt of masturbation.  The risk of HIV from cunnilingus is very, very low as well.  Finally, as I understand it, first without a condom, then with a used condom which had been used for vaginal sex.  This too was a safe sexual activity since HIV is not infectious when secretions are transferred from one person so another on something like a finger or a used condom.  Thus, your sexual activities were very low and probably virtually no risk.

The you has an illness characterized by a severe sore throat and a rash, raising concerns that this might have been the ARS.  The good news however is that your 4th generation test, taken several days after the onset of your acute symptoms was negative.  This means that your symptoms were not due to HIV.  The symptoms of the ARS occur as antibodies to HIV begin to appear at a time when large amounts of HIV virus are present in the blood stream.  As a result, 4th generation tests are virtually always positive during the ARS.  In other words, you can be confident that the symptoms that describe were not due to HIV but something else.  (I would also add that the fact that you did not have fever is also strong evidence that your symptoms were not due to HIV.  Fever is always present with the ARS).

Bottom line, you can be confident that the illness you described was not due to HIV.  I hope that this information is helpful to you.  EWH
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17 months ago

Dear Dr. Hook

 

Thank you for the prompt and fullness of your reply, it would be difficult to overstate how comforting this is.   While I now understand my experience constitutes  very low risk, I will nevertheless get tested at 6 weeks with the 4th Generation Ab/Ag as per the advice found on this website. 

 

When receiving my results from the Day 19 test (yesterday at Day 22), I persuaded my Doctor to do another 4th Gen test and a RNA viral load test.  

 

The reference laboratory undertaking this test uses a quantitative test (COBAS AmpliPrep/ TaqMan HIV-1 Test, Version 2), which is not approved by the manufacturer/FDA as a screening tool.  The test guide for the lab however suggests that it can be used to detect early infection prior to sero-conversion.

 

My question is; how likely would a negative Ag/Ab at 22 days plus a “not detected” RNA viral load result translate be a true negative (per the 6 week current standard) and what is the danger of undertaking (in terms of false positive) the RNA test?

 

My Doctor practices in a low prevalence community so he was unable to provide any light on my questions when I asked.

Thanks again
Edward W. Hook M.D.
Edward W. Hook M.D.
17 months ago
 The combination of a  negative 4th generation test and a negative HIVPCR test at 22 days would definitively rule out HIV.    The HIVPCR test has a somewhat higher false positive rate then other tests but if that result is negative you can move forward with confidence and without additional testing.   EWH---
17 months ago
Dear Dr Hook

My qualitative RNA and 4th Gen, both taken at 21.5 days have both been returned negative.    

At the risk of irritating you (your last answer is perfectly clear ),  I must ask, is their any realistic chance that a quantitative  RNA after this period  would be negative (i.e. is there any merit in taking  a final 4th gen at 4 weeks or 6 weeks to be 100%).    

This final query is more a curiosity, than any residual concern as to my status (largely).  

As this thread is about to close, I would like to thank you for this awesome service you and your colleagues  provide on this site.   

Best 






Edward W. Hook M.D.
Edward W. Hook M.D.
17 months ago
 Thank you for your thanks. The combination of a negative RNAPCR test and a -4th generation test at this time rules out the possibility of HIV. No further testing is required you can move on without concern. 

 As you have acknowledged, this will complete this thread and it will be closed at this time. Take care. EWH 
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