[Question #6285] Hiv and std symptoms from encounter

17 months ago
Hello doctor,
I had an encounter with a girl who turned out to be a prostitute. We had unprotected oral sex(she gave me and I gave her), then we had protected vaginal sex. Towards the end of the encounter, I remember that I had two thrust into her and after I got done with the second thrust I noticed that the condom had fallen off outside off her. She then gave me oral sex without a condom and I ejaculated insider her mouth. This encounter happened around 2.5-3 months back. I am especially freaking out about the two thrusts without a condom(which am assuming happened with the Comdom was out. 
A month or so after the encounter, I started to feel a weird taste in my mouth and my spit/saliva turned yellow. My gums were inflamed and I went to the dentist and they said I had periodontist disease and that I need cleaning. I am concerned that this is a symptom of hiv and STD’s in my mouth. A month after this I got my my blood work done as a part of regular body check and it came back as being abnormal with high RBC counts and low MCH counts and high platelets counts. Now I am really freaking out about the exposure since I am very certain I caught something from it.
The question I have is: 
Based on the encounter, how much risk Was I really exposed to?
She said she got tested 2 months before the encounter and she was clean, and she had 10 partners before we met and somehow I am still freaking out.
2) are the symptoms and the test results  that I explain a part of hiv/std symptoms? 
3) why does my mind always think I have something? 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
Welcome back to the forum. Thanks for your continuing confidence in our services.

Like Dr. Hook's reply a couple of years ago, my first thought is to congratulate you for having safe sex. Too bad the condom slipped off, but good try! But even with that problem, the chance you caught any STD is low. At any time, most sexually active women, ncluding sex workers) do not have active, transmissible STDs; and even when STDs are present, they are not transmitted with every encounter. The unprotected part of your vaginal exposure was very brief, further lowering the chance of infection. Further, peope usually do not lie about STD/HIV status or testing when asked directly, further lowering the chance your partner was infected. As discussed with Dr. Hook in your earlier thread, oral sex is even lower risk, even unprotected. 

So all things considered, the chance you have HIV or other STD from the encounter described is very low. That said, the risk isn't zero, and it would be a good idea to be tested to know for sure. All these comments answer question (1).

2) No STD causes symptoms of the sort you describe, or CBC abnormalities of the sort you mention. (Those CBC results probably mean little at all -- but I will be happy to comment if you would like to tell me the actual results related to red blood cells:  RBC count, MHC, hematocrit, hemoglobin, and MCV, all of which probably are listed among the results.)

3) The mind is a powerful thing. That you "always think [you] have something" is a psychological issue. I would guess you are feeling guilty or ashamed of a sexual choice you regret. Or maybe you just have a worrying type of personality, which in itself is not necessarily abnormal.

For reassurance, I suggest you have routine STD/HIV testing, i.e. a urine test for gonorrhea and chlamydia and blood tests for syphilis and HIV. I'm sure the results all will be negative, but you probably will find them reassuring. In the meantime, I hope these comments are useful in reducing your worry about it. Let me know if anything isn't clear.

HHH, MD

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17 months ago
Hello doctor, thank you for your prompt reply.
I just realized that I fast forwarded the timeline...today is the 70th day after the encounter.it has not been 2.5-3 months. The rest of the time lines are accurate.
Today, I went and bought oraquick inhome hiv kit and tested myself and it turned out to be negative. Again this is on the 70th day or 10 weeks after the encounter. Is the inhome hiv test accurate? Do I need further testing given that it is only 70 days after the encounter instead of the 3 months? Are these home tests accurate?
Can I now relax in peace with this piece of data? Or should I still have this in the back of my mind?

Here are my CBC data 
RBC:6.13
Mcv:79.1
Mch:25.4
Platelet count:410
Vitamin D,25-OH,total,IA: 13
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
Sorry it took me a couple days to get to this.

Good move getting the oral fluids HIV test. It's not quite as reliable as a blood test, however; for conclusvie reassurance you should have a blood test as well.

As for your CBC results, it would have been helpful to also see your remaining RBC indices, i.e. hematocrit (HCT) and hemoglobin (Hgb or Hb). But the results so far indeed are atypical and abnormal, indicating erythrocytosis (over producrion of RBC) and yet microcytosis (low MCV). I'm not a hematologist, but from what I know, this is a peculiar combination. Do you by any chance live at high altitude? Or have any known heart or lung problems? In any case, they have nothing to do with HIV or any other STD, or to the sexual exposure you have described . See your doctor. Good luck.
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