[Question #6678] HIV RISK PROBABILITY?

13 months ago
Hello doctor, I would like my HIV risk for 2 incidents 

1st:
On the 8th of Feb, I had unprotected oral and protected vaginal sex with a csw. Shortly after sex she said she felt pain and went to the toilet. 

2nd:
Yesterday I went to a dominatrix and she used a strap on as well as other sex toys on meand penetrated me anally.Before every use of the  strap on and toys she put a new condom and sometimes 2 condoms in case she suspected the first wouldn’t last. Additionally after we finished,she kept the toys she had used near the sink to wash them and probably would have after I left which leads me to believe that she does this after every person.


I had my last test a little over a month during my medical fitness for my visa and they check for HIV which came back negative.


Questions:
1. For both scenarios,is there any risk of HIV or other stds. 
2. Do you recommend HIV testing In Any of the above mentioned cases.
13 months ago
Forgot to type in the symptoms , over the last week I have had muscle pain on the my left shoulder and today I am having pain behind my left ear. I have not had any other symptoms 
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

Welcome back to the Forum.  I'll be glad to comment.  Let me start by informing you that neither your left shoulder pain, nor the pain behind your left ear suggest any STI.  Both of these discomforts may represent muscle pain as some of the muscles of the left shoulder extend up the neck to the area behind the ear.  Irrespective of the cause however, your left sided discomfort does not suggest any STI, including HIV.

Regarding your other exposures- condoms remain a highly effective way to avoid STIs including HIV as long as they are used throughout the encounter.   Thus your protected vaginal sex was close to no risk for any STI including HIV.  While there are no reports that HIV is spread through receipt of oral sex, occasionally gonorrhea, non-gonococcal urethritis, or chlamydia can be acquired in this way.  Overall the encounter with the CSW you describe was very low risk but these STIs would most likely be symptomatic but could be ruled out entirely at this time with a urine test for gonorrhea and chlamydia. 

Finally, regarding your interactions with the dominatrix, this too is a virtually no risk event as described.  STIs, including HIV are not transmitted on inanimate objects and the combination of cleaning sex toys between uses and application of condoms to the strap on make this a no risk event.

Thus to summarize, nothing you describe suggests any meaningful risk for HIV and I see no need for testing related to these events.  As I mentioned as well, while there is a very low chance of any other STI such as  gonorrhea or chlamydia, a urine test would completely rule out any possibility.  I doubt that you were infected and do not feel strongly that testing is needed at this time.  EWH

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13 months ago
Thank you doctor! 
13 months ago
Another question doc,

In terms of having sex with another male and if it is completely protected, should i worry about HIV transmission? 

In what cases is Prep warranted?
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

Good questions.  Your question is based on the fact that HIV is more common among men who have other men as sex partners (MSM), as well as the fact that certain sex acts among consenting men such as receptive rectal intercourse have higher HIV transmission rates.  Of course all of this varies according to whom your partners are and what the HIV prevalence is.  for instance, in some parts of sub-Saharan Africa the rates of HIV among CSWs are several times higher than the rates of HIV among MSM elsewhere.  That said, for persons who are not taking PrEP, condoms, as well as asking about partners' HIV status and testing history, remain the best way to avoid HIV.  Condoms do occasionally break however, about 1% of the time they are used.  Condoms break slightly more often with new partners and with rectal intercourse.  That said, as long as condoms are used consistently and correctly (and do not break), the risk for acquisition of HIV is about as low as the risk with use of PrEP- very, very low.

PrEP is well tolerated and is highly effective for HIV prevention when taken on a daily basis.  For persons whose sexual activities put them at risk for HIV such as MSM and heterosexuals whose partners are at higher risk for HIV, PrEP is recommended and almost completely prevents HIV acquisition.  PrEP of course has no effect for protection against other STIs.

I hope this is helpful.  EWH

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13 months ago
Hi doc,

Last question, today i have an itch around my penile area,occasional pain in the groin and pimples that are developing on the buttocks. Should I be worried and can this be related to my incidents?

Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago

In terms of your penile itch, your experience is typical of situations in which persons tend to look at themselves for signs of infection more closely following an encounter that is associated with a perceived increase in risk.  This leads to awareness of normal sensations which are often experienced as an "itch".   The same is true for your awareness of occasional groin discomfort.

I am less sure about the rectal pimples.  Nothing you described suggests that they would be an STI however if a lubricant or other substance was used for the penetration there could be an irritative reaction.  The lesions could also be the sort of "bumps" that many people do get in the rectal area from time-to-time.  I would suggest observing them.  If they progress of become more uncomfortable you may want to see a health care provider but I remain confident that they do not represent an STI- too soon and the nature of your exposure would not put you at risk for STI.

I hope that this is helpful.  This will complete this thread and as per Forum guidelines the thread will be closed shortly without further replies.  Take care.  EWH

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