[Question #6969] Hiv risk assessment

10 months ago
Hello Doctors,

Yesterday I went to a csw who was of Asian ethnicity.

Before starting she sprayed alcohol on my hands and on my penis. I did some fingering to her and she gave me a handjob and then she put on a condom on me and I saw that she did some oral on me and for a very brief moment not even 1 minute I came and we wrapped things up. I asked if she has any std and she said no. Should I be worried for HIV and take pep to be on the safe side and tomorrow at 7pm I will complete 48 hours after the exposure.

After that event I am having pain in my arms. Is that a symptom after acquiring HIV.

Thank you
10 months ago
I am sorry for not writing my question properly. After putting on condom she gave me oral and then I penetrated her and within 45 seconds I came and then we wrapped up. I am also circumcised. 

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

Welcome to our Forum and thanks for your question.  let me start with my most important message to you, if you were my patient and I were seeing you in my clinic, I would not prescribe PEP for you.  The events you describe were essentially no risk for HIV or, for that matter other STIs.  Let me provide you with the basis of my reasoning:

1.  Most commercial sex workers do not have HIV.  I would think that would be even more the case for the CSW you saw since she was taking precautions of the sort you describe. 

2.  Even in the unlikely circumstance that she had HIV, the events you describe were no risk.  No one has ever been proven to have acquired HIV from masturbations with an infected partner , nor has there ever been a case of HIV proven to have been acquired from receipt of unprotected oral sex.  Not ever!

3.  you used a condom.  thus in addition to the no risk nature of your exposure, you had the added protective benefit of the condom.

The pain in your arms is not due to HIV or any other STI.  It is too soon for symptoms to occur related to the exposure you describe and arm pain is not a symptoms of HIV.

I hope that the information I have provided is helpful to you.  If anything is unclear or there are additional questions, please do not hesitate to use your up to two follow-up questions for clarification.  EWH

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10 months ago
After some oral I did have some vaginal sex as well with a condom on that is what is of worry to me as far as hiv is concerned or any other sti. 

The vaginal sex lasted not even a minute so based on this encounter should I be worried and if I decide to get tested when is the earliest and what test I can do to confirm that I have no sti. ( Pcr rna or ab/ag test)
Edward W. Hook M.D.
Edward W. Hook M.D.
10 months ago

I understand that you had a vaginal exposure as well but with the condom there is no reason for concern.  condoms work!  Personally I would not seek testing.

If you choose to test, PCR tests typically provide conclusive results by 11-12 days after an exposure and 4th generation antigen/antibody tests are totally conclusive at 6 weeks (42-45 days).  Many experts suggest antigen/antibody tests for persons who test with PCR as a matter of extra precaution.  EWH

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10 months ago
Good morning Dr Hook,

As per your suggestions I tried to stay as calm as possible and tried to not think about the sexual encounter and HIV but as many ppl on this forum I could not stop thinking and anxiety got the best of me and I have experienced sleepless nights.

1. You mentioned that pcr test is pretty much conclusive by 11-12 days and now it's 14th day post exposure and yet I did not get tested because on this forum itself I have read yours and Dr HHH suggestions which were different than what you mentioned so I am confused that should I go for this test or not because I want to get tested only if it can provide me conclusive results so if I get it done today would the results be conclusive and if not after how many days is this test going to be conclusive.

2. The thing which I am scared about is HIV and what makes it more worst for me are ars symptoms. Some posts in this forum itself are confusing concerning the number of days after which ars is too late to appear. So as I have completed 13 days is it now too late for ars symptoms to appear or am I still in the window when they can appear. 

I apologise if I sound rude or something of that nature because this Hiv thing after assurance from an expert like you still is getting the better of me.

Thank you Sir
10 months ago
And the other thing which I forgot to mention is that, what I have learned from reading posts on this forum is that HIV is hard to transmit compared to other sti. I have also read the symptoms one would have for other sti and I after my exposure had no symptoms and discomfort as far as sti are concerned apart from HIV so is that more reassuring that if I didnt experience other sti symptoms and if I didn't acquire them then chances of me getting HIV are more slim.

Thank You
Edward W. Hook M.D.
Edward W. Hook M.D.
10 months ago

Your follow-up is repetitive and does not ask new questions.  This was your last follow-up.  The facts remain, the encounter you describe involved two activities - receipt of masturbation and receipt of oral sex which have NOT EVER been proven to lead to HIV.  If you choose to test, that is, of course, entirely up to you. 

1.  Dr. Handsfield and I are in agreement regarding the reliability of testing.  As I said above - "If you choose to test, PCR tests typically provide conclusive results by 11-12 days after an exposure and 4th generation antigen/antibody tests are totally conclusive at 6 weeks (42-45 days).  Many experts suggest antigen/antibody tests for persons who test with PCR as a matter of extra precaution." 

2.  Regarding ARS symptoms, they typically occur around 10-14 days after an exposure.  Symptoms occurring after 4 weeks are not the ARS.  Further, I'll point out that symptoms are non-specific and testing is recommended to evaluate symptoms.  If you have symptoms that concern you and a test taken at the time symptoms are present is negative, then you can be confident that the symptoms you are experiencing are NOT due to the ARS or HIV.

This is my 3rd reply to your questions.  therefore, as per Forum Guidelines, this thread will be closed shortly without further responses.  I hope that the information I have provided is helpful to you.  Take care.  Please don't worry.  EWH

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