[Question #7498] HIV SCARE

4 months ago
Dear Doctor

I am a male 32 years old and UNCIRCUMCISED from Mauritius.  I had unprotected vaginal and oral sex (both ways) and analingus with a CSW in Mauritius three days ago.  I ejaculated inside her.  She is 40 years old, divorced and mother of 4 children.  She told me she does not do this except with her boyfriend and only protected sex with clients.  She was clean and healthy and is not a drug user as per her version.  She said she does not have any health issues and no HIV but it is unclear if she was tested.  I have deleted her contacts in guilt and have no communication with her.

I have been through a separation from my wife this year and now I am feeling really guilty that I have further messed up my life. I am really worried.  I have no symptoms.  I am in view of settling down with my wife by end of year and working to resolve our differences through couple therapy.  I am feeling really guilty and worried.   A pharmacist friend has prescribed me 2g azithromycin and 2g Metrodinazole which I have taken already as prophylaxis. The only tests available for STDs  in Mauritius are Syphillis blood test, HIV antibody only test and HIV PCR test.  Unfortunately urine tests for chlamydia and gonorrhoea are not done unless there is a discharge.  Only urine culture for NGUs are done.  I have enquired everywhere.  HIV Duo 4th Gen test  is NOT available.

1. I am worried about HIV.  When should I test and using which method - antibody or PCR?  A PCR test in 10-12 days is conclusive or should I wait more and get antibody test?

2.  How worried should be of HIV and other STDs?

 Please help me - the HIV scare is killing me.  Its the only time I have had sex outside my marriage.  I had only one partner over the past 12 years (my wife).  I wish to settle down and have a baby next year.  I am vaccinated and immune to Hep B.
4 months ago
FYI the whole penetration act went for about 10-20 minutes. If this is of any relevance.
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago

Welcome to our Forum. Thanks for your question and your confidence in the information we provide.  I'll be glad to make some comments. 

Even though your recent partner was a commercial sex worker, your risk for infection is rather low.  Most commercial sex workers to do not have STIs, including HIV and when they do, most exposures do not lead to infection.  In terms of gonorrhea, chlamydial ad syphilis infections, the azithromycin you took would cure the majority of infections, if you had acquired one.  I would not worry about these infections going forward.  The metronidazole you took would cure trichomonas, if you had that.  I would not worry further about other STIs and do not see a need for testing at this time. 

This leaves HIV.  As I said above, most CSWs do not have HIV and when they do, a single act of uncircumcised penile-vaginal sex would lead to infection, on average, about once for ever 1200 exposures.  The is not risk for HIV, if your partner was infected, from receipt of oral sex, performing oral sex on her or rimming.  Even with this low risk, I understand that you may wish to have the reassurance that a negative test will provide.  HIV PCR tests are typically considered conclusive when take 12-14 days after an exposure.  In your case, given the limited availability of tests, this would provide you with information on your infection status far sooner than the HIV antibody test which would not be conclusive until about 8 weeks after your exposure.

If I wanted to put this episode behind me and move forward, I would get a HIV PCR test. When it was negative, as I anticipate yours will be, I would move forward without continuing concern. 

I hope this information is helpful.  EWH

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4 months ago
Thank you Doctor.  I have booked an appointment to get the HIV PCR test at the 13th day mark past my exposure.  I am crossing fingers the results are negative.  If my results are negative at the 13th day mark, will it be conclusive and can I have UNPROTECTED sex with my wife without concern after it?  (we are looking forward to have baby next year)

Thank you and Merry Christmas. You brought light in these times of need for me.
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago
Thanks for your thanks.  Happy holidays to you as well. EWH ---
4 months ago
Thanks Doc.  But I guess you missed my question?  Anything to do more after 13 days HIV PCR?  Or can I have unprotected sex with my wife after it is negative? Sorry for the disturbance.
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago
Correct.  When your PCR is negative there is no reason related to the encounter you describe to hesitate to have unprotected sex with your wife.  EWH ---