[Question #770] HIV/STD scare with csw

90 months ago
Hi Docs,

About 6 days ago, I received oral sex from a csw in South America. I am panicking right now, and I am seeking your advice. I am a straight man, and the csw is a woman.

2-3 days ago, I started having dhiarrhea, and yesterday,I spotted a cluster of localized red dots (rash) on my back, near where I have a first degree sunburn.

I went to my local clinic and was tested for all stds yesterday.

I have read that you advised HIV exposure for insertive fellatio is 1 in 20,000 if the partner is known to be HIV+.  Therefore, the HIV+ risk is essentially non-existent.  Has your position changed, or should i be reassured that I do not have HIV.

Do my symptoms sounds like any other stds or more likely, just a travelers virus?

I intend on getting tested with the 4th generation on the 1 month anniversary of the event. In the meantime, if I receive negative results on the other std tests, can I rule out chlamydia, ghonorhea, and a few others?

I have a partner, when may I resume sexual relations with her?

Finally, if I test negative for HIV, can I be assured that the rash and dhiarrhea are not related to an acute HIV infection?

I am also open to any other advice you have for me.

H. Hunter Handsfield, MD
90 months ago
Welcome to the forum. Thanks for your question.

There are no data that supercede the previous 1 in 20,000 estimate, and I agree the risk of HIV was zero for all practical purposes. There has never been a case of scientifically proved HIV transmission oral to penis. That doesn't mean it can't occur, but it does suggest that the risk is sufficiently low to ignore. Your symptoms cannot possibly be due to HIV from that event; new HIV would never present with diarrhea as the main symptom and HIV rash doesn't show up as a "cluster of red dots" -- it's body wide and pink, more like measles. And acute HIV symptoms cannot start sooner than 7-10 days after exposure. No other STD causes such symptoms either.

Feel free to have an HIV test as planned. But FYI, if somehow I were in your situation, I would not feel a need to be tested, and I would continue unprotected sex with my wife without worry. That's my advice to you as well. If you go ahead with HIV testing as planned, you definitely can expect a negative result. For earlier reassurance, you could be tested at 2 weeks; over 90% of newly infected people would have positive 4th generation test results by that time.

I hope this has helped. Best wishes--  HHH, MD

90 months ago
Thanks for your thoughtful response, doc.

I received my 5 day post exposure std results, and they were all negative.

Today, I did notice some redness on the leftside of my scrotum and the inside part of my left thigh. It is a little stingy and a little damp when I touch it. It does not look like the localized macupopular rash on my back, but more like redness from chafing or the like.

I would feel great about my std results, but I just don't know what to make of the localized rash on my back and the irritation on the left side of my scrotum.  Do you have any further thoughts in light of the update?


H. Hunter Handsfield, MD
90 months ago
No STD causes such a skin rash. The vast majority of genital area skin rashes are not STDs, and your description is not typical for any STD. Near my desk is a 300 page Atlas of Genital Dermatology. Of those 300 pages, only 15 are on STDs. See a doctor if it persists or you remain concerned, but I doubt it has anything to do with your recent sexual exposure -- unless, as you suggest, chafing during the event.

90 months ago
Thanks Doc.  I know this is my last follow up, but figured it was worth the update and get your take.

I saw a Physicians Assistant at a dermatologist office today.  She thought the rash on my back was shingles, and the irritation on my scrotum was just imitation--though she did swab what could be a very small lesion to test for genital warts.

I was a little skeptical that it was shingles and said it appeared very coincidental given the incident with the csw.  I read shingles hurt; this rash doesn't hurt. She said shingles can be brought on by stress. She prescribed Valacyclovir, 3 pills a day for 10 days. 

The other symptoms (except for the rash) have cleared up. My gut tells me I caught some sort of community virus or bacteria, but wish a doctor could confirm this in person. I am going to stick with the plan in testing with the DUO at 4 weeks (and maybe even 2 weeks if I am extra anxious). Thanks for all your helpful comments.

H. Hunter Handsfield, MD
90 months ago
Visual diagnosis of herpes zoster (shingles) generally is very accurate, if the clinician is experienced with the problem. And plenty of cases are not painful, and I would strongly advise you to take the valacyclovir treatment as prescribed; the drug is harmless, significantly speeds healing, and reduces the chance of later pain in the affected area (from post-herpetic neuralgia, or PHN). Garden variety "community" viral infections can trigger herpes zoster, so it all fits together without invoking HIV or other STDs. (And maybe you caught a respiratory virus from the CSW -- or from anyone in your environment in the several days before onset of symptoms.)

So all this reinforces my original evaluation and advice. I remain confidence you didn't acqure HIV or any other STD.

Thanks for the thanks about our services. Take care and stay safe.