[Question #7863] CSW drunken incident

51 months ago

Good morning.

I’m a 25 year old male living in NYC. Last week I made a mistake I regret deeply. I visited a massage parlor early in the late night, early morning hours after drinking with some friends.

All that pursued was a quick massage and what I assume to be protected vaginal intercourse. I was intoxicated but I was not so drunk as to not be able to remember the events or be aware what was happening. The place looked closed and one middle aged looking Asian woman was working.

After a 5 minute massage, I remember having issues becoming erect and I felt her slide the condom on. I remember having intercourse, I remember ejaculating after pulling out and ejaculating into a condom. I don’t know if it’s because of severe regret due to being unfaithful but I keep playing what if scenarios in my head like maybe I didn’t use one. I have severe OCD I’m medicated for. I know I ejaculated into a condom so I don’t know why I would think one wasn’t used. Plus she supplied it.

My issue now is it’ll be a week tonight, and starting yesterday I started not to feel great. I presume from stress a lack of sleep. I feel very fatigued and run down, hot breath, dazed. I feel like a sore throat is working on me but I’m looking for a sore throat more than it’s actually there and my anxiety is out of control.

1.) Did I have an HIV risk that would require testing and should I put off unprotected intercourse with my partner?

2.) Whats the absolute soonest I can test for peace of mind? Price isn’t an issue, I just want this situation over with?

3.) I have Herpes. I believe it’s HSV1 but I had an outbreak on my genitals 6-7 years ago once and got diagnosed then but I’m pretty sure the blood test said HSV1 and I have been tested for STDs since just not herpes. I am not sure about HSV2. Other than that I have never had an STD.

Please help me and tell me how I can proceed forward. I feel like I ruined my life and I’m making myself sick.

Edward W. Hook M.D.

51 months ago

Welcome to the Forum and thanks for you confidence in our services. I'll be glad toc comment. First, let's look at your risk. It's miniscule. Few commercial sex workers have HIV, even in NYC and without protection, the risk of acquiring HIV in the unlikely event that your partner had HIV is substantially less than 1 infection per 1000 acts of unprotected intercourse with an infected partner (in other words, Even if she was infected, there is a more than 99.9% chance you would not be infected). Further, the fact that she used a condom is indicative of her efforts to protect herself. Putting these facts together, I would not be the least bit worried about this exposure. I suspect that your guilt over the exposure is what is making you question your condom use. Given what you've said, I would be confident that you did.

1.) Did I have an HIV risk that would require testing and should I put off unprotected intercourse with my partner?

I would not be the least bit worried and see no reason for you to avoid unprotected intercourse with your regular partner.

2.) Whats the absolute soonest I can test for peace of mind? Price isn’t an issue, I just want this situation over with?

RNA PCR tests are said to provide conclusive results when performed more than 11 days after exposure although most experts suggest follow-up of PCR tests with a regular 4th generation HIV test 4-6 weeks after exposure. I have never seen a patient in whom the 4th generation test became positive later if the PCR test was negative. Thus a negative HIV PCR after 11 days would be very strong further evidence that you were not infected.

Thanks. This does not meaningfully change my assessment. The incident you describe placed you at little or no risk for HIV. I hope these comments help. EWH

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51 months ago

Good morning doctor,

I mentioned my event occurred on May 6th, 2021. Yesterday, May 15th, my anxiety was through the roof as I began getting a tingling, burning sensation in and around my urethra. I thought I had burning when urinating but I really don’t as I’m more searching for the pain when urinating than there actually is.

But the slight, dull urethra tingling/burning is there and as a result I am going for a STI test today. Obviously too early for HIV but on Tuesday, May 18th I will be going for the HIV RNA test from stdcheck.com since I can’t relax. I feel like my anxiety is destroying me.

1.) Regardless of my impaired memory, I remember ejaculating into a condom, there was zero oral, zero foreplay, so I don’t know where the risk is. Obviously my manifestation of symptoms has me doubting my condom use and I know it’s my anxiety. What would you recommend if by any chance I do test positive for any of these STI’s?

2.) I know most CSWs are not infected but I worry that it was a different situation being the massage parlor was located in a shopping center across from a not as nice part of town, but the neighborhood itself isn’t bad, just the housing complex across the street. I also worry being she spoke very little English she may not have direct access to STI/HIV prevention. But I’m sure a lot of this is my anxiety speaking. I just don’t understand why I’m having symptoms if I used a condom. I will admit though my anxiety is 10-fold and I’m in such a daze mentally I’m not picking every swelling, pain, and abnormalty I feel.

3.) If god forbid my STI test, the urinalysis is positive, would that change your testing recommendation for HIV? As I said I will be going on the 18th for an RNA PCR.

Edward W. Hook M.D.

51 months ago

Thanks for your follow up. Anxiety can have a powerful impact on the perception of symptoms, causing us to notice otherwise normal sensations. If you go for evaluation, please make sure the clinician seeing you also evaluates you for signs of urethral inflammation, preferably using a Gram stain of urethral secretions. This will allow you to find out if you have none chlamydial NGU. Looking for the presence of white blood cells in a voided urine is somewhat less satisfactory but a possible alternative test to look for signs of inflammation. Regarding you were specific questions:

1. It sounds like your anxiety is working overtime. If you ejaculated into a condom and there was no obvious breakage you can be confident the kind of work. The therapy for any STI which might be present would depend on which STI was there.

2. While I understand your apprehension, nothing you described above changes my assessment in any way. Please see my comments above regarding the potential for your anxiety to cause you to detect otherwise normal sensations which we overlook on a regular basis. As an example of how this works, please focus on the sensation that your watch, if you wear one, or alternatively where a piece of clothing touches your body create. Normally, sensations at these points of contact go unnoticed, however with focus, the sensation of touch becomes apparent and most often manifest itself as an itch.

3. Even if you were to have a positive test for any STI, the likelihood that you have acquired HIV from your misstep remains vanishing low and not a concern. I am confident that your RNA PCR, as well as any subsequent testing will be negative.

I hope this helps. Please don’t worry. EWH

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51 months ago

Good afternoon doc,

Quick update, on Sunday 9-10 days after the event, I tested for Chlamydia and Gonorrhea. The results were received today as not detected. Some quick questions and I know it’s my last:

1.) I wasn’t instructed on what to do for this test at the urgent care. I was just instructed to urinate in a cup. It was not my first urine of the day and my water intake was increased over the last couple of days. Would that effect the result?

2.) the event happened on 5/8 at 2am so that’s why I’ve been using 5/7 and 5/8 as my dates of encounter. Is 9-10 days enough time to consider these results conclusive?

3.) The test was sent out to Quest Diagnostics. The test performed was called:

Chlamydia/N. Gonorrhoeae RNA, TNA Urogenital

Was this the proper test? I ask this all because I would like to move on and continue intercourse with my partner.

Thank you again and I appreciate all the help through my 3 responses.

51 months ago

Also, I’ll assume my urinary symptoms are merely psychological. My doctor instructed me that if my test were negative for C/G to move on and she wouldn’t worry about HIV. She checked my lymph nodes in my groin too and stated they were not swollen. The tingling and burning I feel is psychological and irritation she said if the test is negative.

Edward W. Hook M.D.

51 months ago

Thank you for the additional information. It only strengthens my confidence that you are OK. In reply to your specific follow-up questions:

1. Optimally, the first part of a urination should be collected for testing. The fact that you had already urinated during the day and had a somewhat increased intake of fluids would not have a negative affect on your test results. You can believe them.

2. These tests are very, very sensitive and provide reliable results as soon as 3–4 days following exposure. Results from tests taken more than seven days following an exposure can be absolutely counted on.

3. The TMA Test for gonorrhea and chlamydia are the gold standard for the industry. Quest laboratories is a highly reliable and very professional laboratory.

As you know, we provide up to three responses to each client’s questions. This is my third response. I urge you to have complete confidence in the results of your urine tests. They prove that you did not acquire gonorrhea or chlamydia from the possible exposure that you have described. I hope this information will allow you to move forward without continuing concern. This thread will be closed shortly. .EWH

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51 months ago

Thank you again Doctor,

I only asked before I thought about drinking water before a THC test and if it was the same thing. But I now understand that water intake (which I did do to help me urinate) and timing of urination have nothing to do with the results of the test.

Thank you for all your help and I will continue to work with my doctor for my OCD and anxiety issues.

Edward W. Hook M.D.

51 months ago

I’m pleased I could help. EWH ---