[Question #8061] STD risk please help
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49 months ago
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Hello Doctors. Please I did something stupid and I am currently very scared. I met two prostitutes in Abuja, Nigeria today. The first one we french kissed with exchange of saliva, she spat in my mouth several times and I swallowed the Saliva. Then I sucked her vagina and swallowed the vaginal secretions, I also sucked her anus, she actually defecated in my mouth and I chewed and swallowed the faeces which was quite much. She also urinated in my mouth a little which I swallowed. That was all for the first prostitute.
About two hours after meeting the first prostitute, I used hexedene mouth wash to rinse my mouth and then I brushed my teeth with toothpaste and my fingers. Note I did not use toothbrush to brush for fear it could cause micro injuries in my mouth, I put the toothpaste on my finger and used my finger to brush my teeth and tongue. After this I met a second prostitute, we french kissed with exchange of saliva, she spat in my mouth several times and I swallowed the Saliva. Then I sucked her vagina and swallowed the vaginal secretions, I also sucked her anus, she actually defecated in my mouth and I swallowed the faeces which was quite much. She also urinated in my mouth a little which I swallowed. The sexual activities I engaged in was basically the same for both prostitutes. About 30 minutes after meeting the second prostitute I rinsed my mouth with hexedene mouth wash.
Now I am really scared and have the following questions.
1. What is my risk of getting HIV, Hepatitis A, Hepatitis B, hepatitis C and other STDs. I keep seeing conflicting information on the internet.
2. Should I be worried
3. What should I be worried about
4. Is there anything I can do now to prevent infection and is it necessary
5. Can I continue having unprotected sex with my wife.
6. When is the soonest time I can be tested for HIV, Hepatitis A, hepatitis B, Hepatitis C and other STDs.
7. Will you advise me to get tested
About two hours after meeting the first prostitute, I used hexedene mouth wash to rinse my mouth and then I brushed my teeth with toothpaste and my fingers. Note I did not use toothbrush to brush for fear it could cause micro injuries in my mouth, I put the toothpaste on my finger and used my finger to brush my teeth and tongue. After this I met a second prostitute, we french kissed with exchange of saliva, she spat in my mouth several times and I swallowed the Saliva. Then I sucked her vagina and swallowed the vaginal secretions, I also sucked her anus, she actually defecated in my mouth and I swallowed the faeces which was quite much. She also urinated in my mouth a little which I swallowed. The sexual activities I engaged in was basically the same for both prostitutes. About 30 minutes after meeting the second prostitute I rinsed my mouth with hexedene mouth wash.
Now I am really scared and have the following questions.
1. What is my risk of getting HIV, Hepatitis A, Hepatitis B, hepatitis C and other STDs. I keep seeing conflicting information on the internet.
2. Should I be worried
3. What should I be worried about
4. Is there anything I can do now to prevent infection and is it necessary
5. Can I continue having unprotected sex with my wife.
6. When is the soonest time I can be tested for HIV, Hepatitis A, hepatitis B, Hepatitis C and other STDs.
7. Will you advise me to get tested
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Edward W. Hook M.D.
49 months ago
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Welcome to our forum and thanks for your questions. I’ll be glad to help. The encounter she described occurred in a part of the world where HIV is relatively common amongst commercial sex workers. Your partners may have been infected with HIV. Fortunately the sex acts that you described were very low risk for acquiring HIV. French kissing, swallowing saliva, drinking urine, eating feces, and performing Cunnilingus or analingus on an infected partner are all very unlikely to result in acquisition of HIV or hepatitis B or C. Your exposure to feces will close you at risk for acquisition of hepatitis hey if you have not been vaccinated. Analingus and analingus lingers on your partner with you at modest risk for acquisition of oral gonorrhea if either of your partners was infected. Thus:
1. See above. Your major risks are for hepatitis A and perhaps oral gonorrhea.
2. These were risky exposures. I would suggest consideration of testing. Persons who develop symptoms from hepatitis A typically do so within 28 days of exposure. Prior to that time signs of acute hepatitis A might include fever, loss of appetite, muscle aches, abdominal pain or dark urine. Pharyngeal gonorrhea is typically asymptomatic and can be detected only by testing. Testing for Gonorrhea at any time more than 3 to 4 days after your exposure will provide accurate information regarding this infection. If you choose to test for other STI’s such as HIV, tests will provide accurate results within six weeks of your exposure.
3. Please see above
4. The best way to prevent acquisition of hepatitis A would be to immediately sick vaccination if you have not been vaccinated in the past. I see no reason for other preventative measures.
5. I would wait to have unprotected sex with your wife until you have been tested or if you choose hepatitis explanation, two weeks following your vaccination.
6. See above
7. Yes
I hope the information I have provided has been helpful. If any part of my reply is unclear or there are additional questions, please feel free to use your updates to follow up questions for clarification. EWH
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49 months ago
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Thank you very much Doctor for your reply. I have some further questions please
1. Please clarify the last sentence in the first paragraph of your initial reply "Your exposure to feces will close you at risk for acquisition of
hepatitis hey if you have not been vaccinated. Analingus and analingus
lingers on your partner with you at modest risk for acquisition of oral
gonorrhea if either of your partners was infected"
2. Unfortunately Hepatitis A and B vaccines are not readily available in Nigeria, patients have to book ahead to take them, sometimes it could take up to a few months or more to receive the vaccines after booking. I remember taking some doses of hepatitis B vaccine about 13 years ago (At least 1 dose maybe more) but I am not sure if I completed the full vaccine schedule
3. From your responses, especially from your response number 5, are you saying that if the gonorrhea test comes back negative and somehow I am able to take the hepatitis A vaccine, the risks of me getting HIV, Hepatitis B and C from my exposure are low enough that I can resume unprotected sex with my wife even without testing for HIV, Hepatitis B and C
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Edward W. Hook M.D.
49 months ago
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1. Sorry for the typographical errors, the sentence should have read that your exposure to feces places you at risk for Hepatitis A
2. Hepatitis A can also be prevented by injection of immune globulin if it is available. You’ll have to see if your doctor can get it.
3. Correct
Hope this helps. EWH
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48 months ago
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Hello Doctor, how are you doing? Let me update you on recent happenings.
Today is the 8th day after my exposure. I took the hepatitis A vaccine on the 3rd day after my exposure. On the 2nd day after exposure I developed diarrhea for which I took a 7 day course of metronidazole which was completed yesterday. I have the following questions please. I know the questions are long and may sound annoying but please bear with me. I am only trying to calm my anxiety that's why I went to such extent.
1. I developed a mild sore throat about 3 days after my exposure which resolved the next day, however today which is 8 days after my exposure the sore throat came back. This time it is severe, pain is about 7/10 and it is only on the left side of my throat. I also have a tiny boil about 3cm below the lower lip which is midly painful to touch. No additional symptoms. Please do you think this could be a sign of HIV?
2. I took a pharyngeal swab for gonorrhea and a blood test for chlamydia today. Please do you think the result could be affected by the 7 day course of metronidazole which I completed yesterday?
3. I recall, you said if the chlamydia and gonorrhea test come back negative and having taken the hepatitis A vaccine that the risk of HIV, Hepatitis A and Hepatitis B are low enough that testing is optional and that I can safely resume unprotected sex with my wife. I have also read Dr. Handsfield give a similar response to people with similar exposures and I have heard both of you say the risk from such exposures for HIV is lower than 1 in 10,000 from your previous responses to other patients. I have a tendency to worry over little things and I get anxious a lot. Please can you help me explain this statistic further, sometimes I say to myself, what if the 1 out of the 10,000 comes true. But perhaps i am looking at it from the wrong perspective. Please help me understand why both you and Dr. Handsfield think testing for HIV is not necessary in this scenario and you would both resume unprotected sex with your partners if you were in my shoes when the risk is not zero. I believe if I understand your thought processes well, it will go a long way in calming me down.
4. The thought of waiting a whole 6 weeks to test for HIV, Hepatitis B and C is killing me because it is such a long time to live with my anxiety. i would have opted for an RNA test at 11 days post exposure but I decided against it because it is very expensive, does not detect HIV 2 and it will still have to be confirmed at 6 weeks so it will do little to comfort me even if it is negative.
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48 months ago
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Hello Doctors. Please I am looking forward to getting a response to my 2nd comment. Its been more than 48 hours now
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Edward W. Hook M.D.
48 months ago
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Thank you for the reminder. I apologize for the delay in responding. Straight to your follow up questions:
1. For your sore throat to occur at this time, just 8 days following exposure, is a bit too early to be due to HIV. Furthermore when persons develop symptoms of recently acquired HIV, they typically have not only a severe sore throat as you do, but also a high fever and severe muscle or joint aches.
2. Metronidazole has no activity against either gonorrhea or chlamydia. I applaud your decision to have a throat swab performed. FYI, blood tests for Chlamydia are not recommended and are typically quite unreliable. You can believe the results of your throat swab.
3. I will try to provide a further explanation. Acquisition of HIV from performing oral sex on an infected partner is quite unusual and, as we mentioned, is estimated to occur less than once in every 10,000 exposures, if your partner was infected. Please remember that even in Nigeria, most commercial sex workers do not have HIV and thus your risk of infection is not one in 10,000 but substantially less since it is unlikely your partner was infected.
4. I agree with you and your decision to not go through the difficulties and expense of having an HIVRNA test. At the same time however, given your anxiety about your current symptoms, I will point out that if your symptoms are due to HIV a widely available fourth generation combination HIV antigen/antibody test would be positive. Perhaps having such a test at this time to evaluate your sore throat would be reassuring.
I hope this additional information is helpful to you. Please don’t worry. EWH
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48 months ago
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Hello Doctor Hook. Thank you for your response. I have the following further questions please:
1. My throat swab yielded a heavy growth of Candida albicans, no mention was made of N.gonorrhea. Does this rule out oral gonorrhea?
2. Going through previous threads, I noted that you say the accuracy of 4th generation HIV tests i.e. Ag/Ab tests is more than 99% at 28 days while Dr. Handsfield of recent says the same test is 95% conclusive at 28 days. I was just wondering why the disparity in the figures. Please what is the actual value of how conclusive the 4th generation test is at 28 days?
3. I noted also from previous threads that both you and Dr. Handsfield stated that you have never seen or heard of anyone who tested negative with a 4th generation HIV test at day 28 go on to test positive at 45 days. Please why did the CDC change their guideline from 28 days to 45 days, did they have cases of people who tested negative at 28 days go on to subsequently test positive at 45 days? If so what percentage of people and was there any peculiarities common to such people?
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Edward W. Hook M.D.
48 months ago
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Did you know, we provide up to three responses to each clients question. This will be my fourth and therefore final response after which the thread will be closed. Onto your follow up questions:
1. Testing for gonorrhea requires a specific test. If your throat swab was tested for gonorrhea using a nucleic acid amplification test, your negative test rules out the possibility of gonorrhea. If the throat swab was just a routine throat swab which was not tested specifically for gonorrhea, this result does not rule out the possibility that gonorrhea is present although as noted above it remains unlikely.
2. For all practical purposes the distinction you were making is inconsequential. Like me, Dr. Handsfield has not seen or heard of a patient in home a fourth generation test performed at four weeks became positive subsequently. These events are very, very rare.
3. This follow-up question basically repeats the earlier question. Apparently the CDC is aware of a very very small number of cases in which the test became positive after four weeks. The CDC is a basically conservative organization and tends to provide its recommendations from the most conservative perspective possible.
This completes this thread. I hope the information I provided has been helpful to you. Take care. EWH
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