Amsterdam Hell.

[HailMary1234]

Following is a description of my encounter with a window CSW in Amsterdam (call her M). I am seeking assessment on the risks of HIV/ other STI contraction. During the course of the event I was under the influence of Marijuana.
-M peeled open a condom pack and placed the prophylactic on my limp penis. She then proceeded to suck the penis to erection (momentarily creating an inflated condom effect), and while doing so unfurled the condom over the penile shaft. Once erect she continued to perform oral. This lasted for about 20 seconds.
-Heres where things become a bit hazy. M then peeled off the condom and then disposed of it in a bin. I believe she wiped my penis with a kitchen towel. She washed her hands and said thank you. I dont believe there was any exposed genital to genital contact. I dont believe that I came in contact with any bodily fluids, but I just can be 100% sure. I asked her then if she was clean, and she said dont be crazy, and that I should not worry, as we had used a condom.
-Obvious big questions...Integrity of condom? and accidental fluid exposure.
-I am un circumcised, and am less than very well endowed. Would slippage change things?
I visited a GP after, who said the risk profile for HIV was very low. I went to a special STI clinic, and they said the risk profile was very low. I have a STI scan in 4 days (12 days from event), a DUO test on the 29th day from event and an antibody test 6 weeks from the event. Im scared....very scared....and very ashamed. Dont know what to expect.
HELP!
I

[Edward W Hook, MD]

Welcome to the Forum. I'll do my best to help. I think that providing some background information may help.  Commercial sex workers working in Amsterdam's red light district are licensed and, by law are checked regularly for STIs including HIV.  Thus the risk that your partner had any STI (including HIV) is very low- lower than if you had picked up a casual partner in a bar.  Further, your sex was condom protected by a professional who has a personal interest in remaining uninfected.  

If I were you I would not be the least bit worried about any STI, including HIV.  I am confident that when you test, your tests will be negative.  EWH

[Edward W Hook, MD]

The results of testing following your no risk events are conclusive.  You need to move on.  There will be no more answers.  EWH

[HailMary1234]

Hi Doctor, Please do not delete as I am reporting results and need some advice.
- 28 Day DUO (Antibody/ Antigen): Negative--> Is this conclusive? Do I need to retest at 3 months? or the 6 week antibody test
- Gonorrhea/ Chlamydia: Negative at 4 weeks--> Is this conclusive?
- Hepatitis B/ C Negative at 4 weeks--> Is this conclusive?
- Syphilis: Negative at 4 weeks--> Is this conclusive?

At what point can I move on with my life?

[HailMary1234]

Thank you sir. I appreciate your guidance and support. Have a wonderful rest of the day.

[Edward W Hook, MD]

You are being silly and need to move on.  I will not reply again following this reply.  Your sore throat and lip lesions are not a manifestation of an STI of any sort.

You persist in asking "what if" questions which are of no relevance to the no risk encounter you described.  The dose of azithromycin you describe might have cured chlamydia. gonoorrhea or NGU if you had them, which it would not.  If not taken all at one time however this is not a recommended course of therapy for any STI.

A syphilis blood test 12 days after exposure does not provide defintive results.

This will end this thread.  Further questions will be deleted without comment.  EWH

[HailMary1234]

Hi Doctor. I apologize for this follow up. Since your last reply, I now have dry mouth, a slightly soar throat and small eruptions on my lip and inner lip. My tongue too is coated and is a bit sensitive. Could this be in relation to an STD or just a Folic acid deficiency or iron deficiency. Am I going nuts?

Another question, can an antibiotic course (4x250mg Azithromycin) completed 6 days prior to a Chlamydia and Gonohhrea test influence results (They were negative...so should I just move on)? Also are Syphilis test results 12 days from potential exposure reliable?

My 28 Day Duo test is in 9 days.... Please wish me well.

[Edward W Hook, MD]

No change in my assessment or advice regarding HIV and other STIs.  You need to believe your tests and look for other reasons for your dizzyiness.  perhpas insufficient fluids while exercising, anxiety or something else.  Not HIV, not STI.  EWH

[HailMary1234]

Dr....Still dizzy in the morning....with weakness....and have not a rash but singular bumps on skin on back. Im prone to getting these, but not sure if related to seroconversion.

Also, a background piece of information. I have been attendign exercise camp all week, and thus am a little sore from that too.

[HailMary1234]

Dr Hook....Its been 20 days since my event in Amsterdam, and something strange happened. I have a major feeling of dizziness accompanied by aching limbs. No fever or soar throat, but possibly a white covered tongue. Anxiety levels are high, and while sleeping there was profuse sweating from the forehead, and head area. Its morning now, and I am feeling a little better, but severe lack of sleep. Could I have just sero-converted, or am in the process of?

All my tests at 12 days came back negative, and I have my 28 day test in a week.

Please help!. Any guidance would be most appreciated.

[Edward W Hook, MD]

Sigh.  I hope these replies will help your unjustified anxiety.

"Hypothetically, if there was unprotected contact (external only) not penetrative, Is there a chance of infection transmission? If yes, how long would that contact need to be?"

No risk.


" - Contraction of HIV from virus which was exposed to external environment is also unlikely correct?"

Correct.

"So if my exposed penis head were to rub against the outer side of the condom which were in the process of being disposed, Would that also be low risk?"

No, it would not be low risk, it would be no risk.

" -Is my testing schedule ok? If results do turn up negative at the markers indicated, coudl that be considered conclusive? Or would I need to test at 12 weeks>?"

Testing for common STIs like gonorrhea and chlamydia can be done at this time.  A conclusive test for HIV can be performed anytime more than 4 weeks (28 days) after the encounter.  After that test (which I am confident will be negative) no further testing is needed. EWH

[HailMary1234]

Dear sir, Thank you for your answer above. It does provide me a little peace of mind, which is welcome. I do have a follow up though, which I would really appreciate if you could address. Situation rather than environment analysis.
- Hypothetically, if there was unprotected contact (external only) not penetrative, Is there a chance of infection transmission? If yes, how long would that contact need to be?
- Contraction of HIV from virus which was exposed to external environment is also unlikely correct? So if my exposed penis head were to rub against the outer side of the condom which were in the process of being disposed, Would that also be low risk?
-Is my testing schedule ok? If results do turn up negative at the markers indicated, coudl that be considered conclusive? Or would I need to test at 12 weeks>?