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Condom sex.....Malaysia.....Going Insane
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Condom sex.....Malaysia.....Going Insane

Hi.  FIrst of all thank you for answering these questions that all seem to  be the same.  I know it has to be frustrating :) , but any bit of insight and assurance helps so much cause there aren't many people to talk to about HIV!!
Here's my situation:
Had sex at a massage place in Malaysia.  First time ever having sex with a prostitute....and forever regretting it and paying for it mentally everyday!  She gave me a handjob then put the condom on.  She then gave me oral.  Afterwards we had just vaginal sex with the condom on.  I ejaculated inside her with the condom on.  I would have to say the whole time having sex i wasn't 100 percent hard.....but I don't remember the condom ever coming off completely...I definitely would have noticed....Also I don't really know what kind of condom she used...she had it with her...i ASSUME it had to be latex and hopefully not one that wouldn't help against HIV.  about a week after I came home I started to get paranoid about herpes....so I had a test done and it came out positive for Herpes 2! i was shocked .....I think now that it had to have happened years ago because just 6 or so days would be too early for a herpes test after sex correct?  

Long story short.....the herpes diagnosis is what led me to be paranoid now about HIV,  and also that it was sex with a prostitute.  I had an oral swab test at planned parenthood at 3 weeks after....NEGATIVE then the same test exactly 41 days (just shy of 6 weeks) and it came out NEGATIVE.  Of course just to add to my paranoia, I am having a little pain in my throat glands the last few days.  I'm planning now to test again at 8 weeks exactly...then the 12 week mark.  I have payed for this situation dearly...my mental health is in a terrible state and can't seem to function and make my self get out of bed and do normal things.  I keep telling myself life will be better after the 12 week mark and I can move on but i keep thinking it will be POS. Any insight on this is greatly appreciated
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Welcome to the forum and thanks for your question.

However, I'm not sure I can help.  The problem here is psychological.  From both this question and the one you asked on the community forum, it seems that you know that you had safe sex and there is little or no risk for HIV.  You obviously have a disconnect between that intellectual understanding and your emotional response -- i.e. believing you really are not at risk.  But all I can possibly do is reassure you that your intellectual understanding is correct.

Statistically, it is unlikely your commercial partner had HIV, which is quite uncommon in Malaysian sex workers.  Second, oral sex is safe sex in regard to HIV, with virtually no transmissions ever known to occur from an oral to penile partner.  Third, as you probably know (again, intellectually) it is exceedingly unlikely the condom came off or ruptured without your knowing -- so the vaginal exposure also was safe.

Many positive HSV-2 blood test results are false -- it depends on the numerical result.  If you'll let me know the details, I'll comment on the likelihood that you actually are infected with HSV-2.  But even if we assume you are, having it only doubles your risk of catching HIV if sexually exposed, which is more or less meaningless.  Based on the information above, I would guess your HIV risk at no more than 1 in a million.  Would it really make any difference if the true risk were 1 in 500,000 instead?  Obviously not.

And on top of all this, your negative rapid HIV test at 3 weeks, although too early to be definitive, is probably 80% reliable.  Frankly, based on the risk alone, I would have told you that there was really no need for HIV testing at all.  The only reason for it is the reassurance you will gain from the negative result.  There is no realistic chance it will be positive at any time in the future.

And finally, you really don't need to wait until 3 months for definitive HIV testing.  Take a look at the thread linked below:

http://www.medhelp.org/posts/show/1704700

Given the intellectual/emotional disconnect, I suspect you'll remain worried despite my comments -- although of course I hope you find them helpful.  The bottom line is that there is no realistic chance you caught HIV.

Best wishes--  HHH, MD
12 Comments
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Avatar_m_tn
I have tested the same oral swab at planned parenthood at 41 days (1 day off from 6 weeks) as well as that 3 week test.  Both negative.  Should I go in at 8 weeks and 12 as well?

Thanks Dr.  It helps to hear some rationale coming from an expert for sure.  My mind is set at ease.
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239123_tn?1267651214
Thanks for the thanks; I'm glad to have helped.  But if you have read and understood the thread linked above, you don't need me to tell you again when to be tested.
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Avatar_m_tn
Yes sir, I did read it....one last comment and I will put this to rest!!!

From you: "all new infections by 6 weeks, and certainly by 8 weeks"

Since I have had the 6 week test and it is negative....should this completely calm my fears? And any sickness or sore throat at 6 weeks should be ignored?  

Right now my plan is to take the 8 week and then move on.  
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239123_tn?1267651214
If I were you, I would not have any more testing.  But I'm not you, and you'll have to decide whether to have another one at 8 weeks.
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Avatar_m_tn
Doc! just wanted to update you....went in for an 8 week test....NEGATIVE :)
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239123_tn?1267651214
Of course not a surprise, but congratulations.
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Avatar_m_tn
Doc you told me to tell you my herpes test results from 2 months ago (my last sexual encounter)..... The number was greater than 5..... Does this mean I've had it for awhile? I got a second test hoping it would be negative, it wasn't  .... Well that sucks! ;) never had an outbreak in my life...... Life goes on I guess.  
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239123_tn?1267651214
An HSV-2 antibody numerical value (the ELISA ratio) over 3.5 is almost always a true positive.  With a value of 5, you can be certain you are infected with HSV-2, especially with a second test confirming the earlier result. You should assume you have genital herpes, regardless of absence of symptoms, and will need to routinely inform current or future sex partners of your infection and be sure to use condoms for new or casual partnerships.

Measurable antibody can develop as soon as 3 weeks after catching it, but it usually takes 6 weeks and sometimes 3-4 months.  All you can say is that you were infected at least a few weeks before your first positive HSV test result.  Most likely it's a distant past infection.  In any case, you're not the Lone Ranger:  depending on age, race, and other factors, 10-40% of men in the US have positive HSV-2 blood tests, and like you, most have no recollection of symptoms that suggest herpes.  On the other hand, up to 60% of people newly diagnosed with HSV-2 by blood test come to recognize mild recurrent genital herpes outbreaks.
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Avatar_m_tn
Doctor,

First of all, i'm happy to pay an extra fee if this thread is getting too long, or if i'm over stepping my boundaries with the questions.  Please, let me know.

Concerning my recent HSV 2:

For about 3 months now i've had these 2 small rashes on my shaft...maybe the size of 2 small pencil erasers side by side....completely flat, and with a border...and hard to notice unless you look for it....  last week I started to put some moisturizer on it (Cetaphil) and it definitely seemed to be getting better ....almost overnight.....Anyway, just to be sure i visited my GP and she immediately put me on Valtrex (or the generic of it, which is what i picked up at the pharmacy) without even looking at it again....She looked at it once, 3 months before and said it didn't look like herpes, but she is the one who had me take the test and it came out positive.

Seeing as i've had HSV2 for years and didn't know it...i'm a little worried that taking this drug will cause these outbreaks to be severe.  I guess, my question is, does taking a herpes drug all of a sudden make me have regular outbreaks even though i seemingly have no "outbreaks" over the past 4 years.....I know you're an expert on Herpes and wanted to get your opinion.

Sorry for this incredibly long thread....i'm 30 now, and never really had any "health issues" until now....so, everything is making me quite a hypochondriac :)  Even my 8 week negative Antibody HIV test has me sweating it for the 12 week test that I'm a little nervous for.  

Anyway, any insight on this situation, as i'm now "living with herpes" would be incredibly helpful.
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239123_tn?1267651214
Sorry, but this really is an entirely new question -- and as you have noted, this thread is getting awfully long.  Feel free to start a new thread on the STD forum, or on the herpes forum.
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Avatar_m_tn
No problem!
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