Possible exposure - risks??

[jay_rey]

Hi Drs,

Sorry for the repetitive question but I wanted to share my case with you for peace of mind as I am stressed out in this situation.

I am located in Australia and had protected vaginal sex with a female sex worker (Korean - unknown status) on the 3rd April 2011. I don't know if the condom broke during the encounter but I can't stop thinking about this outcome.

It is taking over my thoughts completely. I'm freaking out as I have had unprotected vaginal sex with my girlfriend a few times since...

About 2.5 weeks later I have persistent all over body muscle aches and pains (lasting 4 days so far) and swollen lymph node (mostly right side neck) and mild sore throat.

I also have symptoms of male thrush on my penis - small tiny white pimple like things (although I think this could be due to my girlfriend having this problem as I have had this symptom a few times before).

1. What are the chances of a condom breaking if used properly?

2. If it did break what are the chances of having become infected from this one time encounter?

3. Do you suggest a test in this instance?

4. Are my symptoms indicative of an infection in this instance?

Your advice would be most appreciated. Keep up the good work.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

You had an accurate reply on the community forum; I could not have said it better myself.  Heterosexually transmitted HIV remains rare in Australia -- and although I cannot comment on the Korean origin of your partner, heterosexual HIV also is rare in Korea and it seems very unlikely your partner had HIV.  More important, you had protected sex. Condoms work -- and as you should now know, it is impossible for a condom to break and not know it.  When condoms fail, they break wide open; it can't be missed.

To your specific questions:

1) Since your condom obviously did not rupture, this is irrelevant.  I can't say the frequency of condom rupture, but my guess is that for vaginal sex it's somewhere around once in 1,000 uses.

2) The average risk of HIV transmission from a single episode of unprotected vaginal sex, if the woman is infected, has been calculated at 1 in 2,000.  That's the same as having vaginal sex, without condoms, with infected women once a day for 5 years before infection might be considered very likely.

3) From a medical or risk assessment perspective, you definitely do not need an HIV test.  However, you probably should be tested psychological support; most likely my reassurance won't be nearly as effective as having a negative test.

4) Your symptoms are consistent with a penile yeast infection (thrush).  However, if the same symptoms have not been professionally evaluated, you should do that to confirm the diagnosis and get advice about treatment.  However, this does not at all suggest you caught HIV.  Yeast infections sometimes occur with late HIV, i.e. overt AIDS (several years down the road), but rare with initial HIV infections.

Australia's sexual health centres are probably the world's best network of STD/HIV clinics.  (If you are in Sydney or Melbourne, those SHCs are the best of the best.)  I suggest you visit your nearest SHC for world class advice both about your HIV concerns and to evaluate your possible yeast infection.

In the meantime, stay mellow.  It is exceedingly unlikely you caught HIV.

Regards--  HHH, MD

[H. Hunter Handsfield, M.D.]

Six weeks is common advice.  It is the same for all HIV antibody tests.  However, it almost never happens that a negative result at 5 weeks becomes positive at 6.  Ditto for syphilis.  You don't have either infection.  Believe it and move on.

That will be all for this thread.

[jay_rey]

Hi Again Dr,

5 week test for HIV, Syphilis and Chlamydia were all negative. The clinic in Melbourne advised me that the window period for their tests is 6 weeks for HIV. I don't know if that gives you more of an an idea of what test they perform however they explained this both verbally and in their reading material.

Can I forget about HIV and Syphilis now?

[H. Hunter Handsfield, M.D.]

The data are not nearly precise enough to guess test performance at 0.5% levels.  But that figure probably is about right; I would say 90-95%.  It is true that the antibody tests usually are positive within a week of onset of symptoms.

There's no point in speculating about what to expect.  Let me know the test result, but let's stop the discussion until then.

[jay_rey]

Thanks a lot. I asked and they are only doing an antibody test. At 5 weeks after exposure it should pick up 92.5% of newly acquired infections - am I right? I think I also remember reading that 1 week after symptoms a neg test would prove it is not HIV??

[H. Hunter Handsfield, M.D.]

Syphilis is no more likely that HIV in this situation, and is no more likely than HIV for the symptoms you have.  Both tests will be negative and nearly 100% reliable, although this depends on exactly what HIV test was done.  If it's an antibody-only test, a definitive result requires testing at 6-8 weeks.

[jay_rey]

Along with my question above I would also like to let you know that I got tested today (36 day mark). How accurate will these tests be for HIV and Syphilis? If negative can I forget the whole thing happened?

[jay_rey]

Thanks you very much for your reassuring words. I am trying to stay mellow however it is hard when some of the symptoms are still lingering. My slight sore throat is gone however I still have swollen gland below my left side jaw and have body muscle/joint aches and pains.

In the absence of any other symptoms ie. no fever, no extreme sore throat and no rash that I can notice - I expect it's likely that HIV is not the cause as you have indicated. Does this conclusion hold true for the other blood borne diseases i.e. syphilis, hepatitis etc?

I know I'm just worrying a little too much now however I'm a lot more relaxed than before after your words above. Thanks a lot. I will be getting tested this week at the 5 to 6 week mark. Will let you know how this goes.

I just wish these aches would go away...!