Risk Assessment !!!

[PZIZZY]

Hello Sir,

3 weeks ago i had PROTECTED oral and Vaginal sex with a CSW (Chinese) in a country where prostitution is underground, hence i dont know if these ladies are safe or not, as they come to the country on visit visas so no screening is done for them (HIV) unlike residents

Now my questions are:

1. I had safe sex, i am assuming since the condom seemed intact and stayed on all the time (same condom for both oral and vaginal) 30 sec oral and not more than 30 sec of vaginal penetration. i came to my senses and stopped. ejaculated utside of her in the condom and everyting seemed fine. does this put me to ANY RISK of contracting HIV even when using the same condom (oral and vaginal) briefly?

i am scared and i have been understress for the past 3 weeks, why? because:

3 days later i got sick (runny nose for 2 days and then felt fine, on day 6  i was coughing and had some fever - went to a doctor gave me some antibiotics and felt fine. i know it is too early for ARS right? i am having severe nightsweats  but with the timing it got me really scared. i also developed a cankersore (underneath my front lower teeth) which stayed for 10 days , it still feels wierd but it gone now. 2 weeks after exposure have a white tongue and i have some embosed white patch at the back that are little bit painful. not to mention the daily headaches and muscle pains and twitches

My GP does not want to see me cause he thinks am crazy if i think i would contract HIV from such an exposure, and he says that this is all psychological. do you agree?

2. i am planning to get tested next week (flying back to my country) where i checked and they have the duo test (31 one days after exposure) - i want to know if i test negative at this interval, will this be reliable?


3. Do you recommend a full std test, will it be reliable at 4 weeks for all including herpes and hep b?

4. Can i resume unprotected with GF?


Thanks in advance for your support.

[H. Hunter Handsfield, M.D.]

Below is the link to a thread that explains why official advice for HIV seroconversion time remains longer than necessary -- typically 3 months, never longer.  Any doctor or clinic that insists on 6 months or longer is simply behind the times.

Also, note that the 3 months window applies for antibody tests alone.  When a combo/duo test is done, or when there is a test for HIV DNA by PCR, in combination with an antibody test, 4 weeks is the window.

http://www.medhelp.org/posts/HIV-Prevention/-A-Question-on-Testing/show/1347755

[PZIZZY]

Hi Doctor,

I was diagnosed with Health Anxiety Disorder, which i find to be the case with many visitors of this forum.
I went for another HIV duo test in the same lab which was offcourse negative at 8 weeks mark, the lab dr. did not want to run the test as he is very confident that the the duo test is 100% reliable after 4 weeks, and he said that this test is standardized in my country and 3 month tests are old fashioned.
Now i did not believe him as i have a burning tongue for the past month even though my thrush is gone - tested negative for mouth fungus and visited a chief of gastroloy who said that burning mouth is not a sign of HIV, and new HIV test shortens the window period to 4 weeks, when he saw my 8 weeks result he laughed and told me to go have a life.
Not satisfied, visited a urologist who also emphasized that COMBO or DUO test are 100% reliable after 4 weeks and my 8 week test is a waste of money.

What i want to say, is  that how come a very small country like mine (LEBANON) is very advanced in means of testing and most of doctors are up to date with HIV which is very rare in general and yet i come to read lots of posts about doctors asking their patients to wait for 6 month and 3 month, and in some large countries these tests are not available.

I Just felt like sharing my experience, feel free to delete or comment :)

Thanks

[H. Hunter Handsfield, M.D.]

It's good to hear of your negative result -- but of course not a surprise!

Oral candidiasis is not rare in healthy persons and is often triggered by antibiotic therapy.  The test result proves you don't have HIV and the oral candida makes no difference.  A duo test at 1 month is 100% reliable; there is no need for additional testing.

[PZIZZY]

Hi Dr. Hunter,

I wold like to share my results with you, I took the HIV duo test in 31 days and the result came back negative :)

I am so reliefed and happy, but one thing I need to mention, I was diagnosed with candida on my tongue and the dr. gave me fluzan (2 pills) - he is a urologist and said that this is not a sign of early HIV ???????????? is it true????? the diagnosis made me a bit uncomfortable

I was on antibiotics 6 days course 1000 mg 19 days ago and he says that is the reason in additoion to stress??????????

Shall i move on? or test in 8 weeks for extra reassurace?

your very briefed answer is highly appreciated :)

Thanks a million

[H. Hunter Handsfield, M.D.]

The vast majority of such sex workers do not have HIV.  If you're in UAE, I can tell you for sure that few sex workers in Dubai are infected, and the main Dubai STD clinic has told me they rarely diagnose HIV in expats living there, despite frequent commercial sex exposures.  But it is equally important that you were wise enough to use a condom.  On that basis alone, no HIV/STD testing is warranted.

[PZIZZY]

Thanks Doc for your prompt reply.

Just for you to know I live in a GCC (Arabian Gulf) country. some chinese ladies come from china (she was from guangzou) the one i had sex with, and she is here on a visit visa and she has been here for 2 month, so they are not screened for HIV, Hep B and TB as most of residing expatriates are screened

[H. Hunter Handsfield, M.D.]

Welcome back to the forum.

As in most of your activity on various MedHelp forums, including this one and the international STD forum, your questions proimarily reflect your anxiety disorder, not HIV/STD risks.  Directly to your questions:

1) As you were told before -- most recently by Dr. Garcia-Gonzalez on the international forum -- intact condoms are completely protective against HIV transmission.  It should not be necessary to say it again in response to each and every sexual exposure that concerns you. Anyway, even in countries where heterosexual HIV is common, HIV is rare in most commercial sex workers.  (I might be able to say more if you'll say where the exposure took place.)  As for your symptoms, it sounds like you caught a cold.  The symptoms indeed started too soon for HIV, and ARS doesn't cause cough or nasal congestion or drip.

2) Based on the exposure, HIV testing isn't necessary except if the negative result will help settle your fears about it.  I'm sure you have seen other discussion on the forum about duo test performance and probably you know the answer:  a negative result 30 days after the last exposure will be 100% reliable.

3) Given condom protection for both vaginal and oral sex, I see no need for testing for any STDs.

4) No distant expert can guarantee someone has no STDs or HIV, and as you already know (your discussion with Dr. G-G not long ago), even with condoms there is a slight chance of herpes or HPV.  However, if I were in your situation, I would continue unprotected sex with my wife witn no worries.

HHH, MD