Risk assessment-TG CSW condom breakage

[dbgs]

Dear doctors,

Around 3 weeks ago (end of August 2013) I had a condom break during insertive anal sex with a transgender CSW in the Philippines. I was checking the condom frequently, so I am fairly certain that it the act was unprotected for probably only 10-15 seconds, during which time I ejaculated.

I was of course very concerned by this. She told me she was clean, and produced a negative report (which I think I believe the veracity of) from August 2013. I then followed this up by asking her directly again, and she told me she was negative for sure. (I realise of course that this was all done the wrong way round, and I should have asked beforehand, or not even got into such a situation in the first place ...)

Now, I realise already this was a misguided and stupid thing to do, and potentially high risk. She could, of course, have been in the 3-month window during this test, or she could have recently acquired HIV.

1 week after this potential exposure I went for chlamydia and gonorrhea testing, which also included an HIV and syphilis test (although I realise the blood tests here require more time that 1 week). I tested negative for chlamydia and gonorrhea, though. I was still in the Philippines during the potential PEP window, although frankly I have only recently really learned about this treatment anyhow.

I plan already to go and get tested again at 3 months. But in the meantime, I would be very interested to know your opinion on potential risks here. And also whether I should get tested at any other intervals in the meantime.

From reading other posts, it would appear that my risk if she was infected (which I assume, given the report, is unlikely) my risk is in the region of 1-200. But of course this could be much higher were she recently infected.

I have a feeling that I'm trying to answer all my own questions here, but since this has been in my head for so long I would appreciate some expert input.

Many thanks in advance for your help.

[Edward W Hook, MD]

I see no reason for testing at 3 months.  EWH

[dbgs]

As you anticipated, my 28-day combo test was negative. Should I regard this result as definitive, or would you still recommend a 3-month test as well?

Thanks again for your help.

[Edward W Hook, MD]

Correct, I anticipate your test at 298 days will be negative.  Take care. EWH

[dbgs]

Ah, I'm very sorry for breaching the forum rules. I just didn't think when posting that follow-up information—silly of me. Thanks very much for still taking the time to reply despite this, and for putting my mind at ease.

I will wait until 28 days and get the combined HIV p24 antigen/HIV antibody test done, then. From looking at your response, it seems like I should probably expect the result to be negative, yes? I do hope so. Thanks again.

[Edward W Hook, MD]

Welcome to the Forum.  I considered not answering your question as you failed to respect the 2000 character limit placed on questions but instead will provide some brief comments.  

Your partner, a transgender CSW, was a high risk partner but the fact that she had recent HIV testing which was negative transforms this into a low risk event.  She had done what was needed to avoid HIV up until at least 3 months before her last test and would have to be quite unlikely to have acquired HIV in the brief interval since her last test.  

While you are correct that had she been in the process of sero-converting for HIV she might have been somewhat more infectious on average than if she had an established infection, as explained above, nonetheless this was a low risk event.  I would not worry and I certainly would not have recommended PEP in this situation

At this time, three weeks after exposure, a combined HIV p24 antigen/HIV antibody test will provide you with definitive results as to whether or not your recent symptoms were due to HIV- I doubt that they were.  If you will wait until day 28 after your exposure, results of the combination test will be definitive.

I I hope these comments are helpful to you. EWH

[dbgs]

Just as an additional note to the above, about 6 days following this potential exposure I experienced what I assumed to be traveler's diarrhea (diarrhea and a fairly high 38.something fever), which cleared up after 3 or 4 days.

And I have now, 3 weeks after this potential exposure, contracted what I assume to be a common cold (sore throat, runny nose, cough, slightly inflamed glands).

I'm guessing a lot of this is down to stress and my previous gastro condition, and is not indicative of ARS (this would certainly seem to be the case, from what I've gleaned from this forum), but I include it here just so you have all the information.

I have recently found a clinic which offers the HIV P24 Ag + Ab test, and I am considering booking an appointment. Would you recommend this, given my situation?