Sex with a prostitute

[AnonymousGuy888]

I was having sex with a prostitute (23 days ago) and we put on a condom before anything happened. We kissed lightly and then she gave me oral sex (with a condom) for a few seconds then we proceeded with vaginal intercourse (with the same condom, which was still intact and I hadn't orgasmed/ejaculated during oral sex) ..... I ejaculated and we kept thrusting for 30-60 seconds after ejaculation, until I started going soft
I pulled out and fortunately the condom neither slipped nor broke nor leaked. It was still intact and the reservoir held my semen in place ..... My penis was fully covered in the condom and it did not slip
1- Am I at risk for any STD and especially HIV due to continuing sex after ejaculation with a condom (for a minute or less), keeping in mind that the condom neither slipped nor leaked nor broke?  I am panicking at the thought of catching HIV
2- Am I at risk for any STD due to kissing?

3- There was a faint smear of blood on the outside of the condom ... I dunno if this was due to spotting, menstrual bleeding or vaginal wall bleeding from the thrusting .... The blood did not touch me, I removed the condom and washed my hands and myself with water and soap immediately. Does this increase my risk?
4- I had sore throat couple of days later. My GP - whomI did NOT tell about the encounter, put me on Azithromycin for 3 days and it went away, taking into consideration that I usually get lots of throat infections (6-8 times a year, sometimes with sinusitis and/or bronchitis)
5- Couple of days ago my sore throat came back, I went today to my ENT specialist - whom I did NOT tell also - who put me on a nasal wash, an NSAID and Clarithromycin for 7 days. There is NO fever (checked few times during the past few days ..... ranging between 37c and 37.5c). Is this ARS? (I think not, there is no fever, lymph node swelling or rash, however I feel fatigued sometimes but I have always felt so)

[Edward W Hook, MD]

Condom protected vaginal sex with an infected parter is virtually no risk. Estimates of how low this is are hard to determine because the risk is so low.  EWH

[Edward W Hook, MD]

Welcome to our Forum.  I see that you are one of our clients who has had their questions answered on the HIV Prevention Community site and then asks the same question again on this site. My answers will be the same as Lizzie's.  Your sex was condom protected and therefore you are not at risk for HIV or other STDs.  Where ever you heard that there is risk associated with continuing to have sex as your lost your erection misinformed you.  The problem with having sex as the erection goes away is that condoms tend to come off.  You are clearly anxious and, I suspect, feeling guilty about the exposure you describe.  Hopefully my answer will help you to move forward.  With that, let's address your questions:

1.  No, you are not at meaningful risk.
2.  No, STDs, including HIV are not spread through kissing.
3.  The blood was on the outside, you were on the inside- no risk.  Even if you got some of her blood on you you would not be at risk.  HIV is not spread through surface contamination.
4.  You had a sore throat- this was not ARS or STD.  Don't worry!
5.  See no. 4
5.  For many people a temperature of 37.7 is a normal temperature.  People’s temperatures vary over the course of the day.  This is not a sign of ARS.

Again, you need to stop worrying.  Somehow I have my doubts that there is anything I can do to change that.  So, despite your NO RISK exposure, why not get tested to prove this to yourself.  A DUO (combination p24 antigen/HIV antibody test) performed at 4 weeks will give you definitive proof that you did not get HIV.

EWH

[Edward W Hook, MD]

This is a test similar to an ELISA.  You do not have HIV.  No further answers.  EWH

[AnonymousGuy888]

Hello Dr. EWH

Finally after lots of developments (manic episodes, depression and suicide ideation) I have started seeing a Psychiatrist and I am on an atypical antipsychotic and a mood stabilizer.

My anxiety is long gone ...... I went two days ago for testing just to take it off my mind. It was not as frightening as it was. I just wanted to put the whole thing behind my back.

I feel much better now living anxiety free, worry free, and depression free. It's as good as it gets.

I got my result today and it is negative. This test was done at 38 days (5+ weeks). I am planning on a retest at the 3 and 6 months mark just to be safe, nothing more.

My question is about my test. I walked in to the lab asking for "HIV test". The test result says:


HIV Ag/Ab. by CMIA: Negative
CMIA=Chemiluminescent Microparticle Immunoassay (that's what was written on the test report)

Any idea what CMIA is because I have never heard of it in the HIV tests (I heard about ELISA, P24, DUO, W.B and RNA PCR) ? Is it better/worse than ELISA? Is it more/less sensitive, more/less specific?

[Edward W Hook, MD]

Oh stop.  If you look hard enough in an anxiety driven fashion I can assure you that you will find additional "rashes", bumps, and other things you had not previously noted or would have overlooked if you were not so anxious.  This is not ARS.

The PCR and standard antibody test at 4 weeks would, like the DUO, be positive.  The chance of a false positive PCR however is higher than it would be with the DUO.

It is now clear that my assurances that your exposure were no risk are not registering - your exposure did not put you at risk for HIV.  It is time for this thread to end.  Take care.  EWH

[AnonymousGuy888]

Thanks. That is quite a relief.

One last thing. I noticed some mild rash on my chest. The size of a big hamburger bun .... slightly reddish, not elevated/raised, not itchy ...... Does this warrant anything?

One last thing..... DUO test is not available where I live. Only ELISA antibody test and RNA PCR. What test should I be taking and after how much time?

[Edward W Hook, MD]

None of this will change my mind or my recommendations.  

the fever of ARS is continuous and high.  Isolated fever is not the ARS.

Your exposure is not risk.  I will not repeat myself again. The time for this thread to end has arrived. Take care.  EWH

[AnonymousGuy888]

Dear Dr. Hook,

My sore throat is getting slightly better with the antibiotic (just had my fifth dose) however it is not gone yet.

Also the fever keeps coming and going. Right now it's up to 37.8. I checked it throughout the day and my temperature ranged between 37 and 37.8 going up and down every couple of hours. I also have intermittent excessive sweating both while sleeping and being awake.

My question is, what kind of fever is associated with ARS? Low grade, mild, high grade? and is ARS fever intermittent or consistent?

No other symptoms are present .... What do you think?

[AnonymousGuy888]

Thanks Dr.

So to reiterate what you've said, you think test is uncalled for, but would just be useful to curb the anxiety?

Frankly speaking, I am a very rational person, educated and have a very good general medical knowledge ..... when I think of it I know it's a no risk situation. It's just the guilt as you've said, and the fear of infecting my wife - who's pregnant now - that is making me panic.

I think I will try to brush it off my mind .... and if I could not, I will get tested. The duo test is not available where I live, only the ELISA antibody test and RNA PCR test. I think I will wait for the 3 months mark and get the antibody test (that's if I am still worried by that time).

Last but not least, what are the odds of contracting HIV via protected insertive vaginal sex with an HIV+ woman?


Your help is much appreciated and is worth much more than what it costs. Thanks again.

[AnonymousGuy888]

One more thing. I checked my temperature now and I have a mild fever (37.7). What kind of fever does HIV/ARS cause? Could this be due to a non-HIV throat infection?

Also, to give you background, I am on 160mg daily of Aspirin (80mg x 2 doses). Could it have masked the fever?