Street Prostitute

[Luntan]

Hi, I made a bad decision four weeks ago and picked up a black street prostitute in my home country Sweden. I briefly received protected oral and then we had condom protected sex for perhaps 5 minutes. I'm sure that the condom was on the whole time and it were firmly attached when I withdrew, I also checked it for holes by filling it with water so it didn't break in any visible way.  What worries me is the that she is a black street prostitute with perhaps 10-20% HIV chance and that she asked me If I had a condom, did she not have one herself ?

I have also had a light headache of and on for the last 1-2 weeks a total of 3-4 occasions during this time frame. It has gone away after taking acetaminophen and come back 1-3 days later. I have not had any other symptom such as fever, muscle pain etc. I was hopping to take a duo test after 4 weeks, which would have been now.

Unfortunately I wont be able to get a test until earliest two weeks from now since there is no private alternatives here in Sweden so you're assigned a test time. Since my plan to get tested at 4 weeks didn't work out I'm freaking out and I start to believe that I might have HIV since of the headache, which if pretty uncommon for me, that I will be that unlucky guy who caught HIV despite using a condom. Should I be worried about the headache? Was there a risk for me here? Is it correct that acute HIV symptoms come between day 10-30 ?  

[Edward W Hook, MD]

The rapid tests are reported to have a slightly higher false positve rate than the lab based test but the difference is not significant.  You should discuss which test to do at the testing site.  EWH

[Luntan]

Hi again i thought of one more thing about the test. I will get a test time in little more then a week, a normal Duo lab test and get the result in 1-2 weeks. What I wonder is if I should try to get a rapid Duo blood test at the same time, I know the hospital provides this (they always send it to the lab as well). What I wonder is how safe is one of these 15 minutes blood testa after 6 weeks minus 2 days ?. I dont know the particular name of the test only that its done in 15 minutes and that they use some of the blood to test directly. i have also heard that there might be more common with false positive results with these rapid tests ?

[Edward W Hook, MD]

I have never seen such a case.  Again, please do not worry. EWH

[Luntan]

Just one last question, I know its impossible to know for sure, but is it you're guess that nobody ever caught HIV when using a condom that didnt break or slipped of or do you believe there might been such cases were fluids somehow got inside the condom from the base?

[Edward W Hook, MD]

Welcome to our Forum.  There is no reason for concern here.  While indeed street prostitutes are more likely to be HIV infected than commercial sex workers in brothels or more expensive settings, I suspect your estimate of her likelihood of being infected with HIV is too high and that the likelihood of infection is less than 10% - probably much lower. Even if she were infected however, there is no risk of HIV from receipt of unprotected oral sex that we know of- there are no cases of HIV which have EVER been proven to be transmitted by receipt of oral sex, even without condom use.  Similarly, the risk of HIV ,IF she were infected, without a condom would be less than 1 infection per 1000 sex acts and with a condom on that risk falls to less than 1 in 100,000- probably closer to 1 in a million.  Thus there really is no appreciable risk from the exposure you describe.

As for your headache, an isolated headache of the sort you describe does not raise any concern about HIV. While the ARS classically occurs at 2-6 weeks after an exposure, an isolated headache is not suggestive of the ARS.

While I wish you could get tested sooner for your peace of mind, I want to reassure you that from what you have described there is no reason to worry about HIV from the exposure you describe.  I hope that my comments will be helpful to you in this way.  Take care. EWH

[Luntan]

Just wanted to add that when I wrote "we had condom protected sex" It meant normal vaginal sex no anal.