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Unprotected sex with thai sex worker
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Unprotected sex with thai sex worker

Hello doctor,

I have been in Thailand recently and, after a stupidly drunken night, had unprotected vaginal sex with a thai sex worker :( It was about 2-3 weeks ago and since then i have developed flu like symptoms, runny nose, sore throat, feeling pretty tired/lathargic.

I am wondering my chances of being infected with HIV. I have read the common strain subtype E is the most common in Thailand and is alot more infectious than other strains of HIV. What are my chances of becoming infected? Thank you in advance
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239123_tn?1267651214
Welcome to the HIV forum.

Although HIV was once common in Thai sex workers, it's much less frequent than 15 years ago, largely due to excellent government sponsored HIV prevention programs in that country.  And when a woman has HIV, the average risk of transmission through a single episode of unprotected vaginal sex is around 1 in 2000.  So on the basis of the odds alone, the chance you have HIV is extremely low.  I don't know that subtype E is all that much more infections than other types -- but even if it is, the chance you have HIV remains very low.

As for your symptoms, they are not very suggestive of HIV, which does not cause stuffy nose.  And you don't mention fever; and absence of fever is strong evidence against HIV.

From a risk assessment or medical perspective, you really don't even need HIV testing.  However, probably you do need it for the reassurance factor; that is, if my reassurance doesn't completely settle your fears, have an HIV test to know for sure.  You can have a single antibody test around 6 weeks after exposure.

Regards--  HHH, MD

7 Comments
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Avatar_n_tn
Doc,

I asked another doctor on another site what the chances are and he said subtype E is a lot more contagious and that there's is a 20-30% chance per episode if the other person was infected that i will be HIV+. I'm going to get testing done of course.

Any ideas why such a difference of opinion among different doctors?

Also what are your thoughts regarding the testing by antigen method done within 2-3 weeks of the exposure in regards to accuracy?

Thank you
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Avatar_n_tn
One more thing, do you know any numbers/statistics for infection rates of HIV amount thai sex workers?
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239123_tn?1267651214
My understanding is that well under 5% of Thai sex workers have HIV, probably less than 1% in most parts of the country.  Antigen testing by itself is not highly reliable, but the combination of an antigen plus antibody testing increases the reliability of negative test results.

Differences of opinion usually mean the evidence is not solid one way or the other.

You have had my views.  I won't have anything more to say.
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239123_tn?1267651214
Well, I have a little more to say after all.  Your statement about "subtype E" transmission led me to do a little research.  Among other things, there actually is no such thing as HIV subtype E; the preferred terminology is  "circulating recombinant form A/E" or CRF A/E.

That this HIV subtype is more transmissible through heterosexual exposure is controversial, supported by some studies and not confirmed others.  Little or no research on this concept has been reported in the past 10 years.  If some HIV strains are more transmissible sexually than others, the difference is likely small and not particularly relevant to individual risk assessment.  It is much more important that vaginal sex is an inherently inefficient transmission mechansism and that HIV is now uncommon in most Thai sex workers.

Avert.org, an HIV prevention organization in the UK, has an excellent summary of HIV subtypes and their significance.  See http://www.avert.org/hiv-types.htm.
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Avatar_m_tn
Dr, i was reading your post and have read many other posts.  Am i mistaken for what I read?  The above person said he had unprotected sex and you said from a medical perspective no testing is needed???  Isn't that contradictory to your other statements and all other medical personnel?
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239123_tn?1267651214
As has been stated many times on this forum, testing is rarely recommended after single episodes of unprotected sex, except in particularly high risk situations -- e.g. if a partner is KNOWN to have HIV, anal sex between men of unknown status, and so on.  In general, sexually active people should not worry about HIV testing after single exposures of low to average risk, but instead should just have routine testing from time to time, like once a year.

This is not intended to open up another ongoing debate or discussion on this issue.  We have discussed it innumerable times.
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