HIV - Prevention Expert Forum
help me out!
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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help me out!

Hi Doctors,

Below are my exposures with 3 different CSW

1. Sep 2012 - unprotected insertive oral for 2 minutes. I came outside of her mouth.
2. Oct 2012 - unprotected insertive oral and protected vaginal. No signs of condom break or slip
3. Nov 2012- unprotected insertive oral and I came in her mouth
4. Dec 2012- unprotected insertive oral and protected vaginal. No sign of condom break or slip. When I removed my penis, I noticed that 2cm of my penis shaft at the base of my penis was exposed and there was vaginal fluid on the base of my penis. The head of my penis was fully covered throughout.
5. In Apr 2013, I came down with shingles on my trunk.  
6. In July 2013, I did a CD4 test and my results were CD4 absolut count of 701 and 29% CD4. Total Lymphocyte count 2,431 at 44.2%
7. I have not experienced any ARS or any symptoms yet, apart from mild folliculitis on my back about 1 month ago.

Questions:

a) What are the probability that I got HIV from the exposures above?  
b) If the condom had broke, what does it look like and would I have noticed it? and if so what would be my risk if the csw was HIV +ve?
c) Are my shingles and folliculitis related to HIV?
d) My CD4 count @701 but my CD4% @29%.. is this normal for %? I did other CBC test last month and my lymphocyte count was 2,780 at 44.6%, quite similar to my lymphocyte count when the CD4 test was done in July. Would my high lymphocyte count be the cause of the lower %CD4?
e) 2cm of my penis shaft at the base and my scrotum have been exposed to vaginal fluid. Is this a risk? I am uncircomcised and condom covered the head of penis?
f) Based on these exposures, do I need to be tested for HIV or STD?
g) Before above exposures, I was tested -ve and have not had any other exposures since the above. Can I still have unprotected sex with my gf?

Thank you so much Doctor for your advise on my situation and for easing out my anxiety.
300980_tn?1194933000
Welcome to the Forum. I'll answer your questions.  My answers will be the same as the answers you have already received on the HIV Prevention Community site.  The exposures that you describe did not put you at risk for HIV.  Most commercial sex workers do not have HIV and more importantly, your activities are not associated with risk for HIV. There are no cases in which someone has acquired HIV from receipt of oral sex and condom protected sex is safe sex, even if the condom slips down and there are vaginal secretions that get onto your skin- still no risk.

In answer to your specific questions:
a) What are the probability that I got HIV from the exposures above?

Zero.
  
b) If the condom had broke, what does it look like and would I have noticed it? and if so what would be my risk if the csw was HIV +ve?

When condoms break ,they break wide open leaving no doubt that they have failed.  The risk for an unprotected sexual encounter with an infected partner is less than 1 infection per 1000 sexual encounters.

c) Are my shingles and folliculitis related to HIV?

No.  while people with HIV are at increased risk for shingles, most people with shingles do not have HIV.  

d) My CD4 count @701 but my CD4% @29%.. is this normal for %? I did other CBC test last month and my lymphocyte count was 2,780 at 44.6%, quite similar to my lymphocyte count when the CD4 test was done in July. Would my high lymphocyte count be the cause of the lower %CD4?

CD4 counts are quite variable and are not useful for HIV diagnosis. If you are worried about HIV you should have an HIV antibody test, not waste your time getting meaningless CD4 lymphocyte tests.

e) 2cm of my penis shaft at the base and my scrotum have been exposed to vaginal fluid. Is this a risk? I am uncircomcised and condom covered the head of penis?

See above.  This does not put you at risk for HIV.

f) Based on these exposures, do I need to be tested for HIV or STD?

No.

g) Before above exposures, I was tested -ve and have not had any other exposures since the above. Can I still have unprotected sex with my gf?

Yes.

I hope my answers are helpful to you. EWH
7 Comments
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Avatar_m_tn
Thank you so much for the re-assurance Doctor Hook. I have 3 more questions:
1. Does shingles in HIV positive people usually occur at the beginning of infection or in the later phases?
2. If I have to do a rapid test, again just for my peace of mind, which one should I do?
3. I live in an Asian country where reports show that more than 25% of CSW are HIV positive. Does this change my risk factor?

Thank you once again for your help
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300980_tn?1194933000
1.   More often as the HIV infection progresses.
2.  All of the rapid tests are held to similar standards.  Any of them should be fine.
3.  No.

EWH
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Avatar_m_tn
Last Q. Can I confirm that I was also not at risk for STD and do not need any test. It's now been almost 9 months since last exposure and I have not had any symptoms.

Thanks.
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300980_tn?1194933000
Than chance that you have other STIs is virtually non-existant however if you have not been tested, you can only be completely sure with testing. Any and all testing performed this long after a sexual exposure will be conclusive.

This completes this thread.  EWH
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Avatar_m_tn
Hi Doctor,

I did a oraquick test and the test came back negative. I am now about 10 months past possible exposure.

How accurate is the ora quick and can I take this as conclusive?

Thanks.
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300980_tn?1194933000
Final answer.  There will be no further answers.  An HIVTest 10 months after exposure is conclusive.  EWH
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This Forum's Experts
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H. Hunter Handsfield, M.D.Blank
University of Washington
Seattle, WA
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Edward W Hook, MDBlank
University of Alabama at Birmingham
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MedHelp Health Answers
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