really anxious!

[nasaldripscare]

Awhile back I had condom protected vaginal and oral sex with a commercial sex worker in Hong Kong/China. I do not recall clearly. I’m paranoid that during removal of the condom the same tissue that was used to remove it was then used to wipe the head of my penis, contacting the vaginal fluids with my urethra. I had sticky mucus type sinusitis/post nasal drip about a week afterwards, which lasted for a week. Two months later I had a cold and sore throat for 2-3 days. Following the cold I had a stuffy nose which had to be cleared constantly. Eventually it cleared into a post nasal drip. The post nasal drip has persisted (2 months!) and the mucous or phlegm drips down my throat. My doctor said these are not symptoms of early HIV. Do you agree?  I also discovered two swollen lymph nodes, which my doctor said were normal swollen nodes. I tried to get tested but he advised against it. The length of the PND has kept me worried because I read somewhere that PND is a symptom of HIV or AIDS patients. Secondly, I recently had protected vaginal and unprotected oral with a Toronto escort. After foreplay, her vagina was wet, even on the outside. When putting on the condom, I accidentally momentarily touched the head of my penis near the surface of the vagina, wet with vaginal fluids for around one second. I realized and quickly moved my penis and slipped on the condom.  
1) What are your thoughts about my PND problem and first situation?
2) I plan to get tested for HIV next week, but given the new encounter, should I just wait for another month and get tested for both situations? Should I get a full STD screening?
3) I read about discrepancy of CDC posted rates where one guy who had sex with 15 women, 5 contracted HIV from him. Another guy had 11 sex partners and 7 were infected.  This math does not come close to the 1/1000 estimate for male to female, assuming it was strictly vaginal. What is an explanation?

[H. Hunter Handsfield, M.D.]

IF your partner were recently infected, yes, it would increase the risk.  But the chance of that is low, and in any case, you had condom protected sex.  Nobody has been known to catch HIV in that circumstance.

[nasaldripscare]

Thank you Dr. Handsfield, you have done much to inform me and alleviate my stress. It is an honorable thing you do. I have one concern in response to your comment about incidents of high transmission. In such circumstances ie. if the partners were recently infected, would my exposures still be considered no risk and larger amounts of secretions would have to be be present?

[H. Hunter Handsfield, M.D.]

Relax. There is no cause for worry about HIV.  You had safe sex; and how a condom is removed doesn't have any bearing on HIV risk.  Like a lot of people, you seem to think that contact with "just one virus" is enough to result in transmission of HIV, and therefore that minor exposures can cause infection.  Not true.  It takes LOTS of virus that gets inside the body in a way that allows contact with certain kinds of cells, which are not present on the skin, for example.  Contact like "momentarily touched the head of my penis near the surface of the vagina, wet with vaginal fluids for around one second" or "the same tissue that was used to remove it was then used to wipe the head of my penis" are zero risk for HIV transmission, even if your commercial partner had HIV -- which most likely she did not.

1) Your doctor is correct.  HIV does not cause nasal congestion or post nasal drip.

2) Feel free to get tested for HIV and/or other STDs if you wish.  You can be sure of negative results.  If it happens to be positive for HIV or any STD, it will be necessary to investigate other exposures that you don't mention here and might not even know about.  It is not plausible that you could catch HIV during the events you describe.  If you insist, get all testing done at a single visit 6-8 weeks after the exposure.

3) The 1 in 1,000 risk is the average.  Most of the time, the chance of transmission through unprotected vaginal intercourse is far lower than that; indeed, it is often zero, even when one partner has HIV (for example, if s/he is on effective anti-HIV therapy).  In rare circumstances, transmission efficiency can be very high, as in the cases you cite.  The reasons for this, when it happens, have been discussed many times on this forum.  They include how recent the infected person caught the virus, the amount of virus in his or her blood and genital secretions, presence of other STD, and numerous other factors.

You have no HIV worries here, but feel free to get tested if you wish.  As I said, you can count on the result being negative.

Best wishes--  HHH, MD