worried sick at the moment

[soworried539]

Dear Dr,
I had visited 5 sex workers (4 British,1 Hungary)  over the past two years. All the encounters were UNprotected oral(receiving blowjob) and protected vaginal sex.  About 11-13 days since the 28th March encouner,i started to notice 7-10 red bumps (1-2mm) on my chest and they subsided after 5 days (still can be seen today but they are flat and light brown). Since 8th April, I have been having terrible Diarrhea and it does not go away and still very severe today (often go to toilet more than 3 times a day). I have a very notable weight loss from 72kg to 65kg over the past 20 days. I found it very hard to explain the weight loss other than HIV. I also suffer from nausea and have not been eating and sleeping well. I have a mild fever(37-37.4C) from 17th April unitl today. However, there is no sour throat whatsoever, no rash on other part of the body so far. What worry me most is that my stomach makes weild sound all the time and the diarrhea wont go away. there is also on and off sharp pains beneath my left and right chest. I also constantly wake up during the night for no reasons and find it very hard to sleep again (no sweating). I also notice dark yellow ureal from time to time,especailly in the morning.

Sorry for my bad English,hope I have made myself clear.
my questions:
1,How risky was my exposure in terms of HIV and other STDs? Aprt from these 5 encounter,I have no sex at all. Are my symptoms suggestive of HIV? (the weight loss is so scary and it has never happened before)
2,A lots of infomation on this sites suggests receving oral sex is free of risk,but what if the sex worker is newly infected (i vaguely recall loads of rash on her chest,but forgot to ask her status,I can not reach her again since,she is a travelling escort).
3, could the condom break without me noticing? I nearly fogot to mention,I pull the condom off by its tip rather than rolling it back,does that make any difference?

Best

[soworried539]

Thanks very much for the last comment,Dr.
Have a nice day!

[Edward W Hook, MD]

I said no more answers but I will make a solitary exception.

Please consider your syphilis test results conclusiive.  You do not need further testing of any sort.  EWH

[soworried539]

Dear Dr,
Thanks for your help along the way.I would very much appreciate if you can have one more comment.I was tested for HIV and Syphilis at 42 days mark,both come back negative.the rest of the STDs were already negative at 3 weeks.I was vaccined for Hepatitis a&b 3 years earlier.
My HIV was a DUO at a NHS clinic in the UK,I know the result is conclusive,as you suggested.But I was told to test Syphilis at 3 month mark again.In other threads,You said 4-6 weeks would be definitive for Syphilis,I am a bit confused,wondering how conclusive was my result at 42 days? Does that depend on the test they used?I fogot to ask them the name of my Syphilis test,i was tested in the same NHS clinic.
Thanks very much!
best wishes

[Edward W Hook, MD]

Last answer.  

I have answered these questions before.  You are not at risk for HIV from the events you describe.  From a medical perspective. testing is a waste of time so it doesn't matter when you test.  DUO tests are definitve at 28 days (4 weeks) not at 23 but most people would already be positve (no specific figures- studies show a range of values).

There will be no further answers.  EWH

[soworried539]

Dear Dr,
I got my negative result today.I tested at 22days post last exposure and the test is a duo one with p24 .I just wonder how conclusive is this result at 3 weeks mark?What is the percentage of the infected people who got negative at 22 days but will turn out positive after 4 weeks with this test?
I have already scheduled another test next monday(33 days post exposure), but I am quite nervous about it because the result is going to be definative by then.
Thanks for your help.
Best

[Edward W Hook, MD]

Please see above. This is not likely to be an STD- syphilis is an STD.  I am confident that you did not get HIV from the exposure you describe. EWH

[soworried539]

Thanks very much for the prompt reply.Your comment on the forum is amazing!
the red patches are not perfectly round,2-3mm in diameter,no lumps,non-itchy, they are scattered across my palm,especially close to the fingers. They appear today-23 days post exposure,not sure they will persist. But i will definately discuss it with my doctor in the next visit. Do you think they could be syphlis or something elses? I wont get my full STD result unitl at least one week latter.
Finger-crossed my HIV test is negative!
All the best

[Edward W Hook, MD]

1, As I was tested with duo at only 21 days post last exposure.What is the chance of the result turns positive latter if my result turns out to be negative at three weeks?(hope this is the case).
Since your exposures were virtually no risk to start with, I would not worry that your next tset might be positve.  It will not be.

2,there seems to be some red non-inchy patchs on the palm of my hands(not very distinctive),they are absent on other parts of the body,what do you think?
No suggestive of HIV.  You should show them to your doctor however.  
EWH

.

[soworried539]

Thanks very much,Doctor. Your advice calms me down a lot.

Yesterday,i went to a private clinic in Swansea ,UK for a duo test but they suggested the result wont be conclusive as at least 28 days is required.I will get my result next Tuesday and let you know it. I also had a full STD screen in a free GUM the day before yesterday and i will have to wait for at least 10 days for the result.

Could you help me with two more questions?
1, As I was tested with duo at only 21 days post last exposure.What is the chance of the result turns positive latter if my result turns out to be negative at three weeks?(hope this is the case).
2,there seems to be some red non-inchy patchs on the palm of my hands(not very distinctive),they are absent on other parts of the body,what do you think?
Thanks so much

[Edward W Hook, MD]

Welcome to our Forum.  I'll be happy to provide some information which I hope you will find helpful.  I believe that you are over reacting and that to assume that you have acquired HIV from the encounters that you describe is quite unlikely.  The symptoms that you describe - rash, diarrhea, weight loss (most physicians would not consider your temperatures to represent a significant fever)- are quite non-specific and could be caused by many things other than HIV.  I will tell you why HIV is not likely, make a suggestion as to how you can prove this to yourself, and then suggest that you go and get evaluated by an internal medicine doctor who can evaluate other possible causes of your illness.


Why this is not HIV.  Most commercial sex workers do not have HIV.  The likelihood that any of your partners had HIV is low.  In addition, the sex acts you describe were not risky.  Condom use prevents transmission of HIV during genital sexual contact and if oral sex leads to HIV at all, it is very, very rare, occurring less than once in 10,000 sex acts.  If your symptoms did represent HIV, at this time your HIV test would be negative.  My suggestion is for you to get yourself tested for HIV, preferably with a 4th generation, DUO-type test which tests for both HIV p24 antigen and HIV antibodies.  I anticipate that this test will be negative.  When it is, please believe the test results and then seek evaluation for other causes of your illness.

In answer to your specific questions:
1,How risky was my exposure in terms of HIV and other STDs? Aprt from these 5 encounter,I have no sex at all. Are my symptoms suggestive of HIV? (the weight loss is so scary and it has never happened before) .
See above, these were low risk exposure, both for HIV and for other STDs.  You can be thoroughly tested at a GUM clinic.  

2,A lots of infomation on this sites suggests receving oral sex is free of risk,but what if the sex worker is newly infected (i vaguely recall loads of rash on her chest,but forgot to ask her status,I can not reach her again since,she is a travelling escort).
Even with recently acquired infection, the risk of unprotected oral sex is very, very low.  Her rash was not necessarily a sign of HIV.

3, could the condom break without me noticing? I nearly fogot to mention,I pull the condom off by its tip rather than rolling it back,does that make any difference?
No, when condoms fail, they break wide open leaving no doubt that htey failed.   The way you describe removing your condoms is the correct way to do this.

I hope my comments are helpful.  EWH

[soworried539]

I am based in the UK.
Thanks a lot for your help.