Chances of contracting HIV in Russia?

Background:

I am 29 M, never had sex with anyone other than my partner/fiance.  On Jan 23rd, I picked up a CSW from an expat pick-up joint. The girl spoke English, told me she would not go to my home, but only to a hotel. So she was careful.
Since I was pissed drunk, I never got fully erect. She tried to give me oral first with condom, then without (20-25 seconds without) I stopped her but she said "don't worry about it". I also had 1-2 minutes of vaginal sex, for which I had the condom on but since I was not erect I don't remember if the condom got off or not. I never ejaculated. After a couple of minute, I threw up massively and passed out. I also got my foot injured by a wine glass- a lot of bleeding and my blood was exposed to any diseases she could transmit.

Next morning I found that she had cleaned my vomit and blood. She even informed hotel reception about the broken glass. I also found 2 used condoms in the trash can. She only took her $300 and didn't touch other money, credit cards, laptop etc

Now my questions:

1- What is my likelihood of contracting HIV and other STDs based on the above...considering:
- She was a CSW in Moscow? HIV rate 10% (?).
- She gave me unprotected oral without me asking...definitely does that with hundreds of other customers too, plus may be unprotected vaginal sex too then (who knows?)
- The fact that She was CSW= she has multiple (high risk?) partners= I have multiple partners...does that put me into a very High risk category?
2- I am planning on getting a 10 day PCR test along with other STDs at Freedom Health in London on 12th day post exposure. What do you think about the reliability of this test? I have read that this is not not recommended for HIV diagonsis-- but has an accuracy of ~94%? And it has more false positive probability than negative? is this correct?  
3- Can most of the other STDs be detected on 12th day?
4- Are there any other labs/tests there that you recommend?

thanks,

[H. Hunter Handsfield, M.D.]

I sort of have to agree with one of the comments in response to the same question on the HIV community forum:  I hope the Coen brothers read it someday.  What a great scene for one of their movies!

I don't mean to belittle your concerns.  I would not have made that joke if I believed you were at signficant risk of HIV from those events.  The bottom lines are that it seems unlikely your partner had HIV; that oral sex and condom-protected vaginal sex are virtually zero risk, probably regardless of the quality of one's erection.  Any injuries from the broken glass would seem to have risked only exposure to your own blood and vomit, not hers.  (Nice lady to have done the clean-up, don't you think?  And not ripped you off?)

1) Low risk you caught HIV, even if she had it.  I don't know if the 10% positive rate among Moscow CSWs is correct -- but my guess is that it's lower in higher-class CSWs of the sort that cost $300.  She probably knows that oral sex is low risk, and apparently she has her customers use condoms for vaginal sex.  That's a good sign, which reinforces the likelihood she isn't infected.  When a CSW insists on condom use, it's often evidence they don't have HIV and want to stay that way -- not that they are infected and trying to protect their partners.  In general, CSWs are at higher risk from their customers than the other way around.

2) I don't really recommend PCR testing in this situation.  If done and negative at 10 days, it will be reassuring -- but there is a small but definite risk of a false positive result.  Think what you'll go through for a few days if you have a positive result, then have to await the confirmatory testing showing you don't have HIV after all.  I suggest just waiting a few weeks and having a standard antibody test.  Further, I recommend you visit a genitourinary medicine (GUM) clinic.  The UK's GUM clinics are among the most expert resources in the world for assessing STD/HIV risk and providing science-based clinical services.

3,4) Gonorrhea and chlamydia testing can be done any time after 2-3 days.  Syphilis blood tests, like HIV, take 4-6 weeks to be reliable.  I recommend against testing for any STDs other than these.  Here again, the best strategy would be to visit a GUM clinic and rely on their recommendations.

I hope this helps.  Best wishes--  HHH, MD

[stupid_717]

Forgot to add: the reason I am in rush for testing is because I'm getting married on March 14th-- and I don't want to pass on anything to my fiance/wife.

Thanks, please advise.

[H. Hunter Handsfield, M.D.]

This is another reason to get expert personal care, such as from a GUM clinic, and not relying on a distant online expert or a non-expert clinic.  Follow the GUM advice about what tests to do at what times.  Trust me, the average clinician in a UK GUM clinic knows just as much about these things as I do, perhaps more.

[stupid_717]

Thanks Dr. This is great advice-- I will wait for the 28 day DUO.
I know, I am acting like a child here, but this stress is costing me my sleep...and very soon my job too...and I can't seem to get over it.

Some followup questions:

1- In case my condom got off due to no erection while have brief vaginal sex and she was HIV positive (worst case scenario)-- what are my odds?
2- I won't be in the UK for the 28 day test- it would have to be in Texas...do you recommend any labs etc there?

[H. Hunter Handsfield, M.D.]

The average risk of HIV transmission through unprotected vaginal sex, female to male, is around once for every 2,000 exposures -- if the woman has HIV.  If we go with your 10% figure for that, then the chance becomes 1 in 20,000.  To put that in perspective, for people who live in North America, that's about the same risk of getting struck by lightning someday.  And your risk probably wasn't that high.

I don't know any specific clinics in Texas.  The local health department STD clinic would be a good bet for excellent advice, however.

[H. Hunter Handsfield, M.D.]

That's all for this thread.

[stupid_717]

Hello Dr.
I just wanted to give  an update on my situation and ask some final questions.

Following your advice, I went to GUM clinic, they did a Gonorrhea and chlamydia test which came back negative. They also referred me to a pvt clinic (much cheaper than Freedom Health) for a quicker test..I am awaiting my PCR result in 3 days.
My questions are:

1- I have spent several hours browsing almost all questions on this board (I took days off from work as they wanted me to go to moscow again- never in my life I am doing that!!). It seems like there are a lot of cases  with CSW condom failures. Do you remember or heard of any case with male getting HIV from a single exposure from CSW?

2- If I get my PCR negative- should I do a 28 day DUO as well for reassurance and a 3 month test too....or just move on? I want to be really sure  about my HIV status before having sex with my fiance. The doctor at the pvt clinic said based on my exposure, I wouldn't need further testing.

Thanks again for your advise- I will not post any further questions.

[H. Hunter Handsfield, M.D.]

You should stop relying on any distant source of information without the direct ability to examine you and provide coordinated health care -- and that includes this site.  Ask those questions of your own doctor or the GUM clinic that referred you there.  (Whether or not I have ever had a patient who acquired HIV from an exposure like yours is irrelevant in judging your risk.  But it happens that I have not.)

FYI, Feedom Health appears to be a respected multispecialty clinic with respected and well qualified HIV/AIDS providers.

That's all for this thread.  Feel free to return once more to report your negative PCR test result.  I will delete any other comments without response.

[stupid_717]

Hello Dr. I just got my 14 day Proviral (PCR DNA) results back....and its NEGATIVE (Thank you, God!).

Thanks again for your support and advise-- it kept me rational during the extreme anxiety driven time. I am pretty sure I will never drink alcohol and/or cheat on my fiance again-- but if I do, I know who to reach out to for advise now:)