Dr. Hook Please Help!

Dr. Hook,

Im a 21 year old  straight male in College who got wasted  stupidly with some friends a couple of months ago and hooked up with a CSW . I read up on the net in a news article this area has a 30% incidence of HIV among CSW'S.I always use condoms but this time during sex the condom tore!! I asked her if she had STD's and she said "no I get checked every week" (is that even possible?). 3 weeks after exposure I got night sweats, a rash on my back, swollen glands (neck, groin), my mouth burned, I got a herpes lesion over my lip and had extreme naseau. I already have HSV2 which I got as a teen. I know my risk is high, im scheduled for full testing next week.I have been to my Dr. now several times and he doesn't seem to think HIV should be a big concern (but said I should be tested anyways)  but more so for other STD's. I have taken anti biotics during this time.

1) What is my numerical risk? If she had HIV I've calculated it to be 1/250!!!! Is that right?!
2) All my sympotoms are gone now but my gland on my neck  below my ear is still swollen for 2 months now! My Dr. thought it would be more likely due to my razor burn/in grown hair on my neck rather than HIV. I've had this for ages however and never had swollen glands. Considering I also had a swollen gland in my grion... what do you think? Why is it not going away?
3) Is this a PEP reccomended type of exposure? I know its too late now :(
4) Of all the positive individuals tested every year how many of them are due to 1 time exposure to a positive female through vaginal sex?

Thanks Dr.

[Edward W Hook, MD]

Welcome to the Forum,  Your question indicates that you have thought carefully and researched the issue of your risk.  thus rather than background statements, i will get straight to your questions:

1.  Considering that you are non circumcised and have HSV-2 that numerical risk, IF she was infected is in the right ballpark.  Since you do not know however, and given that the prevalence of HIV is said to be 30% (I doubt this figure, this is higher than in many parts of sub-Saharan Africa), your true numerical risk is lower, as in about 1 out of 600-700.
2.  In general symptoms, including persistently swollen glands, are difficult to use in assessing risk for HIV.
3.  Exactly who should receive PEP is hotly debated.  There are certainly some people who would give someone reporting an exposure of this sort PEP without a question.  Your concerns and information on HIV prevalence are enough to get my attention so I would not immediately refuse your request as I do with most such requests (which tend to reflect unwarranted anxiety).  I would consider it but certainly not urge you to take it ias I would if I knew your partner had HIV.
4. Sorry but there are not statistics on this. The number however is very, very low.

Hope this helps.   Chances are that your test will be negative. EWH

[Randy5000]

Also to top it off I'm not circumsized.

[Randy5000]

When studies show that circumcsion cuts down transmission risk when they reffer to circumcision does that mean no foreskin at all? Or does that include partial circumcision ie) there is still some foreskin but not enough for it to be pulled on top of the penis head.

[Edward W Hook, MD]

When circumcision is performed to remove enough of the foreskin so that it no longer covers the head of the penis it reduces the risk for HIV by about 50% in exposed persons.  EWH

[Randy5000]

Thanks Dr. Hook. I guess that puts my risk now at 1/500 if she was infected (which I consider a given, considering her response when I asked if she had any std's). In regards to the stat of 30% I believe it is unfortunatley pretty accurate as there was also a study published by Harm Reduction Journal that quoted a 26% of prevelance rate for CSW's in the area.

Anyways I wont have any futher comments or questions until my results come in.....hopefully I'll have good news. Thanks for the support.  

[Randy5000]

Dr. Hook,

I got my test back today for HIV and it was negative. I'm still waiting on my results for other STD's. I have a couple of FINAL questions and than I will leave you alone as I know you are busy helping others.

1) Considering my super high risk (1/500) and 26% prevelance rate among CSW's in my area...should I be tested again at the 6 month mark to make sure I'm ok? I've read prior posts and you typically mention that a 3 month test is conclusive---which I have, but my nurse said to test again at 6 months. What are your thoughts based on my specific situation? I still feel like I might be infected and just cant believe that I could have such a high risk and having all these symptoms is just a coincidence....'

2) Just out of curiosity I have seen prior posts where Dr. HHH quotes a 1/2000 chance of infection and other times I see you both quote a 1/1000 chance of infection for a single hetro female to male vaginal sex act. Does the number fluctuate based on a certain situation? I know it does not really matter as a negligible risk is still negligible but I would just like to know from an education perspective.

Thanks alot Dr. You helped me get through this tough time.  It might sound wierd but I kept comming back and reading your words "chances are that your test will be negative" so I could put my mind at rest.

For the future I will try and be more mature and not let a mistake happen like this again. Take care.

[Edward W Hook, MD]

1.  No, a 3 month test will provide reliable information.  The nurse you spoke with was being overly conservative.  As far as your symptoms are concerned, they remain a most unreliable indicator of infection however, just to put your mind at risk, if your symptoms had been due to HIV, it would be expected that your blood test would be positive within a week or two (at most) after that

2.  No, there just is not a meaningful difference between 1 in 1000 and 1 in 2000.  Dr. Handsfield and I agree on this.  

The longer this goes on and with your recent negative blood test, "chances" are now high that you do not have HIV.  Try to not worry and just get a test at 3 months.  I predict it will be negative.  EWH