HIV Exposure and Risk

DR,

I have a question regarding HIV exposure and risks and possible tests.  I have been in a relationship for a long time, and recently (past two weeks) had 2 one time protected vaginal encounters with two different sex workers in the US (Texas).  I am now worried about possible HIV infection.  The incidents happened within 4 days of each other and are as follows.  The first incident was of protected vaginal intercourse (latex condom).  The condom did not break (to the visible eye) or slip off.  It lasted about 10 mins.  I had ejaculated and stayed inside her for about 2 more mins.  Again the encounter was protected and the condom did not fail.  The second encounter was protected sex for about 10-15 mins and I stopped as soon as I ejaculated (condom did nto break or slip off).  Again a latex condom was used.  Also the second time I sucked on her nipples.  I had a few questions as I am worried.

1.  What are the chances that I could have contracted HIV (two episodes of protected sex with female sex workers in texas)  I am afraid even though I know that the chances are low but since they were sex workers they might have a high probability of HIV I am guesssing?

2.  I read and have been told that a DNA test (type of NAAT test i believe?) is conclusive at 28 days and 90% conclusive at 14 days post exposure.  What are the chances of a false-positive on this test?  Should I take this test?

3.  What should I do regarding tests?

4.  Should I be worried and why or why not?

5.  Any other pssible advice?

Thank You DR,
C.J.

[Edward W Hook, MD]

Thanks for your questions.  They are familiar questions which have been discussed many times on this Forum.  As a result, to verify and expand on my answer you may wish to look at other posts on this site.  The brief answer to your questions is that your risk for HIV from the exposures you describe is so low that the only reason for you to get tested for HIV is to get peace of mind.  There is no meaningful risk from the exposures you describe.  Now to expand on this brief answer I will work through your questions one-by-one:

1.  the basis for your concern, the assumption that most CSWs have HIV is incorrect.  While CSWs may have more HIV than the general population, here in the U.S. it is nonetheless very unusual for a CSW to have HIV with rates being in the neighborhood of 1-5%, depending on where you live.   In addition, condom protected sex is safe sex.  thus there really is no meaningful risk to you of having gotten HIV.
2.  The DNA test is expensive and its performance is not week established.  I would advise against it in your situation.  The rate of false positive tests is far higher than for the more traditional antibody test;  in your situation, your risk of a false positive is many times higher than early detection of HIV.
3.  Your risk is so low that you are getting tested primarily for your own peace of mind.  I would suggest you get an antibody blood test at 6-8 weeks following your exposure.  At that time over 95% of newly acquired HIV tests will be positive and, given the low probability of infection even before your test, the negative test result I am sure you will get should be interpreted as proof that you did not get HIV.
4.  No reason to worry. See above.
5.  No

The symptoms you describe do not suggest HIV or any other STD.  I would not worry about them.

Hope these comments help.  EWH

[okutc22]

Also forgot to mention that 2 days after the second encounter I had two small cankers in my mouth left side.  They dissappeared within 5 days and I have had these before ( I believe they were probably present due to stressing about this and anxiety).  Also had a small feeling in the groin area above the penis area and to the side.  The feeling though is not much and only is there when I think about it.  If I forget for a little I do not feel anything until I start thinking about it again (I am guessing this is due to anxiety also).

Thanks

[okutc22]

Thank you for your help and in answering my questions.  I will get a antibody blood test at the 8 week after period, just for peace of mind.  I already am feeling much more relaxed after getting an opinion from an hiv expert such as yourself.  I looked at the other posts and saw that my chance of getting hit by lightning is even higher than being positive.  I will keep you posted if anything further worries me (though i doubt it).

Thank you,
C.J.

[okutc22]

I had 2 more questions

1.  You mentioned chances are really low, I was just wondering what you think the odds are?

2.  I was confused by your answer on if I should take a test.  You first said no test is necessary but when I asked in ? 3 if I should take any test you said take one in 6-8 weeks.  Was wobdering if that test is necessary or chances r so close to 0 that I don't need any teat at all.

[Edward W Hook, MD]

1. risk is close to zero.
2.  Testing was recommended primarily for your peace of mind.  EWH

[okutc22]

Thank you for your help so far I had a quick few more questions.

The day after my first encounter I had brief unprotected sex with my gf for about 2 mins and pulled out without ejaculating or anything now 2 weeks later she has developed a mild sore throat and no other symptoms.  I am scared even though I had protected sex with the csw any reason this should cause worry?  I have no symptoms.

Also, based on what has been said before would my chances of HIV from one-time protected sex with a csw be around 1 : 100,000 or even lower condom didn't break?

One last question I called the csw to ask if she had been tested recently, she wouldn't tell me an exact date of her last test instead sayig I get tested frequently and have always been clean.  In addition she sounded offended and said don't call me with this bs if ur so worried go to ur doctor.  How should I take what she said.

Thank you so much Dr.

[Edward W Hook, MD]

This will be your last answer.  You are spenidng too much of your time worrying about this and it appears that my responses are fueling rather than helping your anxieties:

1.  No, no risk for your wife.  Her sore throat is coincidence.
2.  Even lower, closer to 1 i 1,000,000 with a properly used condom
3.  I wouldn't worry about it

This will end this thread

EWH