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Risk Assement Requested
Dear Doctor,
Recently I've engaged in stupid behavior that has put me at risk for HIV.
Two weeks ago I visited China for two day sex trip. On the first day of the trip I noticed a very small red area about 1 inch from the base of my erect penis that looked like a mosquito bite. I assumed it was an inflamed blood vessel from walking too much and didn't think much of it. I had a thigh massage with oil and noticed my groin area hurt after the massage, probably from all her probing.
I then proceed to have sex with four street walkers after the next two days. All protected sex, always with condom, no breakage.
At the end of day 2 i had a rash (hives?) from my inner thighs all the way down to the top of my inner knees. The rash looked like hundreds of very tiny red spots and went away in one or two days. I thought it was a reaction to the oil.
On day four after the trip I was diagnosed with Genital Herpes and am now suffering the first initial outbreak. I had no idea I had the disease. The "mosquito bite" seems to be the center of the outbreak".
Given that I had the red mosquito bite thing a few hours before the first sexual encounter, it seems to me that I had the unfortunate experience of suffering from the beginning of a primary (initial) herpes outbreak at the exact same time I was engaging in the risky activity. I checked my penis before sex each time and only the small mosquito bite existed. There were no other lesions or other cracks, etc.
Questions:
1. It is unclear to me whether the condom went down far enough to cover the red area. If it didn't, what is the chance I've contracted HIV through the red area?
2. To make matters even worse, i now believe one of the SW's had warts or herpes or something strange. She had no lesions in her vagina, but had an inch scab area on her bottom chin, a small blister near her right inner knee, and another one left inner thigh.
3. Am I totally doomed to have caught HIV?
Thanks.
Recently I've engaged in stupid behavior that has put me at risk for HIV.
Two weeks ago I visited China for two day sex trip. On the first day of the trip I noticed a very small red area about 1 inch from the base of my erect penis that looked like a mosquito bite. I assumed it was an inflamed blood vessel from walking too much and didn't think much of it. I had a thigh massage with oil and noticed my groin area hurt after the massage, probably from all her probing.
I then proceed to have sex with four street walkers after the next two days. All protected sex, always with condom, no breakage.
At the end of day 2 i had a rash (hives?) from my inner thighs all the way down to the top of my inner knees. The rash looked like hundreds of very tiny red spots and went away in one or two days. I thought it was a reaction to the oil.
On day four after the trip I was diagnosed with Genital Herpes and am now suffering the first initial outbreak. I had no idea I had the disease. The "mosquito bite" seems to be the center of the outbreak".
Given that I had the red mosquito bite thing a few hours before the first sexual encounter, it seems to me that I had the unfortunate experience of suffering from the beginning of a primary (initial) herpes outbreak at the exact same time I was engaging in the risky activity. I checked my penis before sex each time and only the small mosquito bite existed. There were no other lesions or other cracks, etc.
Questions:
1. It is unclear to me whether the condom went down far enough to cover the red area. If it didn't, what is the chance I've contracted HIV through the red area?
2. To make matters even worse, i now believe one of the SW's had warts or herpes or something strange. She had no lesions in her vagina, but had an inch scab area on her bottom chin, a small blister near her right inner knee, and another one left inner thigh.
3. Am I totally doomed to have caught HIV?
Thanks.
MEDICAL PROFESSIONAL
A single antibody test at 6-8 weeks would be sufficient in this situation. If you get more than one test, do it twice, at 1 and 3 months. You can expect negative results.
If your sexual behavior and choices bother you, counseling is a good idea. Congratulations for recognizing and dealing with it.
If your sexual behavior and choices bother you, counseling is a good idea. Congratulations for recognizing and dealing with it.
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help.
Some aspects of your story indicate high risk for HIV, others low risk. Certainly your partners were at high risk. Not all sex workers are, but street walkers tend to be at high risk. And if you have genital herpes due to HSV-2, your risk is higher than otherwise; and the risk appears to be especially high if someone is exposed to both viruses and catches HIV and HSV-2 at the same time. On the low risk side, you used condoms for all the exposures, and condoms are highly protective.
You don't describe how the diagnosis or genital herpes was made. Your description doesn't sound much like herpes. The rash on your thighs was definitely not herpes, and a single penile sore is unusual for the first HSV infection. If you do have HSV-2, you might have had it before the sexual exposures you describe.
To the specific questions:
1) The chance of catching HIV while wearing a condom is very low, regardless of other lesions on the penis. The penile lesion might have elevated the risk, especially if it was due to herpes -- but the odds still are strongly in your favor.
2) I cannot comment on one SW's skin lesions. Certainly the ones on the thigh and knee are not of concern; those are unusual locations for herpes lesions. I suppose the oral lesion could have been herpes, but only HSV-2 is associated with increased risk of HIV transmission; HSV-1 (which causes the vast majority of oral herpes) is not.
3) All things considered, the risks are high enough for you to be tested to be sure you didn't catch HIV. But as I said above, the odds are strongly in your favor. The chance you caught HIV probably is less than 1 in several thousand.
I hope this helps. Best wishes-- HHH, MD
Some aspects of your story indicate high risk for HIV, others low risk. Certainly your partners were at high risk. Not all sex workers are, but street walkers tend to be at high risk. And if you have genital herpes due to HSV-2, your risk is higher than otherwise; and the risk appears to be especially high if someone is exposed to both viruses and catches HIV and HSV-2 at the same time. On the low risk side, you used condoms for all the exposures, and condoms are highly protective.
You don't describe how the diagnosis or genital herpes was made. Your description doesn't sound much like herpes. The rash on your thighs was definitely not herpes, and a single penile sore is unusual for the first HSV infection. If you do have HSV-2, you might have had it before the sexual exposures you describe.
To the specific questions:
1) The chance of catching HIV while wearing a condom is very low, regardless of other lesions on the penis. The penile lesion might have elevated the risk, especially if it was due to herpes -- but the odds still are strongly in your favor.
2) I cannot comment on one SW's skin lesions. Certainly the ones on the thigh and knee are not of concern; those are unusual locations for herpes lesions. I suppose the oral lesion could have been herpes, but only HSV-2 is associated with increased risk of HIV transmission; HSV-1 (which causes the vast majority of oral herpes) is not.
3) All things considered, the risks are high enough for you to be tested to be sure you didn't catch HIV. But as I said above, the odds are strongly in your favor. The chance you caught HIV probably is less than 1 in several thousand.
I hope this helps. Best wishes-- HHH, MD
I wish to add that I of course will get HIV tested, realize it needs to be done at 30, 60, and 90 days. I also have started counseling so I do not engage in risky behavior again.
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