Risk exposure with CSW - East Africa

Dear Doc,

Brief background about myself:
26 year old healthy white male, with no STD’s, and HIV neg.

I had a possible risk exposure with a black CSW in East Africa – Tanzania to be specific.
We had protected sex, until the condom broke. The “unprotected” sex lasted for around 3 or 5 seconds. I basically immediately realised this and withdrew. However, we continued to have unprotected oral sex (which she performed on me), and ended with me ejaculating in her mouth.

After the whole incident, I asked her what her HIV status is to what she replied Negative. I have no idea if she was truthful or not.  Regardless:

What are the chances of me contracting HIV – with this brief but definite risk exposure?
Should I rather focus on the possibility that I contacted other STDs, i.e. Chlamydia, gonorrhoea, HPV – through the brief vaginal contact, and then unprotected oral sex?

At this point in time (4 days) after the risk exposure, the only symptom that I can see/feel is the urge to urinate quite a lot. But this can be contributed to the high levels of anxiety I’m feeling.

What I propose is to have full std screening 6 days after the exposure. And then HIV on 6 weeks. Would you agree with this approach?

Your help is much appreciated.

[Edward W Hook, MD]

Welcome to the Forum. I am sorry to hear of your condom malfunction, particularly in the setting of a partner who is a CSW in Tanzania where HIV rates are high.  Your partner may well have had HIV but even so your risk for infection is low.   On average, the risk of acquiring HIV from unprotected genital intercourse is about 1 in 1000 act of intercourse and in your case the sort duration of exposure makes it likely that your risk is lower than average.  There is no meaningful risk for HIV from receipt of oral sex, even if your partner was infected.

I think your plans for getting screened for the more common STDs such as gonorrhea, chlamydia and NGU at 6 days is fine. At that time tests for these infections will be reliable. We do not recommend testing for HPV or for Herpes, for different reasons. For HPV there are no recommended tests for screening men for the infection.  Further, even if you were to get HPV, the infection would ultimately likely clear itself over a period of 18-24 months without consequence.  For herpes, in general if you do not develop lesions by 14 days of exposure, it is unlikely that you were infected.  Blood tests for HSV are not recommended since in the absence of lesions the risk of a false positive test is higher than the actual risk for infection.

I hope these comments provides some useful guidance. EWH

[Whatnow99]

Doc,

Thanks for your reply. It doesn't however spell good news for me. 1 in a 1000 is much worst that 1 in 10 000 or 1 in 100 000.  I take it there is definitely a chance that I contacted HIV through this brief experience.

You didn't mentioned anything about HIV testing in your response!?  Should I be worried and get tested at 4 weeks with DUO test? I guess so. 4 weeks being a confident result?

I'll definitifely get tested for the STD's mentioned in your reponse.

Regarding HPV: I'm getting married in 6 months time. Should I have protected sex until the mentioned timeframe has passed, or should I just make sure my fiance has had an HPV vaccination? As screwed up as it possibly can be....

I'll be on the look out for any herpes/HSV outbreaks in 10 days time. Get treatment if this is the case.

I appreciate your response tremendously.

Best regards.

[Edward W Hook, MD]

As I said, the quoted figure for unprotected vaginal intercourse is 1 in 1000, IF your partner had HIV (you do not know that she did).  Thus I cannot say there is no risk but it is rather low.  A DUO tst at 4 weeks will provide reliable results

As for HPV, over 80% of sexually acitve persons will get HPV at some time in their life. If you and your fiance have had prior partners, there is a fair chance that you have already been infected and didn't know it.  I really wouldn';t worry too much.  I don't mean to diminish your concern but most people have already had the infection.  EWH

[Whatnow99]

Doc,

Update on my testing/symptoms:
Full Std screening on 11 days past exposure: tested negative for all.
No symptoms yet - 16 days after exposure.

Is there anything significant about the negative STI test results in terms of HIV. Can one conclude that since I did not contract any STI, the chances of me contacting HIV is less now than the initial 1 in a 1000 scenario?

Thank you for your professional and prompt assistance.

[Edward W Hook, MD]

If you had acquired an STD from the exposure you risk for HIV, IF your partner was infected, would be higher than the 1 in 1000 figure I quoted.  Not having acquired an STD is good news.  Persons can however develop HIV without experiencing the ARS.  Overall however, things are increasingly in your favor.  You still should follow-up with further testing however. EWH

[Whatnow99]

Doctor,

Update on my situation and testing:
5 weeks & 2 days after exposure - 4th Gen AG/AB HIV test result: non reactive.
No symptoms of any sort whatsoever.

This is a big relief!

Should I retest in a couple of weeks time, or can I take this as conclusive?

Regards

[Edward W Hook, MD]

Believe these test results. there is no need for re-testing

EWH

[Richard1985]

My experience was very similiar to this (East african CSW in London) but sex was protected and lasted around 2 minutes, with protected oral for around 4 minutes. Can I assume my risk is zero? It was around 3 days ago and I have a sore throat now.