possible Hiv infection

[londonman]

Im 38 year old male. was in Tanzania (high risk country) with work and had encounter with sex worker. I received oral sex for about 1 minute unprotected,then put on condom and had vaginal sex. I did go a bit soft but on retraction condom was in place. hard again then continued till orgasm, retracted and condom was still in  place. 3 days later had burning sensation inside penis which lasted for 15 days went to gum clinic and nothing was found . 21 days after sex woke up with fever, aching muscles and sore head this lasted for 2 days the headache however for four. About 10 days later started to have night sweats wetting my t shirt from chest up to head, nowhere else on body though, have had about 6 or 7 of these over a period of six weeks I had one little ulcer in my mouth although i get them quite regularly. I have been panicing ever since. I keep telling myself I had safe sex but my mind is playing with me constantly now. And now at thirteen weeks after sex I have headaches have broken out with painfull spots around my mouth and nose and now have pains in the groin . please help me . Have I had ars and seroconverted?

[H. Hunter Handsfield, M.D.]

At a UK GUM clinic, you probably are getting excellent advice and care by people who know as much about this sort of thing as I do.  Since the condom remained in place and oral sex is low risk, the chance you acquired HIV during that exposure is very low.  Your symptoms are consistent with ARS, but also with a hundred other conditions that are more common.  So on balance, the odds are strongly in your favor.  But the way to know is to have an HIV test.  Go back to the GUM clinic and follow their advice, which undoubtedly will include testing.

I won't lecture about your decision to have sex (even protected) with a commercial sex worker in Tanzania or any other sub-Saharan country.  You know how dumb it was. But it was protected--for that you get credit!

Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

I want to add a comment about commercial sex workers and HIV risk.  Most questions on this forum related to CSWs ask about exposures in North America or other industrialized countries, often high-priced escorts.  The likelihood such CSWs have HIV is generally low, and many who are infected probably are on treatment.  

The situation is radically different in sub-Saharan Africa, where most women who prostitute themselves do so out of economic necessity, not choice.  Often that necessity exists for the precise reason that they have HIV!  They caught it from their husbands, then became widows; or got kicked out of the house because of their HIV infections.  So the likelihood a CSW in Tanzania, South Africa, Zimbabwe, Mozambique, etc, etc has HIV is very high.  Further, most such persons cannot affort antiviral therapy, so they have high viral loads and likely are highly infectious.  And the overall rate of other STDs is high (especially herpes), further increasing the chance of transmission.

There are plenty of exceptions to all these comments, both in industrialized and developing countries.  For example, owing to intensive and highly successful education programs in Thailand, the rate of HIV in Thai CSWs is low (much different than 10-15 years ago). But travelers to Africa, the Indian subcontinent, most of Asia, and most developing countries should think twice (or 3 or 4 times!) before having commercial sex.

HHH, MD

[scared_25]

What about the escorts that are now in North America who have come over from Asia.  Thanks  

[dumbo]

I believe they have to test negative before entering the US unless they are of refugee status then don't think that applies.

[inthecorneralone]

A related discussion, oral risk in Africa was started.