Your Thoughts

[Monroe4]

Doctors: Would you provide your thoughts based on the following:

1. Brief (3-5 min) protected vaginal sex with a csw from China in a Nevada massage parlor. Condom remained intact. CSW claimed that she is healthy and that there is "nothing to worry about".
2. Condom was very, very  tight which caused some irratitation and small scabbing around the base of the head of the penis. the scabbing lasted for 3 days.
3. Three days after the encounter skin on the penis was very hot and tingly--although no pain on urination--Symptons subsided within 5days of the encounter.
4. Some feeling of possible lymph node pain, cannot feel nodes but feel some soreness under arms and in groin--maybe from touching the area to see if there is lymph node enlargement?
5. No fever, but temperature ranging from 98.6-99.3--no other physical symptoms
6. Extreme guilt, worry and anxiety.

Based on the above:
1. What is the risk for an HIV infection?
2. What do you think caused the burning sensation on the skin of the penis?
3. Do you recommend an HIV test in this situation--if so, what type, and at how many weeks?

thanks

[H. Hunter Handsfield, M.D.]

Welcome to the HIV forum. I'll try to help.

You describe a sex partner who almost certainly doesn't have HIV, which is very rare (virtually nonexistant) in Las Vegas CSWs, especially if she was in a licensed brothel. And HIV infected people rarely lie about it, and when a CSW uses condoms it's usually evidence she is not infected and intends to stay that way.  (After all, CSWs are at higher risk from their clients than the other way around.)  Even if she was infected, you had condom-protected sex.  I don't see how condom tightness alters the situation, and skin "feeling hot" doesn't sound like anything signifcant.  To the specific questions:

1) Zero for all practical purposes.

2) Neither HIV nor any other STD causes skin burning sensation without visible rash, sores, etc.

3) From a medical or risk assessment standpoint, no HIV testing is needed.  The only possible reason is that if this reassurance doesn't settle your fears, you might benefit psychologically knowing you have a negative HIV test.  If so, wait 6 weeks then have whatever standard test is done by your doctor or your local health department.  All tests in routine use in the US are equally reliable.

I hope that helps.  Best wishes--  HHH, MD

[Monroe4]

Dr:

I am very grateful for your response.

One last and final thing--does the irritation caused by friction of the condom and subsequent scabbing below the head of the penis concern you? My paranoic thought is that it would be a potential entry point for infection--yet the rational side of me knows that the site where the irritation occurred remained covered by a condom for the duration of the activity.  It has been a very anxious, tense and unpleasant 8 days since the encounter I described. Once again, thanks so much for your wisdom and advice.

[H. Hunter Handsfield, M.D.]

I was aware of your concern about friction and took it into account in my reply.  It doesn't change my opinion or advice.