Please Help!! Londoner Needs HIV Risk Advice on Broken Condom Incident

[westyz]

Hi I coulnt find a HIV section so thought id try this area... I know a couple of similar(-ish) questions have been posted but none really relate to my situation. I'd really appriciate it if you can help
i was in thailand almost 6 weeks ago and i had protected vaginal hetero sex with a local dancing bar girl- im sure she was a sex worker (although she didnt charge me for some reason!) during sex the condom broke- i realised instantly and withdrew. Thus was minimal contact as far as i am aware.
there was no shower in the place we were in so it took me about 1/2 an hour to get back to my room & clean myself up.(this is a concern as i didnt get to immediatly wash my penis, saying this there didnt seem to be any vaginal fluid on it-it was pretty dry!)
the next day i thought it best to call a clinic in the uk about what had happened- they said there was pretty much nothing to worry about.
on returning to the uk 26 days after exposure I had HIV antigen and antibody test at a local sexual health clinic -this came back as negative on both counts. the health worker was very upbeat & said with all his experience there was nothing really to worry about.  

Nearly all the healthcare workers/help lines i have spoken to have mirrored this advice, however one doctor I saw during a screening for other sexual infections said the risk of me having contracted HIV was far greater, especially due to the nature of the contact (ie. that it was in thailand with a sex worker) she said it would even have prompted the consideration of me using PEP! She said that because hiv usually enters through the mucus membrane in the ureatha of the penis, even minimal contact is v dangerous. I didnt know this at the time, i thought the HIV in vaginal fluids only really penetrates the head of the penis if there is sufficient friction/abrasions there.    
she also said the test i had wasnt of any great use.
In your opinion where do I stand in respect of the advice ive been given?

My second problem is -Just over a week after my test(35 days after exposure)i woke up feeling quite nauseous,& suffering from a gassy/dodgy stomach. it was out of the ordinary like i was a bit car sick. i was concerned that this could be a symptom of possible seroconversion. about 30 hours later it had gone but now its back 4 days later since i got up this morning & pretty much all day its been the same, can eat/cant eat, feeling like im hung over. but no headaches.

I've spoken to a couple of people on helplines and they have said it doesnt sound like anything as serious as the effects seroconversion can bring (although i also know these can vary)
I know its diffucult but could you please give me a second opinion.
now im running out of space, one last thing.tomorrow it will have been 6 weeks since my exposure, some people have said here that its enough time to be able to have an accurate HIV test?is this right?
I hope you can help, thanks so much, this site is truly a great resource. Nick

[H. Hunter Handsfield, M.D.]

I agree with the people who described your exposure as low risk and strongly disagree with the one who would have recommended PEP; the risk from any single episode of vaginal intercourse is just too low to warrant PEP.  I might make an exception if a person's partner were known for sure to have HIV, but most Thai commercial sex workers are not infected.  In any case, you can rely with 90% certainty on a negative HIV test result 35 days after exposure.  Symptoms never are a reliable indicator either for or against HIV infection; the blood test result (even as early as 35 days) is much more reliable.  But your symptoms don't sound like HIV anyway.

Bottom line:  Your risk for HIV seems low and the negative test so far confirms it.  To be even more certain, you can have a test at 6-8 weeks.  Some would recommend a 3 month test as well, but with modern tests it really isn't necessary.

Best wishes-- HHH, MD

[carnageofthepast]

You risk for acquiring HIV was very low, probably less than 1/1000 for the exposure you describe(thats assuming the sexworker had hiv)

Additionally, a negative hiv test that includes antigen testing is highly encouraging at 26 days.  Since the average time to seroconversion is 25 days, and the antigen shows up about a week before the antibody, your test is probably accurate.  Get a test at 8 weeks if you are still worrying but you are probably fine.

[thiskilling]

i have a question..and i have not got the answer for this question yet...is ORAquick(rapid) test is as conclusive as other test after 6 weeks?..please doctor reply or any other person about this ..thanks

[H. Hunter Handsfield, M.D.]

Yes.  A negative Oraquick is just as conclusive as any other test.

HHH, MD

[westyz]

hi thanks for replying so soon, one thing though - the full HIV test I had was at 26 days - (just under 4 weeks) and not 35 days as you mentioned - it was me feeling ill that started at 35 days! carnageofthepast has posted that this wouldn't be a problem, but would this change your advice at all? cheers, Nick

[dbbman]

I had a very similar experience around the same time but didnt realise for 1-2 minutes.What would be the the risk in my case?

[thiskilling]

thanks for replying..take care..

[carnageofthepast]

As you will read on any reliable hiv site, symptoms are never a way to diagnose hiv infection since there are much more common causes for symptoms than hiv.  The only answer that will alleviate your anxiety is to get another test at 8 weeks, this will be conclusive.

If it makes you feel any better, I'd bet money that you dont have hiv mainly because the chance that the antigen would show at 25 days is like 95% even if the antibody was still negative.  The p24 antigen is an actual part of the hiv virus so it shows independently of your body's response.   It only disappears once antibodies appear.

[westyz]

sounds like your pretty clued up on a lot of this stuff, & it's certainly knowledge worth knowing I can tell you! can you recomend any decent HIV info sites, since I've come across quite a few over the last few weeks that are based both in the uk and usa - its sometimes difficult to know which ones are putting accross the right information... Nick

[carnageofthepast]

aidsmeds.com is a good one and thebody.com is a good one.  The official recommendation by the cdc is to wait 13 weeks for a reliable test.  This is more than long enough for the majority of people and is used as a safety net to catch all cases.  However, as stated before, 25 days is the average time to seroconversion so almost everyone will show between 4 and 6 weeks on antibody test.   I suggest you IMMEDIATELY STOP searching the internet about test times and symptoms and wait either 8 weeks or 13 weeks so you can get this behind you.  I wasted 3 months of my life obsessing and worrying over having this disease when I was totally fine the whole time.

[westyz]

hi carnage - just one last thing regarding our conversation, do you know if there is a time gap in-between the antigens disappearing and the antibodies appearing in the blood? It’s just that if this is the case, because my test was at 26 days could it have possibly been in that gap period between antigen and antibody? My fears are just heightened because I had a mystery illness (ie. just feeling nauseous on and off from around the 35 day mark…) thanks Nick

[westyz]

Hi there was just one other question, do you know if it takes a certain amount of time for the symptoms of seroconversion to appear after the actual seroconversion - or does it generally take hold pretty instantly? Nick

[carnageofthepast]

generally antibodies appear during or shortly after the seroconversion illness.

Just get tested again and get your negative result so you can move on

[anxious23]

A related discussion, unprotected oral and tested negative at 42 days was started.