Protected sex with escorts/random women

[rustylittle]

Dear Dr. Hook,
Hope this finds you well.
I am a 30 y/o male. I have had 6-7, latex condom protected sexual encounters, oral & vaginal since October last year, involving escorts & random women. I used the same condom for Oral,followed by vaginal sex. I checked the condoms after, with water & squeeze & they were all intact.I dont do drugs or alcohol. I used Durex Ultrathin/trojan, within expiry & well stored.
I do have chronic allergic rhinitis/sinusitis since year.
Was doing well, when I had a bout of severe sinusitis Dec 4, which resolved on its own, following sex with escort, mid Nov. I started feeling weak, sleepy after that episode.
Had a trip to Florida in Mid December,got exposed bcz of unexpected chilly conditions. I did not have any symptoms for a week after, when on Dec 25, I had fever with chills, acute tonsillitis,malaise, following sex with a random girl on 24th night. Tosillitis responded well to Levaquin. This was followed by burning & pain on the left side of the Corona of my glans penis, Jan 5. There were no ulcerations/discharge. I had to void frequently because of irritation of my lower urethra. I have had somewhat similar sensation in the past when I wasnt sexually active, which resolved on their own, & sometimes with a course of ciprofloxacin.
I went to a doc, who gave me a 1gm dose of Azithro.. My UA was WNL. Symptoms improoved dramatically after but i still get the same burning & pain at times when I masterbate/ejaculate.
I flew back to my native country a week back & my sinusitis got worse, making this 3 episodes since early Dec. I feel week, sleepy, with low energy. I dont think Iam depressed but keep thinking about HIV exposure.  I got a home HIV ab test in MID DEC & was negative..Might hv had low grade temp, random also.
1)Could I have been exposed to HIV, assuming I had chlamydia responding to Azithro?
2)How do u explain my symptoms of weekness, severe sinus congestion,low grade temp.Can this be ARS?
3)MyHIV risk,ur advise

[Edward W Hook, MD]

1.  There is no way to interpret the improvement of your symptoms with therapy.  There is little reason to worry that you had an STD however.

2.  You are correct that the other STDs you mention are easier to transmit than HIV (for which transmission occurs once in every 1000 exposures to infected persons).  As for your symptoms, they could have been due to trauma, to an allergic reaction, or to anxiety.  

3.  Not that I would recommend.  If you wish to get tested why not just go to your local health department. They provide expert, inexpensive service with great confidentiality.

4.  Every time you have sex with a new partner who has not recently been tested, there is a risk for getting an STD, including HIV.  Overall however, the risk is low.  Most exposures to infected partners do not lead to infection.   Condom use reduces risk further, to negligible levels.

The prevalence of HIV among CSWs in the U.S. varies according to the sex worker.  Higher rates in street CSWs who use IV drugs, very low in other settings.

5.  Your symptoms are not compatible with ARS.

EWH

[Edward W Hook, MD]

Welcome to our Forum. I'll try to help.  I congratulate you on your commitment to safe sex.  It will keep you healthy. Condoms are the best protection against acquisition of STDs and HIV as long as they are used correctly and consistently.  It sounds as though you are doing that and if so, you are not at risk for either STD or HIV.

Scientific study of personal protection by condoms is difficult to do because you cannot observe condom use between infected persons in experimental situations. As a result to study condoms we must conduct the studies in which data are collected using reports of person's behavior.  This of course makes things difficult because people sometimes say they used condoms when they don't.  Despite these limitations, all well conducted evaluations of condoms show that condoms at least reduce the risk of getting STDs when used properly.  Whether they are 100% effective or not is hard to prove but most experts believe that in situations like yours there is virtually no risk of HIV or of other STDs from condom protected sex.

In your own case, not only were you using condoms but you have also taken a dose of azithromycin which would be effective for treating many STDs, if you had one.  You don't mention whether the doctor you saw took any tests or not. If he didn't that is too bad and I wish he had.

At the present time, form all that you tell me, it is very, very unlikely that you have an STD of any sort, including HIV.  If your are concerned, you should see your own personal doctor and get tested.  I am confident that the tests will be negative and your symptoms are due to something other than an STD, including HIV.  As far as your specific questions:

1.  Do you know you had chlamydia for sure?  You do not say you were tested.  If you did have chlamydia, it means you weren't using your condoms properly.

2&3.  Your symptoms do not suggest ARS.  Your HIV risk is virtually zero.   Your December HIV test was too early to provide you with definitive test results.  Using standard antibody tests, results are definitive 8 weeks following your last exposure.  I would advice re-testing, to be sure and to convince yourself that this is not HIV.  When you learn that you do not have HIV, talk with your doctor about other possible causes of your symptoms

I hope this is helpful.  I would not worry about HIV or STDs if I were you.  EWH

[Edward W Hook, MD]

Last answer.  A test obtained 8 weeks following exposure provides conclusive information about the presence or absence of HIV.  You id not get HIV. EWH

[rustylittle]

Dear Dr. Hook,

Hope you are doing well. I got a HIV 1/2 Elisa through the Home Access HIV kit test, & it was negative.
My last sexual encounter was on 2nd of Jan, & I tested on March 7th, almost 9 weeks apart.
Would the result be considered conclusive? Any more testing required?

Thanks.

[Edward W Hook, MD]

These are pretty much the same questions you asked of me earlier. My answer has not changed.  your course is compatible with mononucleosis.  If you choose to test for HIV that is, of course up to you. I am confident that if you do, the test will be negative.  EWH

[rustylittle]

I hope you are doing well.
You might remember me. I have ordered a home HIV test to be sure of my issues. I have discussed my concerns with a few MD friends of mine, who were of the opinion that I might be having Infectious Mononucleosis, which can be caused by EBV,Herpes, CMV etc, as you had suggested.

1) I continue to have Malaise, & constant back stiffness & pain when I get exhausted from work. Do you think that HIV might present in this fashion? I

2) Would Mononucleosis last this long? I have had this malaise since December, but the back aches since January.

3) Would you consider changing your eval with my on going fatigue??

I am sorry to bother you with the questions again.

[rustylittle]

Thanks a lot Dr. Hook.
I know it was stupid question but I needed to see things objectively.
Have a good day.

[Edward W Hook, MD]

I have to say, "have you ever...." questions are really a bit silly.  While I have seen thousands of patients and read the literature, what if it had happened once?   My guess is that that would not change things meaningfully.  People have been hit by meteorites falling from the sky.  So what.  I will not let that FACT change me or make me start wearing a helmet.

Having said that, the answer to question 1 is no.

2.  Of course other viruses can do this and do so far, far more often than HIV.  In fact your symptoms are more compatible with mononucleosis (which can be called by at least two different viruses) than HIV.  

3.  Your symptoms are really not suggestive of HIV.  HIV symptoms tend to be far more short lived, lasting just a week or two, as opposed to your symptoms which are far more lng lived.  EWH

[rustylittle]

Sorry, I meant "How many" & not hope many. #1

[rustylittle]

I hope you are doing well. Sorry to bother you again. I had a few questions:
1) Hope many cases have you had in your clinical practice who were certain they used condoms everytime without breakage, who tested positive for HIV?

2) As I had told you I have had severe malaise, muscle aches & joint aches since December. I had sinusitis about 2 weeks back I told you about. My CT snius showed inflammation of the sinus mucous membrane & was Rx antihistaminics. My CBC, BMP were WNL. Although, I dont have a reason to be  worried about HIV, my weakness & body aches keep reminding me of immunity going down promoting viral replication.
Can community acquired viruses other than HIV lead to such symptoms??  I have checked my Temp regularly & it ranges from 97-98.

3) Would early HIV infection behave in the stated way??

Please help me with the above.

[rustylittle]

Thanks for answering my questions. I wd get tested & let u know abt them later. I might ask you some more questions if any thing new comes up in the future.

Thanks again.

[rustylittle]

Thanks for the assessment & answers.

1) Yes I wasnt tested for any STD, therefor I wouldnt know if I had Chlamydia for sure. My Bad. Only thing was, my symptoms improoved after Azithromycin. Are there conditions similar to NGU, with similar symptoms which respond to antibiotics??

2) If I were to consider I had Chlamydia, & as you said that may have been due to my improper use of condoms, would it mean I might have been exposed to HIV as well?
I have heard that other STDs like chlamydia, Gonn, Tricho, etc are much easier to be transmitted than HIV, at times with condoms?
I used the condom from the begining to the end, & if they stayed intact, what else could have led to the Urethritis or like I had??

3) Is there a home kit available for other STDs similar to HIv ab test?

4) Would you advice against sexual relationships with strangers, especially sex workers in the future??
Is the risk of STDs, including HIV more with sex workers??
Do we have any statistics on percentage of sex workers pos for HIV  in the US ( North east tennessee). Stupid one, i know!

5) My weekness, lethargy, have been there for over 7 weeks now, possibly post flu. Such a long span wouldnt classify as being due to ARS, as I wd know. Any comments on that?


Thanks for bearing with me.