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STDs (Expert Forum)
a few questions on HIV/STDs
Answered by
University of Washington
Seattle - WA
Welcome to the STD Forum, which is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
a few questions on HIV/STDs
by GregA, Sep 02, 2005 12:00AM
Dear Doctor:
I will ask questions in bullet point fashion to make it easier to answer. Short background: about 25 days ago, I had sex with a sex worker for one minute. But 30 seconds of the sex was unprotected, because the condom tore. Let’s assume it was 60 seconds of unprotected sex. Inquiries:
1. I am uncircumcised. It is my understanding that uncircumcised men are at greater risk for HIV transmission. All in all, assuming the woman were HIV-positive, does this translate into greater risk for me?
2. During the 2-4 week period after initial HIV infection, would ARS come all at once? Or does it come in steps? For example, after 8 days, I experienced nasal congestion for two days. Then after 14 days, I experienced one swollen lymph node in the groin. It went back to normal size fast (within 4 days). Then at Day 21, I experienced one more swollen lymph node in the groin. Also, during this 2-4 week period, I experienced a 100 degree fever for 2 hours. (I don’t even know if that would classify as a fever as my understanding is that our body temperature do fluctuate during the day). Does this sound like HIV-ARS at all?
3. If I can feel my lymph node below my ear, does that mean they are swollen? Everyone says that they are either pea-sized or bean-sized. I can feel one lymph node when I press below my left ear, but it is MUCH, MUCH smaller than any pea. Assuming that my one lymph node in the groin were swollen, and my one lymph node below the ear were swollen, is that what they consider generalized lymph node swelling during ARS? Based on what I’ve read, if lymph nodes swell during ARS, they will swell almost everywhere in chains. But please correct me if I’m wrong?
4. My understanding is that HIV could be found in a woman’s vaginal secretions. If a man has unprotected sex with a woman (say, such as in my case for 60 seconds), and IF the woman is not “wet” at all in the vaginal area, does this mean no HIV exposure. Of course, this assumes NO blood from current or prior menstruation. The reason, I’m asking is that during this 60 seconds, I highly doubt that I was exposed to any (maybe very minimal) vaginal fluids. Most of the wetness, I guess, came from lubrication (since there was NO foreplay at all).
5. I keep hearing that HIV is much harder to transmit. Is that really true? For example, if I had unprotected sex with a woman (e.g., 60 seconds again), and she has HIV, Herpes, Gonno & Chlamydia, Syphilis, and Hepatitis, wouldn’t my risk of acquiring HIV be exactly the same as acquiring the other STDs?
6. Lastly: does my scenario warrant HIV testing? I did see my Primary Care Physician, and I even told him it was a prostitute, and of course, he knows that I’m not circumcised. However, he said that he is not even concerned, even assuming the prostitute were HIV-positive. His concern is His concern is more along the lines of Herpes, Gonorrhea, and Chlamydia. Am I missing something here?
I will ask questions in bullet point fashion to make it easier to answer. Short background: about 25 days ago, I had sex with a sex worker for one minute. But 30 seconds of the sex was unprotected, because the condom tore. Let’s assume it was 60 seconds of unprotected sex. Inquiries:
1. I am uncircumcised. It is my understanding that uncircumcised men are at greater risk for HIV transmission. All in all, assuming the woman were HIV-positive, does this translate into greater risk for me?
2. During the 2-4 week period after initial HIV infection, would ARS come all at once? Or does it come in steps? For example, after 8 days, I experienced nasal congestion for two days. Then after 14 days, I experienced one swollen lymph node in the groin. It went back to normal size fast (within 4 days). Then at Day 21, I experienced one more swollen lymph node in the groin. Also, during this 2-4 week period, I experienced a 100 degree fever for 2 hours. (I don’t even know if that would classify as a fever as my understanding is that our body temperature do fluctuate during the day). Does this sound like HIV-ARS at all?
3. If I can feel my lymph node below my ear, does that mean they are swollen? Everyone says that they are either pea-sized or bean-sized. I can feel one lymph node when I press below my left ear, but it is MUCH, MUCH smaller than any pea. Assuming that my one lymph node in the groin were swollen, and my one lymph node below the ear were swollen, is that what they consider generalized lymph node swelling during ARS? Based on what I’ve read, if lymph nodes swell during ARS, they will swell almost everywhere in chains. But please correct me if I’m wrong?
4. My understanding is that HIV could be found in a woman’s vaginal secretions. If a man has unprotected sex with a woman (say, such as in my case for 60 seconds), and IF the woman is not “wet” at all in the vaginal area, does this mean no HIV exposure. Of course, this assumes NO blood from current or prior menstruation. The reason, I’m asking is that during this 60 seconds, I highly doubt that I was exposed to any (maybe very minimal) vaginal fluids. Most of the wetness, I guess, came from lubrication (since there was NO foreplay at all).
5. I keep hearing that HIV is much harder to transmit. Is that really true? For example, if I had unprotected sex with a woman (e.g., 60 seconds again), and she has HIV, Herpes, Gonno & Chlamydia, Syphilis, and Hepatitis, wouldn’t my risk of acquiring HIV be exactly the same as acquiring the other STDs?
6. Lastly: does my scenario warrant HIV testing? I did see my Primary Care Physician, and I even told him it was a prostitute, and of course, he knows that I’m not circumcised. However, he said that he is not even concerned, even assuming the prostitute were HIV-positive. His concern is His concern is more along the lines of Herpes, Gonorrhea, and Chlamydia. Am I missing something here?
Doctor's Answer
by H. Hunter Handsfield, M.D., Sep 02, 2005 12:00AM
, Sep 02, 2005 12:00AM
Lots of nuance in those questions; I'm going to answer each one quite briefly. For further information, look at numerous other threads; you can search for "HIV transmission risk", for example.
1) Circumcision increases the risk. But when the risk is too low to even measure, a 2-fold or even 10-fold increased risk still leaves a miniscule risk. (10 times almost zero = almost zero).
2) Mostly ARS symptoms will all begin in a few days, not spread out over 2-3 weeks. Your symptoms don't sound particularly like ARS.
3) The lymphadenopathy (lymph node enlargement) due to ARS is all over the body (neck, underarms, groin), not just a spotty little bump here and there.
4) There are no data to answer your question directly. However, I doubt that the amount of sexual lubricating fluid present has no relationship to risk of transmitting HIV or other STDs.
5) Different diseases are not transmitted with the same efficiency. To give a non-STD example, the diarrheal disease shigellosis (bacterial dystentery) can be induced in human volunteers by feeding them as few as 50 shigella bacteria; but another diarrheal disease, salmonellosis, requires at least 50,000 to a million samonella bacteria to cause infection. HIV transmission (average 1 transmission per 500-1000 episodes of vaginal intercourse) is very much lower than, say, gonorrhea, where the risk is 20-50% (1 in 2 to 1 in 5). The biological reasons for such differences are only partly understood, and in any case are too complex to go into detail here.
6) If having a negative HIV test result will reassure you more than my words, by all means do it. But your PCP is right about the relative risks.
Good luck-- HHH, MD
1) Circumcision increases the risk. But when the risk is too low to even measure, a 2-fold or even 10-fold increased risk still leaves a miniscule risk. (10 times almost zero = almost zero).
2) Mostly ARS symptoms will all begin in a few days, not spread out over 2-3 weeks. Your symptoms don't sound particularly like ARS.
3) The lymphadenopathy (lymph node enlargement) due to ARS is all over the body (neck, underarms, groin), not just a spotty little bump here and there.
4) There are no data to answer your question directly. However, I doubt that the amount of sexual lubricating fluid present has no relationship to risk of transmitting HIV or other STDs.
5) Different diseases are not transmitted with the same efficiency. To give a non-STD example, the diarrheal disease shigellosis (bacterial dystentery) can be induced in human volunteers by feeding them as few as 50 shigella bacteria; but another diarrheal disease, salmonellosis, requires at least 50,000 to a million samonella bacteria to cause infection. HIV transmission (average 1 transmission per 500-1000 episodes of vaginal intercourse) is very much lower than, say, gonorrhea, where the risk is 20-50% (1 in 2 to 1 in 5). The biological reasons for such differences are only partly understood, and in any case are too complex to go into detail here.
6) If having a negative HIV test result will reassure you more than my words, by all means do it. But your PCP is right about the relative risks.
Good luck-- HHH, MD
