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Chance of transmitting HIV in case of transmission of an STI

Dear Doctors
I am a heterosexual 32 year old man.  I had sex with a sex worker last week. I used condom BUT mid way through the condom broke. After a few seconds (less than 10 seconds), I changed condom without washing myself and continued and ejaculated.  Being a math freak, before I slept with her, I calculated my risk being 1 in 4,000,000.  Which is 1 in 2000 risk of transmission from a HIV+ woman to a man times 1 in 100 chance of breaking condom times 1 in 20 chance of her being HIV positive (I did it in dominican which the rate of HIV+ amongst sex worker is 5%).  After three days I get symptoms of STI (burning feeling while urinating, very small discharge, extreme back pain, and minor testicular pains).  It is really shocking as my exposure was in matter of seconds.  I started taking Amoxicillin (the only antibiotic I have with me here).  My three questions are:
1.  If she is infected with HIV, and she transmitted an STI (Chlamydia perhaps), does it mean that HIV is also transmitted? (this is so scary).
2.  I recalculated my risk to be in the range of 1 in 1600 and 1 in 100.  I read that if someone is infected with an STI, the chance of transmitting and receiving HIV increases between 5 to 20 times, so the 1 in 2000 chance becomes between 1 in 400 and 1 in 100.  Also as she is infected with an STI, there is a bigger chance that she has been infected with HIV 5 to 20 times more, which means the chance of she has HIV varies in the range of 1 in 4 (5% x 5) and 1 in 1 (5% x 20), so my chance of being infected varies between 1 in 1600 (1 in 400 times 1 in 4) and 1 in 100 (1 in 100 times 1 in 1).  Am I being realistic, optimistic, or pessimistic.
3.  Does the fact that my exposure was a matter of seconds, makes any difference.  If so, why I got the damn STI?
Please help me as I have no one here to talk with and I am literally scared to death.  Haven't eaten or slept for the past three days.   was reading, crying, and making plan for the worst (god forbids).
10 Responses
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239123 tn?1267647614
MEDICAL PROFESSIONAL
That result is reassuring with respect to HIV but not definitive.  The gold standard is an antibody test done several weeks after the last potential exposure (6-8 weeks usually is sufficient).

That will be all for this thread.  I have nothing more to add.
Helpful - 1
239123 tn?1267647614
MEDICAL PROFESSIONAL
I mean that anatomic anomalies increase the risk of UTI, i.e. predispose to UTI.  And repeated or chronic UTIs are risk factors for kidney failure later in life.  The latter risk is not high, especially if each infection is treated promptly.  But still a risk that usually can be avoided by dealing with the predisposing factor.
Helpful - 1
239123 tn?1267647614
MEDICAL PROFESSIONAL
Interesting that you had an E. coli UTI in the past.  As I indicated, that's rare at your age.  When it happens, it often suggests an underlying urinary tract anomaly that might increase the risk, perhaps especially if it happens a second time -- as it may have done now.  Alternatively, unprotected insertive anal sex also is a risk factor.  If and when you have such symptoms in the future, I strongly recommend you see a health care provider promptly and have a urinalysis and culture, before starting self-treatment.  And when you have access to sophisticated medical care, talk to your primary care provider or a urologist about whether evaluation for an underlying urinary tract problem is warranted.  Often such anomalies are are minor anatomic irregularities in the urethra or bladder -- not harmful in themselves, but recurrent UTI can eventually cause serious kidney damage.  There is no hurry, but you should not neglect this.

I can't advise you about continuing or stopping the amoxicillin, not knowing whether you have any infection or what the cause is; it comes too close to practicing medicine from a distance.  It has already prevented accurate testing for STDs, so from that aspect it makes no difference.

That will have to end this thread.  Take care.
Helpful - 1
239123 tn?1267647614
MEDICAL PROFESSIONAL
Sorry, I missed or forgot your location; I scanned the earlier thread rather quickly.

1) With your expanded description of symptoms (or my better understanding of them), gonorrhea seems less likely than I originally thought.  Gonorrhea and other sexually transmitted urethritis don't cause back pain or urinary frequency and urgency, and usually discharge and urethral pain are prominent with gonorrhea.  However, even though non-sexually acquired UTI can cause those symptoms, UTIs are rare in healthy younger men, i.e. younger than the prostate disease ages.  In any case, if the symptoms are clearing up, all should be well.

2) This really isn't releveant, since you did indeed treat your symptoms very promptly.  In any case, I doubt the speed with which gonorrhea is treated makes much difference in HIV risk.  The reason gonorrhea would increase the HIV transmission risk in this situation is that it increases the concentration of HIV in your partner's cervical fluids, so the transmission event itself should have more influence than speed of gonorrhea treatment.

3) I don't provide direct care to AIDS patients and cannot comment on death rates in Canada or elsewhere.  In any case, this seems like unnecessarily morbid speculation, given that almost certainly you weren't infected.  Cross that bridge if you come to it, which you probably won't.

Thanks for the thanks about the forum.
Helpful - 1
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the HIV forum.  I'll try to help.  I reviewed your discussion on the HIV community forum.  I gather you are someplace without ready access to health care (a developing country? where?).

Your STD probably is gonorrhea.  Chlamydia and NGU don't cause symptoms within 3 days; gonorrhea does.  Unfortunately, in most of the world, amoxicillin is not active against gonorrhea.  If your urethral discharge and painful urination are clearing up, that's great.  But if not definitely improved within 48 hr, you definitely need to find a provider to prescribe something more appropriate.  Also, be aware that ciprofloxacin and related drugs (the quinolones) also are not active against gonorrhea in most of the world.  I say this because cipro and its cousins are among the most commonly available antibiotics in developing countries -- but you must not rely on them.

To your specific questions:

1) Gonorrhea and other STDs raise the risk of HIV, if exposed.  But the risk is roughly doubled -- so if the HIV risk starts at, say 1 chance in 1,000, then it rises to 1 in 500.  Not to be disregarded. but it still leaves the odds strongly in your favor.

2) Your probabilities approach makes sense, and we use it frequently in advising questioners on this forum (which you might already know).  Be aware that all such exercises are very approximate.  As I already said, the accelerated HIV risk in the presence of gonorrhea likely is 2-fold, not 5-fold and certainly not 20-fold.  I suppose having gonorrhea raises the odds your partner had HIV, but there are no data on which to base a numerical estimate.  A better predictor would be the country you are in and the local data on HIV prevalence in commercial sex workers.  The risks are very different if you are in, say, Kenya versus Thailand.  In any case, no matter how you calculate it, the odds are very heavily in your favor, i.e. against the chance you caught HIV.

3) There are no data on transmission risk as a correlate of duration of exposure.  Logically, the risk is lower with the brief exposure you describe, but I cannot judge how much.

In addition to all you are doing so far, are you in a position to identify and talk to your commercial partner?  What does she say about her HIV status?  If she doesn't know or hasn't been tested recently, why don't you offer to pay for her HIV test?  If negative, you would kow you weren't at risk.

Feel free to return with some of the missing information suggested above.

Regards--  HHH, M
Helpful - 1
Avatar universal
A related discussion, what should be the depth of wound for HIV infection was started.
Helpful - 0
Avatar universal
Hi Dr. Handsfield;

Exactly 15 days after my high risk exposure, I did a P24 test along with White Cell count.  The P24 came back negative and White Cell count was 8.5 (Normal range 4-10).  Is it convincing enough that I am HIV free? I searched a bit through the internet and could not find a conclusive answere about the reliable window period for P24.  Your answer is much appreciated.

Best Regards;
  
Helpful - 0
Avatar universal
no more questions, just one clarification of your statement:
"...When it happens, it often suggests an underlying urinary tract anomaly that might increase the risk, perhaps especially if it happens a second time -- as it may have done now. ...",
Do you mean if infection happens the second time, it increases the risk of having urinary tract anomaly? or you mean it increases the risk of getting HIV infection? (BTW I did not have anal sex).

Again and again thanks so much
Helpful - 0
Avatar universal
Again, thank you for your prompt response.  And at any time you feel I'm being unreasonable or asking too much, you can just stop me from quesioning.  As you've ran into these cases a lot, you know the feelings...I literally could'nt sleep properly for three nights and am crying every now and then.  

Anyhow, just one more question:  to be exact with my symptoms, after taking amoxicillin for 3 days are, 1) I have no discharge, 2) almost no urgency for frequent urinating, 3) a little bit of burning feeling while urinating, 4) extreme and kind of unbearable back pain right at the centre at 3rd and 4rh last vertobreas which increased significantly in the past couple of days, 5) testicular pain on the left side which just started from yesterday, and 6) sometimes a craqmp feeling near my anus.  
I also remeber to be diagnosed with E.Coli infection some 10 years ago.  

I appreciate, if you can re-evaluate my symptoms given these detailed symptoms.  I will get tested on Monday, but since then I need some guide.  Also should I keep on having Amoxicillin or shall i stop it?    
Helpful - 0
Avatar universal
Thanks Dr. Handsfield for your feedback;

As I mentioned in my earlier post, I am in Domonican Republic.  Taking Amoxicillin reduced the dischard (in fact, I had very little discharge at to begin with, the apparant symptoms are extreme back pain, slight burning feeling while urinating, and more frequent urination that ususal).  I will be back in 4 days to Canada and will see a doctor ASAP.

Q1: is it pssible that the symptoms are from a UTI rather than a STI totally irrelevant of the incident?  To my knowledge, gonorrhea rarely causes back pain in men.  My pain is severe and concentrated at the bottom 3 vertobreas.

In response to your question re HIV rate amongst the sex worker, I found the 5% rate in Wikipedia,  The average rate of the country is 1.1% according to Unicef database.
I do not have access to her anymore, so unfortunately I can not figure out her status.  She was healthy looking, but thin (I don't think I can put any weight on her status either way).  It's crazy how quick the 1 in 4,000,000 chance dropped to 1 in 500.  

Q2: Is NOT treating gonorrhea on a timely fashion, increases the HIV infection chance or is it irrelevant?

One more question:

Q3: me being pessimistic, I looked at the death rate by HIV in Canada being 1 in every 100 infected persons a year, meaning that nowadays people with HIV will die with HIV but very rarely from the HIV.  Is that true?

Regards and best of luck in what you are doing  
Helpful - 0

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