HIV Risk and Lymph Node Question

[Fedor]

I had sex with an escort at her hotel last night. We had only vaginal sex. I was wearing a condom for at least half the time but after I came and pulled out my penis, the condom was not on it. It (the condom) was totally inside the escort's vagina, not even hanging out. She pulled it out and I saw some semen still inside the condom. I spoke to her and she said she gets a birth control shot so she won't get pregnant. I then washed my penis head thoroughly with soap.

My worry is that I have contracted HIV from her during the time the condom had slipped off. We had sex in two different positions, the missionary and from behind. The missionary was without incident but the condom slippage came during the vaginal sex from behind after we switched positions (for approx. 2-5 mins).

How worried should I be about contracting HIV? I will get tested later obviously but I want to know what my risk was during this situation. It has now been 3 days since the risky exposure. My right lymph node (in the groin area) is swollen and a bit painful and I am very worried. No other lymph nodes swelled just that one. Can a lymph node swell so soon after a possible exposure to HIV or is it stress related?

Please help

[H. Hunter Handsfield, M.D.]

Thanks for the geographic information.  I can imagine that a among patients at the Ft. Greene STD clinic, a high proportion who have new sexual exposures are at pretty high risk for HIV, far higher than on average in most cities.  Parts of Brooklyn have among the highest rates of heterosexually transmitted HIV in the US.  So they might have a low threshold for routine PCR as well as antibody testiing.  By contrast, in my STD clinic, we rarely see heterosexually acquired HIV, and our PCR testing to pick up antibody-negative persons early after infection is limited to gay/bi men.  Still, the Ft. Greene approach might not be the same for all patient groups.  For example, even there the heterosexual HIV rate in whites probably is much lower than in other ethnic groups (not that I'm guessing at your race/ethnicity -- I am not); and even in Brooklyn, my guess is the chance an "escort" has HIV is low, compared with streetwalking CSWs, for example.

Anyway, this is interesting information -- but it doesn't change the main thrust of my opinions and advice.  It is extremely unlikely you caught HIV and you can expect any remaining tests to also be negative.

[H. Hunter Handsfield, M.D.]

1) The negative 25 day test is strong evidence you weren't infected.  Around 80% of newly infected people have positive test results by then.

2) I would not have recommended the PCR test and don't understand why the clinic suggested it.  But if negative it will provide additional assurance.  But most experts still would recommend a final antibody test at 6-8 weeks.

I stress that you describe an extremely low risk situaiton -- low enough that you didn't need HIV testing at all except for anxiety relief from the negative results.

What became of the lump in the groin?  Did you get checked out for a hernia?

[H. Hunter Handsfield, M.D.]

Thanks for the clarification. Re-read my comment about the risk even if you had entirely unprotected sex.  Even among brothel or stree-walking CSWs, fewer than 1 in 1000 have HIV (in the US).  If no condom had been used at all, my advice would be the same:  the risk is too low to even need HIV testing except for psychological/reassurance reasons.  Further, when a CSW insists on condom use, usually it is evidence she is not infected with HIV and wants to stay that way -- not that she is infected and is trying to protect her clients.  This only makes sense, since CSWs are at greater risk of infection from their clients than the other way around.

So none of this changes my opinion or advice. I recommend against early testing and still suggest waiting until 6-8 weeks.  But it's your time, your money, and your risk for a misleading false positive result -- which although uncommon, is a definite risk with HIV testing at 10-11 days.

That will be all for this thread unless/until you want to return to post your test results, which will be negative.

[Blues12345]

A related discussion, Swelling in left groin & Sore Throat/Fever Day after Sexual Contact with Boyfriend was started.

[Fedor]

Thanks for your advice during this whole situation. You helped me settle my nerves at my worst moments of fear and worry. I wish you nothing but good things. You do a great service through Medhelp to help all of us who needed guidance for some pretty scary situations. Thank you.

Take care sir,
-Fedor  

[H. Hunter Handsfield, M.D.]

You can put HIV to rest.  But of course follow the Ft. Greene clinic advice if they suggest any additional testing.

That will be all for this thread.  Take care.

[Fedor]

Sir, I got my results for the PCR test. It was negative and I feel relieved. At the clinic after I got my negative antibody result (25 days after exposure), they told me if the PCR comes back negative you don't need to come back and you're fine. I'm not planning to get retested unless you have a different opinion and I should get tested at 3 months just in case. I want to be safe but it seems I'm already in the clear. What do you think?

Thanks in advance Dr.,
-Fedor

[Fedor]

Thank you Dr, I will update you within the next 2 weeks about the PCR results. I appreciate your time and patience.

-Fedor

[Fedor]

Thank you for your reply sir.

It's the clinic's policy to do an antibody/PCR combo to help with possible Acute HIV diagnosing. I've been there before and they have always done this. The clinic is the Fort Greene STD Clinic in Brooklyn, NY if you're interested in researching it.

As for my groin swelling, it is indeed a lymph node and not a hernia. It came up as a result of a mild kidney infection that took me 2 weeks to clear up with the use of fluid ingestion (cranberry juice, tea, water) and frequent urination as well as plenty of rest. The pain in my lower back and right groin subsided but the node remains a bit stiff.

In regards to how the above mentioned was diagnosed and resolved I will say that I did not go to a doctor. My mom and step-dad (who know my WHOLE situation, sadly) saw the node and and knew of my symptoms (pain in lower right back area, sore right groin, stiff enlarged node, frequent urination, and wierd smelling urination) told me from years of the experiences of Soviet life and medical expertise (Eastern European medical practice is underrated). Their response: "3 days is too early for HIV to show symptoms so shut up and calm down. You obviously have a kidney infection so drink a lot and stay out of the cold."---------> I did just that and recovered. No antibiotics necessary. Definitely not a hernia.

Anyways Dr. thank you very much for your response. I will update you when my PCR comes in and I'm interested to see what your critique of my lymph node "diagnosis" will be (I expect you to not trust it). It has really cleared up except for the node stiffness and I and my parents know the difference between a hernia and a lymph node in the groin.

Best wishes to you Dr,
-Fedor

[Fedor]

Doctor,

I had a rapid antibody test done at 25 days post-exposure at an STD clinic in NYC. It came back negative. My blood was also taken for an acute HIV test for which I'm still waiting (I think its a PCR but not sure). Its results will be available in about 7 days. 2 questions for you Dr:

1. How much can I read into my negative antibody test at 25 days?

2. If my acute test comes back negative also do I need to retest later on or is it finita la comedia?

Thank you in advance Dr,
-Fedor

[H. Hunter Handsfield, M.D.]

HIV is not a possible cause.  But this is something for which you should seek health care right away.  It sounds like a hernia, perhaps on the verge of getting trapped,  which can be a very serous event.  ("Incarcerated hernia" is the medical term.)  Visit a clinic or doctor right now; if you can't get into your primary care provider, go to an urgent care clinic or hospital emergency department.

[Fedor]

Dr. Handsfield,

I woke up today and my lymph node on the right side of my groin is still enlarged and painful. When I walk or cough I feel pain. This pain also seems to reach my lower back (on the right side). My mom checked the rest of me for swollen lymph nodes but found none, so this seems to be the only one. Its hard and although not big, its noticeable in the mirror (as opposed to my non-swollen left groin side). My mom said it could be from the cold weather or from a minor infection but not HIV. Its too coincidental that my lymph node becomes enlarged and painful after a risky exposure.What do you think?

Also how long is the HIV incubation period? I know you said there can be no symptoms in under 10 days but my enlarged lymph node is real and something I could see with my eyes and feel via pain. Today is day 5 for me since my risky exposure.

And one last thing. How long before I could take an HIV acute blood test done to reduce the risk of false positive and/or inaccurate results. Six weeks is a long time to wait for standard anti-body testing but if I wait the six weeks I will know my result that day from a finger prick, 30 min test (for anti-bodies). I'm weighing this in my mind.

Thank you Dr. Handsfield

[Fedor]

Doctor you didn't understand. I didn't just pull out and left the condom inside, I'm pretty sure it slipped off during intercourse and I had unprotected sex for a period and only realized when I pulled out that the condom wasn't on my penis but was inside the escort's vagina.

And she wasn't that "high class" but she was not a streetwalker. I didn't have the type of girl Eliot Spitzer had if you know what I mean. But she was concerned about protection and made sure we used condoms until the unfortunate slippage.

After 11 days pass I will go to a clinic and get an acute HIV blood test done, since an anti-body test will not show anything at this point. I hope it will be accurate and negative. What do you think?

Thank you Dr. Handsfield

[H. Hunter Handsfield, M.D.]

In the US and other industrialized countries, the chance any particular female "escort" (i.e., expensive commercial sex worker) has HIV is very low, well under 1 chance in 1,000.  If she did have it, the average risk of transmission by unprotected vaginal sex is once for every 2,000 exposures.  So even without a condom, your maximum chance of having caught HIV was 1 in 2 million. (1/1000 x 1/2000 = 1/2,000,000.)  But just pulling the penis out of the condom, which remains behind in the vagina, still is condom-protected sex.  With a condom-protected exposure plus the low odds anyway, for practical purposes it is impossible you caught HIV.

A single enlerged lymph node is never a sign of HIV; and no, it is not possible for HIV to cause symptoms in less than 10 days.  Something else is responsible for the lump -- whether it is a lymph node or anything else.  If it persists or you remain concerned, see a health professional about it.

From a risk assessment viewpoint, you don't need HIV testing at all.  But if this reassurance doesn't resolve your fears, have a standard HIV antibody test in 6-8 weeks.

You have asked questions on low risk exposures similar to this one on the HIV community forum.  We are happy to answer such questions, up to the permitted maximum of 2 questions every 6 months on the professionally moderated forums.  But you really shouldn't need to spend a posting fee every time you have a new sexual exposre and then feel regret or nervousness about it -- especially when there is zero risk for all practical purposes.

Regards--  HHH, MD