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HIV exposure after a day of "sex tourism"?
Good Afternoon Doctor,
I was hoping I could get a bit of perspective from you before I decide to visit my local clinic about specific STD and HIV risk. As a quick background, I am a married, straight professional American in his mid-30s. I have visited several "escorts" and had casual hook-ups outside of marriage over the past 3 years, involving protected intercourse - the few times it was unprotected, I tested negative via my annual physical required for my job.
In the past few months, I have made several trips down to Tijuana, Mexico for what can best be described as "sex tourism". These have uniformly involved condoms (except for oral sex) with CSWs. Approximately 3.5 weeks ago, I had two "noteworthy" encounters - one was unprotected sex with a CSW that led to me ejaculating inside of her. The second was a protected sex episode with a woman who, unbeknownst to me, was starting her menustural period.
In this second encounter, I had protected vaginal sex and had oral sex performed on me - and I also "fingered" her quite extensively. Approximately 3 hours later, when arriving home, I noticed dried blood around the nail of my middle finger and the knuckle area of my index finger, and no cut or "hangnail". I washed the fingers thoroughly, applied some peroxide, and in a bit of paranoia, really pulled back the area next to my nail to see if there was a cut there. There was not, but this post-wash picking led to a infected fingernail (paronychia) on the side where I had been picking. Within 5 days, I saw a doctor, and was given a week of antibiotics that healed it.
Since late Saturday, I have had a rather persistent "pressure" headache somewhat behind my eyes. I had what I assume was an undercooked seafood meal on Friday, and my lower intestines still fell "bad". Is there anything particularly noteworthy about any of this you can give advice on?
I was hoping I could get a bit of perspective from you before I decide to visit my local clinic about specific STD and HIV risk. As a quick background, I am a married, straight professional American in his mid-30s. I have visited several "escorts" and had casual hook-ups outside of marriage over the past 3 years, involving protected intercourse - the few times it was unprotected, I tested negative via my annual physical required for my job.
In the past few months, I have made several trips down to Tijuana, Mexico for what can best be described as "sex tourism". These have uniformly involved condoms (except for oral sex) with CSWs. Approximately 3.5 weeks ago, I had two "noteworthy" encounters - one was unprotected sex with a CSW that led to me ejaculating inside of her. The second was a protected sex episode with a woman who, unbeknownst to me, was starting her menustural period.
In this second encounter, I had protected vaginal sex and had oral sex performed on me - and I also "fingered" her quite extensively. Approximately 3 hours later, when arriving home, I noticed dried blood around the nail of my middle finger and the knuckle area of my index finger, and no cut or "hangnail". I washed the fingers thoroughly, applied some peroxide, and in a bit of paranoia, really pulled back the area next to my nail to see if there was a cut there. There was not, but this post-wash picking led to a infected fingernail (paronychia) on the side where I had been picking. Within 5 days, I saw a doctor, and was given a week of antibiotics that healed it.
Since late Saturday, I have had a rather persistent "pressure" headache somewhat behind my eyes. I had what I assume was an undercooked seafood meal on Friday, and my lower intestines still fell "bad". Is there anything particularly noteworthy about any of this you can give advice on?
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
Let's first address HIV. Heterosexually transmitted HIV remains rather rare in most circumstances, including exposures like yours. It is statistically unlikely any of your partners had HIV, which according to my understanding is present in well under 1% of CSWs in most parts of Mexico. And even if one or more was infected, the average transmission chance for any single episode of unprotected vaginal sex is around once for every 2,000 exposures, and sexual exposure to menstrual blood has little effect on transmission risk. (And anyway, the menstrual blood event was with a condom, which means no realistic risk at all.) HIV is not transmitted by fingering, regardless of cuts on the fingers, and your later development of paronychia makes no difference in your risk.
There is slightly more risk for other STDs. Gonorrhea, nongonococcal urethritis (NGU), and herpes can be transmitted by unprotected oral sex; and there is always some risk of genital herpes, syphilis, and human papillomavirus (HPV) infection by vaginal sex even with consistent condom use.
Finally, your symptoms are not at all suggestive of HIV or any other STD.
In view of the sexual lifestyle you have described, I would recommend routine periodic testing (e.g. once a year) for HIV and other common STDs (chlamydia, gonorrhea, syphilis). Testing for other STDs like HSV and hepatitis B isn't usually recommended in settings like this, but might be considered given your lifestyle. However, the risk for all STDs is sufficiently low that I would not recommend testing after any single encounter unless there are symptoms that suggest an STD.
Best regards-- HHH, MD
Let's first address HIV. Heterosexually transmitted HIV remains rather rare in most circumstances, including exposures like yours. It is statistically unlikely any of your partners had HIV, which according to my understanding is present in well under 1% of CSWs in most parts of Mexico. And even if one or more was infected, the average transmission chance for any single episode of unprotected vaginal sex is around once for every 2,000 exposures, and sexual exposure to menstrual blood has little effect on transmission risk. (And anyway, the menstrual blood event was with a condom, which means no realistic risk at all.) HIV is not transmitted by fingering, regardless of cuts on the fingers, and your later development of paronychia makes no difference in your risk.
There is slightly more risk for other STDs. Gonorrhea, nongonococcal urethritis (NGU), and herpes can be transmitted by unprotected oral sex; and there is always some risk of genital herpes, syphilis, and human papillomavirus (HPV) infection by vaginal sex even with consistent condom use.
Finally, your symptoms are not at all suggestive of HIV or any other STD.
In view of the sexual lifestyle you have described, I would recommend routine periodic testing (e.g. once a year) for HIV and other common STDs (chlamydia, gonorrhea, syphilis). Testing for other STDs like HSV and hepatitis B isn't usually recommended in settings like this, but might be considered given your lifestyle. However, the risk for all STDs is sufficiently low that I would not recommend testing after any single encounter unless there are symptoms that suggest an STD.
Best regards-- HHH, MD
MEDICAL PROFESSIONAL
Ah, yes -- I should have thought of the military requirement!
Thanks for the thanks. Best wishes.
Thanks for the thanks. Best wishes.
Thank you, Doctor. Your response was extremely helpful, and I appreciate your frank and honest advice.
In regards to your question about "where I live", I was previously an active-duty US military officer, hence the annual requirement of an HIV test.
In regards to your question about "where I live", I was previously an active-duty US military officer, hence the annual requirement of an HIV test.
MEDICAL PROFESSIONAL
This makes me wonder where you live. In most countries, including the US, it would be illegal to require annual HIV screening as a condition of employment. However, if the workplace provides health insurance, it is conceivable their policy would request routine HIV testing.
I might add that I have a new job and am no longer required to undertake annual HIV screening.
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