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Avatar universal

HIV transmission, condom broke, gonorrhea

Hello ,
I am 30 male,I had sex with a street prostitute in Las Vegas 2 wks ago. She was a young white female 23-26 age. She looked clean. I had  oral sex without condom. During vaginal intercourse ,I used condom and condom broke. I probably penetrate her for almost a minute without the condom till I realized that it was broken. Her vagina didn't look normal. I don't know her HIV status. I went to a government clinic and got PEP ( truvada-only) within 36 hrs. They tested me for all STD including HIV. I tested positive for Gonorrhea, I got it from her. I haven't  seen a doctor since then and  not  taking any medication for gonorrhea yet. I have mild sore throat, feeling little  chills sometimes and  negligible joint pains( joint pain--maybe just psychological ). Since she already transmitted gonorrhea and I have these symptoms , I am freaking out about getting HIV transmitted . My concerns are below :1. Knowing her as a street prostitute in USA, what is the probability that she was HIV positive ? 2. As she had gonorrhea, how this impacts her being a HIV positive ? 3. Since this was the only one time potential exposure, what is the probability of getting HIV infected ?
4. Should I see a doctor and get medication for gonorrhea and should wait till I complete 28 days PEP medication?
5. How much PEP ( specifically Truvada only ) is effective protecting from HIV infection in my case? 6. Since she transmitted gonorrhea, does that mean HIV might have transmitted as well?  7. Does HIV transfer through unprotected oral sex as well ? 8. As I already got gonorrhea from her, does it put me on more risk of getting HIV from this exposure ? 9. What type of test and after what time period ( at earliest) can give me a conclusive  result ? I have lost peace of mind. I am not sure if these are symptoms or more  just my psychological thinking after going through many online resource on HIV.  I am so much worried and can't keep myself concentrate with work or anything.Thanks-Nick
8 Responses
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.

Although the frequency of HIV appears to be low (I have been told) among most Las Vegas CSWs, that may not apply to street walkers.  Since a local public health clinic thought PEP was warranted, I would assume they believe the risk is real.  And catching gonorrhea )or if you already had gonorrhea before this exposure) that also increases the risk.  OTOH, the average risk of HIV transmission during any single vaginal sex exposure, if the female partner is infected, is around 1 chance in 2,000, and that would be dramatically lower following PEP.  Therefore, while I recommend you have follow-up HIV testing, it is very unlikely you were infected.

Another approach here would be to contact your CSW partner, if you are able to do that.  She needs to be tested and treated for gonorrhea anyway, so the health department may assist in this.  If she is tested for HIV with a negative result, you could stop PEP, knowing you were not at risk.

To your specific questions:

1,2) I don't know the data in Las Vegas, but as a guess, the chance she had HIV -- even considering her possible gonorrhea -- is under 1%.

3) See above.

4) Of course you should be treated for gonorrhea.  It won't interfere with PEP.  Return immediately to the clinic.

5) The effectiveness of PEP has never been proved. However, most experts believe it is highly effective.  I recommend you follow the advice of the clinic that prescribed it and finish the prescription -- unless the CSW is located, tested for HIV, and found to be negative.

6,8) See above.  There probably is some increase in transmission risk if she has gonorrhea, but the odds remain in your favor.

7) HIV is rarely if ever transmitted by oral sex.  Just scan this forum for more information; there are several questions a week about oral sex and HIV transmission.

9) Follow the clinic's advice about what tests to have and when.  They probably will recommend HIV testing 2-3 times in the next 6 weeks, and maybe as long as 6 months.  (One of the downsides of PEP is that if it doesn't work, it may extend the time to reliable test results.)

All things considered, the odds are strongly in your favor, so don't freak out.  But do follow the clinic's advice.  It would be great if you could find your CSW partner and make sure she is tested.  If negative for HIV, your worries will be over.

Best wishes--  HHH, MD
Avatar universal
Thank you Doctor for your quick response. No, I didn't have gonorrhea before for sure.  I have no way of finding the CSW unless I would go again and try to find her around Vegas and it is not guaranteed way to find her.  Actually I was on vacation trip to Vegas, and I took PEP in a local health clinic in LA. They suggested me to do a test at 4 weeks, 3 months and 6 months of potential exposure.  I am back to NJ, so I can't go to the same clinic but I would go to local health clinic or any other Doctor and take the gonorrhea treatment and would follow their advice. I would definitely complete the PEP prescription. Any comment from your side on my Symptoms ? I am thinking of having PCR test at 4 weeks, how conclusive this would be in your opinion ?
Avatar universal
One thing , I forgot to mention, even though I have mild soar throat I have cough too. No fever, but feverish feeling. Today is exactly 17 days of potential exposure.
239123 tn?1267647614
MEDICAL PROFESSIONAL
Plenty of HIV or infectious diseases experts are available in NJ or surrounding areas (NYC, Philadelphia).  Everybody on PEP should be under the care of such an expert.  Find one and follow his or her advice about specific tests and their timing.

Your symptoms don't concern me.  It's too late for onset of ARS symptoms; ARS doesn't cause cough; and absence of fever also is evidence against it.  You caught a cold.
Avatar universal
Hello Doctor, updates on my case. I did a full panel STD test yesterday at LabCorp. This was after 10 weeks of the exposure, and 6 weeks after completion of my last dose of PEP. All others are negative but Herpes Simplex Virus Type 1 came back  as positive. This is scaring me about HIV. First gonorrhea and now herpes. Questions :
1.) I know herpes is not curable, how would this impact my sex life ? Can I have unprotected sex with my girl friend/wife ? Should I disclose this to her ?
2.) An Antibody HIV test at lab after 6 weeks of completion of PEP, how definitive is this ? Does acquiring herpes increase the risk at this time ?

if you have any archive posts on herpes, can you please provide the link for my information  ?
I think herpes -1 might have overall less impact but I am just worried as this adds to risk of HIV infection.
Thanks !
Avatar universal
I still haven't experienced any significant outbreaks on oral or genital area. I do have some itchy rash on back and chest, I usually get these kind of itchiness, even though this time many with small bumps which I never had before. I had minor mouth ulcers couple weeks back  which now I can attribute to herpes 1.

Q.3) How herpes 1 and 2 are different in terms of their impact and how are they  interrelated ? Does  having type herpes type 1 increases the risk of getting herpes type 2 ?

Thanks again !
239123 tn?1267647614
MEDICAL PROFESSIONAL
Half of all adults in the US have positive blood tests for HSV-1.  Usually it is from an infection in childhood.  It has no effect on people's sex lives.  It is possible you could infect your partner by kissing or by performing oral sex on her, but probably not as long as you avoid such contact if and when you have symptoms, i.e. a cold sore on or near your mouth.

2) There are no medical conditions, including herpes, that change the time required for HIV testing.  However, if PEP is unsuccessful in preventing HIV, iin theory it might prolong the window period.  Therefore, many experts recommend delayed testing after PEP -- for sure to 3 months and sometimes to 6 months.  (This is one of the reasons PEP should not be used unless truly necessary -- i.e. it prolongs anxiety by delaying the time to conclusvie test resutls.  In any case, you should be under the care of an HIV expert to advise you on this -- or discuss with the doctor who prescribed your PEP.

3) These symptoms are not due to herpes.  The differences between HSV-1 and 2 are complex, but information is easily available.  One difference is that although HSV-2 increases the risk of HIV if exposed, HSV-1 does not.  If you use the search link on the STD expert forum, you can find lots of discussions; or visit the MedHelp herpes expert or community forum.

That will end this thread.  Best wishes--  HHH, MD
Avatar universal
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