Hello again

[zabazabazoo]

Hi Doc, to recap 30y old white male with beautiful wife and kids and serious guilt issues. I was invited abroad by friends. I stayed for three nights. I had an erotic body massage by a Russian masseuse on the first day, protected vaginal with a lot of unprotected oral with a Ukrainian CSW the next day before I went out, and protected vaginal with a black Dutch CSW in the bathroom of a club. The last night I was there i got to the hotel at 4am, found 2 beautiful polish CSWs having breakfast. Ended up having protected vaginal and a lot of unprotected oral with them. I got on my flight the next day not having slept.I wake up the next morning with huge tonsils. The total unreliability of being able to predict the disease from the symptoms actually makes ruling out offshoot early ARS symptoms as unreliable and thus the symptom, a threat. I sent the white pus on my tonsils to the lab, they ruled out bacterial infection (mini question here doc does that mean it can’t be a rare type of oral gonorrhea or some such), this would prove it is viral and I don’t know why but that scares me. got a urine test for Chlamydia and gonorrhea and a blood test for mono at 4 days (negative). That was the end of my detective work because the incident is 10 days old and there's not much more i can do. I’m Going to test for HIV at 4, 6 and 8 weeks because some doctors won’t make up their minds.

One main risk factor is an open herpes sore on my upper lip from before the trip. By the time I got there was no pus but it was still bleeding and there was a lot of kissing and oral involved.  

My question this time also concerns something you posted in another thread, about having spoken to someone who's in charge of an std clinic in Dubai. Well I was in Dubai. And you said something about no new cases in Dubai. How true is that? Should that fact alone ease my fears?

[Edward W Hook, MD]

Welcome back to the Forum. This time I will be answering your questions.  I'm pleased to see that you have adopted regular use of condoms for your sexual encounters, this will protect you from HIV and greatly reduce your risk for other STDs as well.  As far as your specific questions:

HIV rates in Dubai are very, very low (practically non-existent) so the fact that your exposures occurred there will go a long way towards making sure that you did not get HIV from the exposures you describe.  

HIV is not transmitted by kissing and there are no cases in which HIV have been transmitted either by a man receiving oral sex and there are no instances in which HIV has been acquired by performing cunnilingus on an infected woman.  Thus your exposures, even in the presence of the sore on your lip, did not put you at risk for HIV.

The penile rash you mention did not put you at increased risk for HIV either.  

My advice is not to worry about having acquired HIV from the exposures you mention above.  I see no reason to abstain from unprotected sex with your wife and in fact, she no medical reason for HIV testing.  If you choose to test, it is hard to know precisely what proportion of recent infections would be detected at 2 weeks- certainly over half but the precise number is difficult to say.  

I hope these comments are helpful to you.  EWH

[Edward W Hook, MD]

Last answer.  "Improper removal" of a condom is not a risk for HIV.  End of thread.  EWH

[zabazabazoo]

Doc sorry to bother again, but how much of a risk is improper removal of condoms? Meaning having contact btw the tip of the penis and the vaginal secretions on the outside of the condom

[zabazabazoo]

Many thanks Doc

[Edward W Hook, MD]

Rarely and an isolated sore throat/tonsilitis is not ARS.    EWH

[zabazabazoo]

Thanks Doc,

You've been a great help, one last question and I'll get out of your hair.
How often do ARS symptoms like tonsillitis show up before the 10-20 day incubation?

[Edward W Hook, MD]

At two weeks a combination HIV p24 antigen/HIV antibody test will detect well over 50%of recent infections but as I said above, precisely how many is difficult to say.  

Most oral gonorrhea is asymptomatic and performanace of oral sex on a female partner rarely leads to infection.  If you are worried, you could request and oral gonorrhea culture.  If you do, I anticipate that it will be negative.  

As far as the root of your anxiety is concerned, I do have specific advice.  STOP searching the internet.  Much of the information there, while usually well inteneded, it wrong.  Don't let it mislead you.  EWH

[zabazabazoo]

Thanks Doc, I'm going to do the test just for the peace of mind. I'm getting the antigen/ antibody test, can you estimate the accuracy for such a test at 2 weeks?

Also, should I test for anything else? The tonsilitis had me worried i had oral Ghonorrhea or something.

The root of my anxiety is the internet. everyone tells you to quarantine yourself for 3 months and get a test just in case.. I have a family.. so I need to hear a doctor tell me everything's ok

Thanks again Doc

[zabazabazoo]

Hi Doc, maybe I need to clarify the question a bit.

Having given oral sex to several women with an open occasionally bleeding sore on my upper lip, am i at any risk?

Would the fact that it happened in Dubai alone mean the risk is nonexistent?

Since I can't put off sleeping with my wife for much longer, how accurate would an HIV test be at 2 weeks?

Thanks a million doc

[zabazabazoo]

BTW also had a very itchy rash on my penis before i went. Applied dactacort and by the time a saw my dermatologist when i got back he said it almost cleared up and he couldn't really tell what caused it. is it a risk factor?