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Sore throat ARS
Dear Doctors, 4 weeks ago I had sex with CSW (vaginal with condom), condom broke and I think that I felt it pretty quickly (not sure, was quite drunk at that time), but don't think that exposure was too long. I removed condom and cleaned myself right away. Knowing that type of exposure would be pretty low risk for HIV (been on your forum before), I wasn't too nervous, but last two weeks I have persistant sore throat, no other symptoms, no fever, no enlarged lymph nodes, may be light runny nose/nasal congestion on/off. It worries me now big time since it doesn't feel like typical cold - that persistant, kind of mild sore throat that gets worse in the morning and before I go to bed and lasts already 2 weeks.
Two questions:
1. Is risk of broken condom equal to unprotected vaginal sex for male?
2. Could my sore throat be related to acute HIV infection?
Thank you so much!
Two questions:
1. Is risk of broken condom equal to unprotected vaginal sex for male?
2. Could my sore throat be related to acute HIV infection?
Thank you so much!
MEDICAL PROFESSIONAL
No, I am aware of no such cases.
As for not testing for fear of the result, that's plain dumb and I have no patience for it. The test isn't what gives someone HIV; you have it or you don't. If you do, you have to know in order to receive life-sustaining medical care and to protect future partners. And research and everyday experience show that when frightened persons finally bite the bullet and get tested, anxiety declines, even when the result is positive. In other words, the stress and worry about the test outcome are worse than the stress of leaning of a positive result. And in your case the result will be negative; you can count on it.
So just suck it up and just do it. Feel free to return to report the result, but I will delete without reply any other follow-up comments.
As for not testing for fear of the result, that's plain dumb and I have no patience for it. The test isn't what gives someone HIV; you have it or you don't. If you do, you have to know in order to receive life-sustaining medical care and to protect future partners. And research and everyday experience show that when frightened persons finally bite the bullet and get tested, anxiety declines, even when the result is positive. In other words, the stress and worry about the test outcome are worse than the stress of leaning of a positive result. And in your case the result will be negative; you can count on it.
So just suck it up and just do it. Feel free to return to report the result, but I will delete without reply any other follow-up comments.
Thank you for reassurance Dr. Handsfield.
This sore throat is really killing me. I still have it (almost 3 weeks now!), it doesn't look like allergy or typical cold, just kind of annoying, persistent sore throat. I know you will probably think I'm an idiot to keep asking you about it, but I'm going crazy and scared to get tested: in your practice or in HIV literature did you hear about sore throat being the only sign of early HIV infection?
Thank you again.
This sore throat is really killing me. I still have it (almost 3 weeks now!), it doesn't look like allergy or typical cold, just kind of annoying, persistent sore throat. I know you will probably think I'm an idiot to keep asking you about it, but I'm going crazy and scared to get tested: in your practice or in HIV literature did you hear about sore throat being the only sign of early HIV infection?
Thank you again.
MEDICAL PROFESSIONAL
"...sore throat by itself even if its going on for two weeks can not be the sign of early HIV infection, there should be other symptoms - is that right?"
Yes.
"if the risk is so low (1:2000), why so many people get infected form sexual exposure - I think it is the main route of transmission in US nowdays".
Not true. The main HIV transmission route in the US is by sex between men, primarily unprotected anal sex. Gay men make up only 2-3% of the population (roughly 5% of males) and yet they account for 70-80% of all new HIV infections. Further, among the heterosexually transmitted cases, almost all are in the regular partners of infected persons, who typically become infected only after months or years of repeated exposures. It is very rare for anyone to catch HIV after a single heterosexual exposure. And anyway, in the US fewer than 1% of CSWs have HIV, and in most settings it's less than 1 in 1,000.
The reasons heterosexually transmitted HIV is common in many populations despite inherently low transmission efficiciency is very complex, not really amenable to a brief reply. Suffice to say that it's the result of sexual partnership patterns, frequency of other STDs, the proportion of males who are circumcised, and a number of other factors.
I suggest you re-read the last paragraph of my reply above. Then feel free to be tested if you would like the additional reassurance. But personally, if I were in your situation, I wouldn't feel the need and would continue unprotected sex with my wife without worry.
Yes.
"if the risk is so low (1:2000), why so many people get infected form sexual exposure - I think it is the main route of transmission in US nowdays".
Not true. The main HIV transmission route in the US is by sex between men, primarily unprotected anal sex. Gay men make up only 2-3% of the population (roughly 5% of males) and yet they account for 70-80% of all new HIV infections. Further, among the heterosexually transmitted cases, almost all are in the regular partners of infected persons, who typically become infected only after months or years of repeated exposures. It is very rare for anyone to catch HIV after a single heterosexual exposure. And anyway, in the US fewer than 1% of CSWs have HIV, and in most settings it's less than 1 in 1,000.
The reasons heterosexually transmitted HIV is common in many populations despite inherently low transmission efficiciency is very complex, not really amenable to a brief reply. Suffice to say that it's the result of sexual partnership patterns, frequency of other STDs, the proportion of males who are circumcised, and a number of other factors.
I suggest you re-read the last paragraph of my reply above. Then feel free to be tested if you would like the additional reassurance. But personally, if I were in your situation, I wouldn't feel the need and would continue unprotected sex with my wife without worry.
Thank you very much for your answer Dr. Handsfield.
Two more questions to follow up: based on your answer my understanding is that sore throat by itself even if its going on for two weeks can not be the sign of early HIV infection, there should be other symptoms - is that right?
Second thing is about testing: you said that you don't recommend HIV testing based on my symptoms and exposure, but my impression was that sex with CSW is more like high risk exposure (even from expensive escort agencies) and still can't get that statistics - if the risk is so low (1:2000), why so many people get infected form sexual exposure - I think it is the main route of transmission in US nowdays, even if you calculate multiple exposures with that risk it still would be less than 1%.
Thank you again.
Two more questions to follow up: based on your answer my understanding is that sore throat by itself even if its going on for two weeks can not be the sign of early HIV infection, there should be other symptoms - is that right?
Second thing is about testing: you said that you don't recommend HIV testing based on my symptoms and exposure, but my impression was that sex with CSW is more like high risk exposure (even from expensive escort agencies) and still can't get that statistics - if the risk is so low (1:2000), why so many people get infected form sexual exposure - I think it is the main route of transmission in US nowdays, even if you calculate multiple exposures with that risk it still would be less than 1%.
Thank you again.
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
Thanks for reading the forum and scanning other threads with similar questions. You are correct about the inherently low risk of such an exposure. There are no data on whether broken condom vaginal sex carries lower risk than entirely unprotected sex, but it's logical to assume the risk is lower, simply because your duration of exposure was a lot less than if you hadn't used a condom at all.
Persistent sore throat, without fever, skin rash, and other symptoms, does not suggest HIV. Further HIV doesn't cause runny nose or nasal congestion. And of course in the northern hemisphere, it's the right time of year for allergies; and colds occur all the time. These are by far the most likely explanation of your symptoms.
Therefore, from a strictly medical standpoint, or on the basis of exposure risk, I don't recommend HIV testing. On the other hand, most people anxious enough to come to this forum to ask a question probably benefit from the additional reassurance gained from a negative test result, in addition to whatever confidence you gain from this reply. And anyway, all non-monogamous sexually active people ought to have routine HIV testing from time to time, so this might be a good time, when it's on your mind. But not because of the sexual exposure or symptoms you describe.
I hope this helps. Best wishes-- HHH, MD
Thanks for reading the forum and scanning other threads with similar questions. You are correct about the inherently low risk of such an exposure. There are no data on whether broken condom vaginal sex carries lower risk than entirely unprotected sex, but it's logical to assume the risk is lower, simply because your duration of exposure was a lot less than if you hadn't used a condom at all.
Persistent sore throat, without fever, skin rash, and other symptoms, does not suggest HIV. Further HIV doesn't cause runny nose or nasal congestion. And of course in the northern hemisphere, it's the right time of year for allergies; and colds occur all the time. These are by far the most likely explanation of your symptoms.
Therefore, from a strictly medical standpoint, or on the basis of exposure risk, I don't recommend HIV testing. On the other hand, most people anxious enough to come to this forum to ask a question probably benefit from the additional reassurance gained from a negative test result, in addition to whatever confidence you gain from this reply. And anyway, all non-monogamous sexually active people ought to have routine HIV testing from time to time, so this might be a good time, when it's on your mind. But not because of the sexual exposure or symptoms you describe.
I hope this helps. Best wishes-- HHH, MD
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