Info exposure and way forward

[Ponrtde]

Hi doctors, I already posted on Community Forum but I decided to post here also because I would like to run a test for reassurance in the next weeks. The exposure took place 1 week ago.
My risk situation is the following: protected vaginal sex, unprotected oral sex got and gave with two Chinese prostitutes in a brothel in Jakarta. A condom was used for the first vaginal penetration with one of them and another one for the second penetration. I received unprotected and protected oral sex and I gave unprotected oral sex to one of them. I gave very short oral sex almost exclusively on the clitoride, no evidences of bleeding cycle, the girls clean their vaginas and their mouth more than one time with tissues and there was no blood, maybe I saw a drop on the tissue on the one I gave oral sex but I can't remember it for sure, I had a small sore in my mouth at that time due to a bite I wear. I came after the second penetration after an handjob. I did not fell a condom broke. The condom slip a bit so the base of the penis was not entirely covered but I remember having it always on, also one girl put it better after a minute of penetration. After each penetration it did not remain in the vagina. I have been so detailed because I tried to figure out how it went.

It's the first time I had sex with prostitutes. I was not drunk.

I would like to run main STD tests and a normal antibody available here in Jakarta after two weeks from the exposure. Then I am planning to run a combo test after 5 weeks from the exposure in Singapore. I could not find any combo test available here in Jakarta at the moment. Do you know any clinic to which I could refer in Jakarta?Maybe I will be with my girlfriend before the end of the year. Worried because usually we practice unprotected sex.

What's your opinion on the risk and on the planned tests?

Thanks a lot. I will update my post when tests results will be available.

[Edward W Hook, MD]

Welcome to the Forum. I'll be pleased to comment, adding to the accurate information you have already received on our Community Forums.  There is HIV present among commercial sex workers in Indonesia but most do not have infection.  Further, even with unprotected intercourse, the likelihood of HIV transmission is quite low and not something to worry a great deal about.  Your use of condoms will also go a long way towards keeping you safe.  As long as the condom is in place, covering the tip of your penis, worn throughout sex, and does not break there is no meaningful risk for acquisition of HIV from condom protected sex at any site.  This leaves your receipt of unprotected oral sex and giving on oral sex to one of your partners.   As Teak has told you with a series of quotes from Dr. Handsfield and me, there are no instances in which someone has been showing to have gotten HIV from receiving oral sex from an infected person.  In fact there in most cases we see no medical reason for testing if a person's only exposure is receipt of oral sex.

This brings us to the topic of your performance of oral sex (cunnilingus) on one of your partners.  The risk for HIV from this act is exceedingly low. There are a very few cases in which persons may have gotten HIV from performance of oral sex on an infected female partner however even these events are a bit suspect.    At most, the risk for infection from performing cunnilingus on an infected partner (unlikely as mentioned above) is less than 1 infection per 10,000 acts (i.e. performing oral sex on an infected partner once daily for over 27 years).  Thus this too is not something to worry about.

I have no problem with your decision to test to reassure yourself.  I am confident the tests will be negative.  At 2 weeks a standard HIV antibody test will detect well over 50% of recent HIV infections and if you get a combination test at 5 weeks, your results will be conclusive (and almost certainly negative).

I hope my comments are helpful to you. Please continue to practice safe sex.  EWH

[Ponrtde]

Thanks for your quick replies and for the great job you all are doing with this forum. Bye

[Edward W Hook, MD]

Yes, these tests are conclusive and tell you that you did not get HIV from your exposure 5 weeks earlier.  EWH

[Ponrtde]

Dear doctor, here below the results of the combo test at 5 weeks post exposure:

HIV I,II Ab & p24 Ag Non reactive

Can I consider it as a conclusive negative result? Thanks

[Edward W Hook, MD]

I am not aware of how to find out about the availability of combo tests in Jakarta.  Local health authorties may be able to help.

As for your risk for infection and sex with your GF, if I were you, I would not be worried about having unprotected sex.  This however is, of course, a personal decision.  EWH

[Ponrtde]

Thank you doctor. Really helpful.

If I will meet my girlfriend prior to combo test should I go for protected sex or complete abstinence?

Regarding the possibility to find combo test in Jakarta do you have any comment?

Thank you.