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PEP Required: Vaginal juice / Sex toy / Risk of Exposure?
Dear Doctors,
I recently tested negative for an HIV test. and have no other risky behavior since the results except the following ridiculous incident:
This afternoon I was with a CSW in Germany at a legal brothel (eros center). She is from Ghana but has been at this brothel I frequent from time to time. for a few years Having recently reviewed HIV risks; I decided to avoid penetrative sex with her even with a condom and opted for the sex toy collection she had.
This CSW has been there off and on over the years and practices very hygienic work and always with condom even for oral. She advised that she gets tested once every 3 months, I specifically asked if she had HIV and said no. She also confirmed to always practice safe sex with a condom (but who knows if she is lying or not).
She then proceeded to get out the sex toys but first applied lubrication to her vagina, and then with the same fingers applied more lubrication to her sex toys covered with new clean condoms. Next she inserted the sex toys in my anus. Strange experience and will not be repeating.
It was probably 5 minutes or so between her "contaminated" finger on the sex toy before it was inserted in me. She also washed the sex toys after wards.
We did not engage in any vaginal sex or oral sex.
It was also around noon and I was her first customer for the day; in other words not to sure if any vaginal juices were even present and she seemed to focus on the outer vagina when applying.
Understood HIV begins to die or weaken when out of the body.
My question is what is the risk of HIV exposure from the above? Specifically, her vaginal juices being mingled with the lubrication on her finger and then on the sex toy followed by anal penetration?
It is now approximately 8 hours post exposure: Should I go immediately to an emergency room and get the PEP or the "morning after" or other emergency treatment for recent exposures? Or am I exagerating the risk here?
Yours truly,
I recently tested negative for an HIV test. and have no other risky behavior since the results except the following ridiculous incident:
This afternoon I was with a CSW in Germany at a legal brothel (eros center). She is from Ghana but has been at this brothel I frequent from time to time. for a few years Having recently reviewed HIV risks; I decided to avoid penetrative sex with her even with a condom and opted for the sex toy collection she had.
This CSW has been there off and on over the years and practices very hygienic work and always with condom even for oral. She advised that she gets tested once every 3 months, I specifically asked if she had HIV and said no. She also confirmed to always practice safe sex with a condom (but who knows if she is lying or not).
She then proceeded to get out the sex toys but first applied lubrication to her vagina, and then with the same fingers applied more lubrication to her sex toys covered with new clean condoms. Next she inserted the sex toys in my anus. Strange experience and will not be repeating.
It was probably 5 minutes or so between her "contaminated" finger on the sex toy before it was inserted in me. She also washed the sex toys after wards.
We did not engage in any vaginal sex or oral sex.
It was also around noon and I was her first customer for the day; in other words not to sure if any vaginal juices were even present and she seemed to focus on the outer vagina when applying.
Understood HIV begins to die or weaken when out of the body.
My question is what is the risk of HIV exposure from the above? Specifically, her vaginal juices being mingled with the lubrication on her finger and then on the sex toy followed by anal penetration?
It is now approximately 8 hours post exposure: Should I go immediately to an emergency room and get the PEP or the "morning after" or other emergency treatment for recent exposures? Or am I exagerating the risk here?
Yours truly,
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help.
My first, knee-jerk response is strictly from the title you chose. "Vaginal juice / Sex toy / Risk of Exposure?" suggest you don't really understand safe sex. Without a bare penis inside a partner's vagina or rectum (or maybe mouth, but only very rarely) there is no risk of sexual transmission of HIV. That's all you have to know. The virus has never been known to be transmitted by less direct exposure to sexual secretions. So my guess is that you really haven't had an exposure to worry about and need not consider PEP with anti-HIV drugs.
Now I have read the qeustion itself. Guess what? You made a wise decision about avoiding insertive sex. And it also sounds unlikely your partner had HIV anyway. Most sex workers don't lie about HIV status when asked directly. But even if she did, the chance of transmission through sex toys or other indirect contact with secretions is very low, probably zero. (Even with entirely unprotected vaginal sex for several minues, the average female to male transmission risk -- if the female has HIV -- averages once for ever 2,000 exposures. Given that, what could the chance possibly be with such minor exposure to secretions?)
For those reasons, the chance you caught HIV is zero for all practical purposes. The biological reasons (e.g. how quickly HIV is inactivating outside the body by drying etc) really don't matter. The important fact is that HIV has never been known to be transmitted by the sorts of events you describe, and you're certainly not going to be the first! You not only should not seek PEP, you don't even need HIV testing (unless, or course, you need a negative test for additional reassurance beyond my words).
I hope this has helped. Best wishes-- HHH, MD
My first, knee-jerk response is strictly from the title you chose. "Vaginal juice / Sex toy / Risk of Exposure?" suggest you don't really understand safe sex. Without a bare penis inside a partner's vagina or rectum (or maybe mouth, but only very rarely) there is no risk of sexual transmission of HIV. That's all you have to know. The virus has never been known to be transmitted by less direct exposure to sexual secretions. So my guess is that you really haven't had an exposure to worry about and need not consider PEP with anti-HIV drugs.
Now I have read the qeustion itself. Guess what? You made a wise decision about avoiding insertive sex. And it also sounds unlikely your partner had HIV anyway. Most sex workers don't lie about HIV status when asked directly. But even if she did, the chance of transmission through sex toys or other indirect contact with secretions is very low, probably zero. (Even with entirely unprotected vaginal sex for several minues, the average female to male transmission risk -- if the female has HIV -- averages once for ever 2,000 exposures. Given that, what could the chance possibly be with such minor exposure to secretions?)
For those reasons, the chance you caught HIV is zero for all practical purposes. The biological reasons (e.g. how quickly HIV is inactivating outside the body by drying etc) really don't matter. The important fact is that HIV has never been known to be transmitted by the sorts of events you describe, and you're certainly not going to be the first! You not only should not seek PEP, you don't even need HIV testing (unless, or course, you need a negative test for additional reassurance beyond my words).
I hope this has helped. Best wishes-- HHH, MD
Thank-you doctor!
MEDICAL PROFESSIONAL
2) With or without symptoms, at 10 days probably only 20% of newly infected people would have positive antibody tests. Don't waste your money.
1,3) This isn't an ARS symptom; and no, it is exceedingly unlikely that ARS would cause only a single symptom of any kind.
The odds of a "coincidence", i.e. that you have a garden variety muscle spasm or something similar that just happened to come on a few days after a sexual incident, is thousands of times higher than the chance that the two events are related. Ignore any and all health symptoms you have in the next 4 weeks and rely on testing -- if you do anything at all. Personally I wouldn't feel a need to be tested and would continue unprotected sex with my wife without worry I could infect her with anything from the event you have described.
That will end this thread. There is nothing you can add that would change my opinion or advice. Take care and stay safe.
1,3) This isn't an ARS symptom; and no, it is exceedingly unlikely that ARS would cause only a single symptom of any kind.
The odds of a "coincidence", i.e. that you have a garden variety muscle spasm or something similar that just happened to come on a few days after a sexual incident, is thousands of times higher than the chance that the two events are related. Ignore any and all health symptoms you have in the next 4 weeks and rely on testing -- if you do anything at all. Personally I wouldn't feel a need to be tested and would continue unprotected sex with my wife without worry I could infect her with anything from the event you have described.
That will end this thread. There is nothing you can add that would change my opinion or advice. Take care and stay safe.
Doctor,
As of yesterday (9 days after my incident with sex toy and vaginal secretion risk), I began having intense pains in the side of the neck and back of the head. No other symptoms except possible very mild fever but I took my temperature and nothing above say 99 F (37.5 C). Sore throat: not really (though for months I have post nasal drip due to allergies and have mild sore throats from time to time), no rash.
1.Might this be a symptom of ARS (pain in lymph nodes of back of head and side of neck)? Understood the exposure I had seemed virtually no risk, there still was some theoritical risk?
2. How soon after ARS would an antibody test be reliable? 10 days assuming this is ARS (even if unlikely)?
3. Do all the ARS symptoms generally cluster on the same time and there is more than just 1 symptom, ie, highly rare to have only 1 symptom?
Many thanks,
ET
As of yesterday (9 days after my incident with sex toy and vaginal secretion risk), I began having intense pains in the side of the neck and back of the head. No other symptoms except possible very mild fever but I took my temperature and nothing above say 99 F (37.5 C). Sore throat: not really (though for months I have post nasal drip due to allergies and have mild sore throats from time to time), no rash.
1.Might this be a symptom of ARS (pain in lymph nodes of back of head and side of neck)? Understood the exposure I had seemed virtually no risk, there still was some theoritical risk?
2. How soon after ARS would an antibody test be reliable? 10 days assuming this is ARS (even if unlikely)?
3. Do all the ARS symptoms generally cluster on the same time and there is more than just 1 symptom, ie, highly rare to have only 1 symptom?
Many thanks,
ET
Lots of deadly variables. Thank-you for all your service work on this forum - best HIV forum on the Internet!
MEDICAL PROFESSIONAL
Excellent question. The average of 1 in 2,000 is just that, an average. There are some sexual exposures where the risk is much higher, maybe even as high as 1 in 100 -- e.g. if the viral load is high, the infected person only recently acquired HIV, other STDs are present, and others. Those circumstances are much more common in sub-Saharan Africa than in most industrialized countries. Probably I should be more careful in clarifying that the 1 in 2,000 average is for North America and Europe, but not necessarily in AIDS-endemic areas like tropical Africa.
Doctor just one follow-up question on your 1 in 2000 statistics. How with such low odds of acquiring do countries like South Africa or Swaziland end up with 25% adult prevalence?
I suppose it is some complex average logorythm but I guess that would mean on average a male would must have unprotected vaginal sex in the 100s of times before infected. Would you concur?
I suppose it is some complex average logorythm but I guess that would mean on average a male would must have unprotected vaginal sex in the 100s of times before infected. Would you concur?
Thank-you Doctor. For the rapid and detailed response which conclusively addresses my concernts.
Just my surge of perhaps paranoia in this age of AIDS.
Just my surge of perhaps paranoia in this age of AIDS.
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