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Avatar universal

Potential HIV expoesure

Hi Doctor,

I had an encounter with a sex worker about a month ago. I want to add that after the incident, I found out that she was menstruating, and I had blood on the condom. The condom was not broken. Everytime I think about it, I realize what a fool I have been. I have had some more encounters with her previously.

Last week, I had pain in my left lymph node (the pain went away in 1.5 days) and I felt tiredness (also lasting about 1 day), so I was worried to death and I went to the doctor. The node was not swollen and was not hard. In fact, the doctor felt them and said nothing was wrong until I told him about my history. He then checked for a sore throat and took a culture which tested positive for gonorrhea. I have since gotten an antibiotic injection and have also been tested for HIV. I am waiting for the results.

In the meantime, I am scared to death. The vaginal sex was PROTECTED, but oral was not. I do not have a fever, in fact I am checking my temperature everyday, and it is 36.6-36.8C. My lymph nodes are now not painful and not swollen. I do still have a sore throat (after 2 days of antibiotic injection). I do not have a rash anywhere. I do not feel overly fatigued (I have a little more fatigue than usual, but due to anxiety I think). One worry is that I have a small single spot on the penis (which appeared about 2 weeks from the last encounter) - it is about 5mm in diameter, slightly raised and smooth skin. I don't know if this has any connection with ARS.

My results are due in 3-4 days time, and in the meantime, I am worried beyond death and extremely anxious. In fact, I am unable to sleep properly and very tired as a result.

I am worried to death if I have potential ARS?
17 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
Welcome to the forum.  Bottom line:  you were not at risk for HIV and something else is the cause of your symptoms, which don't sound like those of a new HIV infection anyway.

Statistically, it is unlikely your commercial partner has HIV, which -- contrary to what you might assume -- is quite rare in sex workers in the US and other industrialized countries.  Second, it is pretty much impossible to catch HIV by unprotected vaginal sex, and the risk of HIV transmission is not significantly higher when infected women are menstruating.  Menstrual blood on the outside of a condom doesn't mean anything important.

As for symptoms, perhaps the single piece of advice we give most frequently on this forum is that symptoms are virtually never useful in judging whether or not someone has HIV.  The same symptoms caused by HIV accompany innumerable other minor health problems.  And in any case, your symptoms don't suggest HIV anyway and your doctor's reassurance should be taken at face value.  He is correct that there is nothing in your symptoms that raise concern about HIV.

Most important, an HIV test is in the works.  You can definitely expect a negative result.  If it was a duo test (for both HIV antibody and p24 antigen), the result at 4 weeks will be definitive.  If it was an antibody-only test, it will be highly reassuring, but your doctor might recommend another test after a few weeks.  But in the meantime, you should be mellow and relaxed about HIV.  It is exceedingly unlikely you have it.

I hope this helps. Best wishes--  HHH, MD
Avatar universal
I just want to clarify that the "left lymph node" mentioned above is the lymph node under the left jaw. I am actually not 100% sure the pain was from the lymph node, since the doctor failed to see any hardness or enlargement of the node on physical examination.

Also - a clarification about the "raised spot" - the spot is not really raised, it is flat, but is distinguishable from surrounding skin by the fact that is more smoother - leathery, if you will. It is of the same color. About 4mm - 5mm in diameter.
Avatar universal
Doctor,

I would also like to add that I have never had an discharge from the penis etc., nor any pain/swelling under the armpits or in the groin.
239123 tn?1267651214
MEDICAL PROFESSIONAL
I saw these comments before replying above.  They make no difference in my opinion or advice.  Please stop examining yourself.
Avatar universal
Thank you for your help, doctor.

I just want to clarify, that my doctor did not reassure me about the possibility of not having HIV. He just could not find any symptoms on a physical exam, until I pointed out that I had sex with a CSW. He then examined my throat which he found to be redder than usual, and hence took a throat swab that came back positive for GC, but negative for Chlamydia. The diagnosis was GC Pharyngeal. He then said I should get all the remaining STD blood tests done.

It is because of this diagnosis that I am deathly scared, since I have read elsewhere that Gonorrhea occurrences are highly correlated with a HIV+ status.
239123 tn?1267651214
MEDICAL PROFESSIONAL
Interesting that you have pharyngeal gonorrhea, which is not commonly aquired by cunnilingus, but it happens.  I hope you have informed your commercial partner; she must have genital gonorrhea and should be tested and treated for it.  And since that in turn indicates that she does not always use safe sex, I would advise you to find a different partner if you continue occasional commercial sex adventures in the future.

As for gonorrhea being "highly correlated" with HIV, that really makes little difference.  The risk of HIV may indeed be 10 times higher in people with gonorrhea than without it.  (I'm guessing -- 10X probably is too high, but it will work for this purpose.)  So if your risk of having caught HIV was 1 in a million, with gonorrhea it becomes 1 chance in 100,000, i.e. much too low to be considered high risk.

So this information this does not change my opinion or advice about HIV.  It somewhat raises the odds your partner has HIV, but still the odds are strong that she does not; and as we discussed, you have had no exposures likely to result in HIV transmission.  (HIV has not been reported to be transmitted by cunnilingus.)  Stay calm as you await your test result, which I still expect to be negative.  I'll be happy to comment further if you want to report that test result, but won't have anything more to say until then.
239123 tn?1267651214
MEDICAL PROFESSIONAL
And by the way, your sore throat probably had nothing to do with gonorrhea at the same site.  Over 90% of pharyngeal GC infections are asymptomatic.  You probably still had a cold.  And not HIV.
Avatar universal
Thanks doctor. Just one last thing - I also performed analingus on on the CSW (I know, really foolish). I think transmission via this route is highly unlikely - am I right?

I will wait for the results in the meantime - although I am having anxiety, panic and have lost appetite and sleep.
239123 tn?1267651214
MEDICAL PROFESSIONAL
Analingus has not been studied in relation to HIV risk, but probably there is little or no risk.  However, analingus is perhaps the highest sexual risk activity there is with respect to hepatitis A and any number of serious gastrointestinal infections.  I recommend against it except in permanent, mutually monogamous relationships -- and even then, serious infections can result.  There is a reason human societies work so hard to separate their feces from their food and water -- and analingus bypasses all that history and science.

I cannot help with your emotional reaction to all this, except to convey the known science and probabilities, plus my own clinical judgment.  All those should be highly reassuring to you.  If they are not, perhaps professional counseling might help.  Or just suck it up until definitive HIV test results are available.  Until then, I can't help -- so I'll have no further comments.
Avatar universal
Hi Doctor,

I got tests done for Syphilis, HIV and Hep. C. The Hep. C. and Syphilis tests came back negative (they were posted on Saturday night, 12AM), however the HIV 1&2 results have not yet been posted. I am wondering why. The thought that labs/hospitals will automatically post a negative result and hold back a potentially positive result so that the doc has a chance to call me up before the results are posted is driving me mad.

Do you have a take on this?

Thank you.
Avatar universal
My sore throat by the way is still continuing, although I have no other symptoms such as fever or painful nodes, or malaise.
239123 tn?1267651214
MEDICAL PROFESSIONAL
No comment until your HIV test result is available.  Some tests just take longer than others. In the meantime, carefully re-read my replies above.
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