Testing for one time unprotected vaginal intercourse (insertive partner)

[Worriedonabike]

Dear doctors

Thank you for spending time answering questions on this forum. I have found it very useful but still would like some clarity with my foolish actions.

6 days ago, i had unprotected vaginal intercourse with a masseuse in malaysia. She was indonesian with unknown hiv status although she mentioned she does regular bloodwork every month. It is regular practice at this 'massage parlour with extras'

This is my first time ever having unprotected vaginal intercourse and it lasted about a few minutes.

Reading from many responses, my chances are low (its still a risk) IF she was positive but that does little to my anxiety. I am married and extremely anxious and have avoided unprotected intercourse with my wife.

May i know -
1) does the 1 in 2000 risk hold true for my side of the globe? She is considered a CSW right? They do get tested regularly right?

2) i need to get a peace of mind, when can i do the pcr testing? At least i can do thay before the somewhat conclusive 6 weeks test and 12 weeks one

3) i havent exposed myself like this before, would it be unlikely i can get hiv?

4) how soon should i test for stds? I have had unprotected oral sex before and had no symptoms of penile discharge etc.

I wanna turn a new leaf. This incident opened up my eyes on how reckless this could get. I allowed this to happen even after knowing about hiv and aids. I took that information for granted just for a few minutes of fun.

No more risky business. And thank you in advance for your reply.

-eager to test and leave this beind-

[Edward W Hook, MD]

Thanks for your thanks.  I am confident that your tests will show that you were not infected.  EWH

[Worriedonabike]

thank you. got a hold of the masseuse and she said there is nothing to worry as she checks her blood every month and has no said infections.

anxiety says she is lying and should see proof. but like many other threads in this forum, anxiety just makes you a bit crazy.

nevertheless will still do a check to have a peace of mind.  

thank you for your time and appreciate the work you do to help people on this forum, even one who is thousands of miles away.

[Edward W Hook, MD]

A third genration test at 4 weeks would detect over 90% of recent infections while a 4th generation test would detect all infections.  In your case it makes no difference what test you choose- your exposure was no risk.  EWH

[Worriedonabike]

Dr Edward,

May I ask how accurate is a 3rd Gen EIA test? is it a combi test? i am trying to piece together information on the internet. Am i right when it says 4-6weeks post exposure take 4th generation test (antibody and antigen) and after 6 weeks, 3rd gen or any antibody test would suffice (as antigen has already dissipated)

Sorry for the question. just wanted to get ready for testing.

[Worriedonabike]

Thank you for the responses. It helps a lot. Have a good weekend ahead.

I'll post my results here when i get them. :) i am pretty confident it should be a negative.

[Edward W Hook, MD]

2- as for the test, is this combi test the same as the rapid test? I cant seem to find the right information. Back in kuala lumpur it seems they have this rapid test with results within 20minutes. Cant find if its the antigen and antibody test/4th generation. Would such a test get rapid results within half an hour?

There are many varieties of tests.  Most rapid tests however tesst only for antibody, not antigen and antibody.

3- just to be clear, i formed my sentence quite confusingly in my previous post.  your risk assessment for my chances is very low to be infected with hiv right? I have more of a chance getting sti? In the meantime, although low risk (still a risk), i should avoid unprotected sex w my wife right until i get tested? Seems logical thing to do.

You have to decide about sex with your wife.  As I told you, your risk is low for both STI and for HIV.  Lower for HIV than for STI.

4- thank you for the detailed steps in checking for
Stds. I have done some bloodwork last week for 'previous' escapades and awaiting results. So far no sores and just jock itch and suspected sciatic nerve pinch. So in other words, within 4weeks or so if health is all good, i should be clear of stds right? I'll get some bloodwork done tomorrow as well.

Correct.

EWH

[Worriedonabike]

Thank you for your reply sir

1- i understand this. Thanks for the clarification

2- as for the test, is this combi test the same as the rapid test? I cant seem to find the right information. Back in kuala lumpur it seems they have this rapid test with results within 20minutes. Cant find if its the antigen and antibody test/4th generation. Would such a test get rapid results within half an hour?

3- just to be clear, i formed my sentence quite confusingly in my previous post.  your risk assessment for my chances is very low to be infected with hiv right? I have more of a chance getting sti? In the meantime, although low risk (still a risk), i should avoid unprotected sex w my wife right until i get tested? Seems logical thing to do.

4- thank you for the detailed steps in checking for
Stds. I have done some bloodwork last week for 'previous' escapades and awaiting results. So far no sores and just jock itch and suspected sciatic nerve pinch. So in other words, within 4weeks or so if health is all good, i should be clear of stds right? I'll get some bloodwork done tomorrow as well.

Thank you for the comment and clarification. I hope i can get tested asap and move on from this episode

[Edward W Hook, MD]

Welcome to our Forum.  I'll be glad to comment.  Your decision to have a single episode of unprotected sex with a commercial sex worker  may have placed you at a slight risk for acquisition of STI but that risk is not terribly high.  Most people, even most CSWs do not have STIs and most exposures to infected partners do not lead to infection.  Regarding your question about your partner checking, the answer is yes., many CSWs do get checked regularly for STIs both for their own protection and because infections are bad for business.  Thus sex with a CSW may be a lower risk event than sex with someone who is less aware of their potential risk for infection.

As for your specific questions:
1) does the 1 in 2000 risk hold true for my side of the globe? She is considered a CSW right? They do get tested regularly right?
Yes, she is a CSW and the figures on risk for HIV following unprotected sex are the same across the globe.  If she happened to be infected, your risk for infection from unprotected vaginal sex is between 1 in 1000 and 1 in 2000 per act of intercourse.

2) i need to get a peace of mind, when can i do the pcr testing? At least i can do thay before the somewhat conclusive 6 weeks test and 12 weeks one.
We recommend against PCR tests- they have more false positive results than other tests, the time course over which they provide reliable results is less clear than for other tests, and they are expensive.  We recommend testing with 4th generation, combination HIV antigen/HIV antibody tests.  These tests will provide conclusive results 4 weeks after an exposure.  

3) i havent exposed myself like this before, would it be unlikely i can get hiv?
See above- very low.

4) how soon should i test for stds? I have had unprotected oral sex before and had no symptoms of penile discharge etc.
The absence of symptoms six days after exposure is a good sign but not an absolute assurance that you were not infected.  The most common STIs are gonorrhea, chlamydia and NGU- you can test for them now and get reliable results.  If you do not have a sore develop on your penis in the 14 days following the exposure, you can be confident your did not get herpes.  The same is true for syphilis but it takes 30 days to be sure.  We do not recommend blood tests for herpes.

I hope these comments are helpful  Take care.  EWH