Unprotected Vaginal Intercourse with Sex Worker

[GuiltyHusband]

Dear Dr. Hunter Hansfield,

Like many idiotic husbands on this site I had an episode of unprotected vaginal intercourse with a sex worker.  This happened in a Shanghainese hotel Sauna.  These girls have customers daily but I've never seen one who didn't use a condom in the last few years.  I chose the same girl I had during my last visit as  I had a sense she was fond of me. One thing lead to another, and then out of SHEAR STUPIDITY I let her insert my penis into her vagina while lying beneath her.  The unprotected sex perhaps lasted less than a few minutes and was not rough.  I snapped out of it and pulled out..  But I was not wise & continued with unprotected oral & protected sex for another 15 minute or so. (I had a few unprotected incidents with a regular sauna CSW when I first moved here and got caught on by the availability of sauna sex and those gave me anxiety hell for a month until luckily my Duo turned out to be negative.)  

But a week after this episode, I'm freaking out even more than before.  It is MORE terrifying this time.  I have a wife now (who gave her best years to me) and I plan to have a child in 1-2 years.  I feel almost that I deserve to be HIV positive.

The sex worker told me that also foreign clients fancy her, I don't know if she also has unprotected sex other clients.  She tells me that she's been in the business for a year now and usually gets HIV testing every 3 months.  I don't know whether to believe that, and there's always the window period.

In your professional opinion:

1. Would my risks be also 1 in 1000?
2. Given the situation and geographical setting.  Would you characterize this as low risk and what would be your assessment of the test result?
3. Have you encountered a positive HIV transmission from such a single unprotected event before?

Thank you for your reply.

[Edward W Hook, MD]

Your result is conclusive at 30 days. Time for you to move forward.  EWH

[GuiltyHusband]

Dear Dr.  Hook,

I got my duo test today and the result was HIV negative after 30 days of exposure.  I have read on other posts that this is considered conclusive.  Can you comment on that?

Thank you very much for your previous assessment.

[GuiltyHusband]

Dear Dr.  Hook,

Thank you for the prompt response.  Have a nice weekend.

Best

[Edward W Hook, MD]

Your respiratory symptoms are not suggestive of the ARS and you can be confident that the antibiotics you are taking will not interfere with your test results.  EWH

[GuiltyHusband]

Hi Dr.  Hook,

I apologize if I'm intruding on your weekend.  I have a question regarding ARS.  I've had continuous phloem buildup in my respiratory tract in the last week causing me some discomfort in breathing and stuffy and dull pain in my right chest.  I got a prescription of moxifloxacin antibiotic and some mucosolvan to deal with the respiratory tract infection.  I have chronic rhinitis and I have been sleeping very little and usually tensed up from anxiety causing muscle fatigue so I was thinking that they may attribute more to this infection than ARS.  To my knowledge I have not had a fever.  Could you share your assessment?

Would the prescription antibiotic (over next 6 days) interfere with a duo test that I plan to take in 8 days?

I hope I didn't take too much of your time.  Have a nice weekend.

Thank you.

[Edward W Hook, MD]

Thaks for your note.  I am confident you wil be fine.  EWH

[GuiltyHusband]

Dear Dr Hook.

Thank you for providing your professional opinion.  I realize you and the other doctors would have to respond to these on a daily basis, but having a reinforcement seems to make me somewhat better.  I guess I just have to suck it up until the 4 week test and make preparation for the worst outcome of what I have to do if this family is to fall apart. (Which has been running through my mind constantly each day.)

I notice a lot of people don't post their results, so I guess I'll rely on the statistical figures while I wait.  I guess if the stats are wrong, there should would have been a lot of negative feedback.

I truly hope I am at low risk and that my result will be negative.  I will post my results.

Thank you again.

[Edward W Hook, MD]

Welcome to our Forum. Dr. Handsfield and I share the Forum and take questions based on our availability.  We are comfortable in doing this as we have worked together for over 30 years and while our verbiage may vary the facts and essentials of our recommendations are the same.  We have not disagreed with each other in many years.  I will be answering your question this evening.

The exposure you describe was relatively low risk for HIV and for other STIs.  STIs and HIV are bad for CSWs business and typically they take precautions to avoid infection.  In fact, sex with a CSW who typically uses condoms is lower risk for infection than a casual pick-up in a bar who may not take the same precautions.  Most CSWs do not have HIV or other STIs and as you know, most exposures do not lead to infection. With this as background, I'll go on to your questions:

1. Would my risks be also 1 in 1000?
The risk for HIV from a single episode of unprotected vaginal sex, IF your partner happened to have HIV (unlikely) is, on average between 1 in 1000 and 1 in 2000.  

2. Given the situation and geographical setting.  Would you characterize this as low risk and what would be your assessment of the test result?
I would characterize your risk for infection as being low.   When you test, I anticipate that you will find that you were not infected.  

3. Have you encountered a positive HIV transmission from such a single unprotected event before?
What a silly question which has more to do with statistics than anything else.  Yes I have.,   I see many, many patients and see unusual cases. I have seen a few persons who became infected after a single infection. That does not, by any means make it common.

I hope these comments are helpful.  EWH

[GuiltyHusband]

Hi Doctor,

Sorry.  I just want to clarify a few things.

I am planning to get a Gen 4 test at the 30day mark.  Question 2 refers to your assessment of the result I should expect.

I mentioned I had Gen 4 done for previous exposures a few years (not related to this.) as a reference to my utter stupidity for doing this again.