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Avatar universal

Unprotected vaginal with CSW

Hi Doctors,

Really appreciate the work you guys do. About a week ago I made a stupid mistake and had unprotected vaginal sex with a CSW in Toronto, Canada. She said she was "very clean". I am very worried about a possible HIV risk. I got tested for everything 5 days after the exposure including a rapid test for HIV (neg). I have yet to receive the results for everything else (I will on Wednesday). I know the chances of catching other STD's are higher but I am worried sick about HIV

I have not had any symptoms yet however I have noticed that I have a white coating on my tongue with some spots near the back. I went to a walk in clinic and the doctor quickly prescribed me Nystatin however he did not take any tests. I realize anyone could have it and it is most likely just bad timing. I noticed it probably 2-3 days after my exposure. I could have had it earlier but I am not sure, I was drinking a lot the last few weeks and did not have the best eating habits

I have read that in Toronto 1/120 people are infected with HIV.  I am a circumcised male and do not use drugs. The girl I saw was most likely in her mid 20's and she was Japanese I believe. She did not seem like she used drugs and I hope she does not engage in unprotected sex a lot (though she did with me). She was a relatively upscale escort, not a street girl

1. Exactly how big is my risk for this exposure? I have read on these forums and estimate anywhere from 1/50,000 to 1/100,000+. The numbers seem to be in my favour however that helps my anxiety none

2. What do you think about the oral thrush? I am going to see my family doctor tomorrow and hopefully get some tests done

3. What do you think about a rapid test after 2 weeks? Should I try to get a standard test at that point (I believe they do the combo/duo test in Canada for standard lab tests) I know its not conclusive but I've read about 50% accuracy for a standard antibody test after 2 weeks and about 95% at 4-5 weeks
11 Responses
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum.

First, it is unlikely your commercial partner had HIV.  Your figure of 1 in 120 Toronto residents having HIV doesn't compute -- although I suppose it is possible if 5-10% of gay men in Toronto have HIV.  As in most eastern North American cities, the large majority of HIV infections in eastern Canada are in gay men.  Also, upscale (expensive) escorts are believed to generally have low rates of HIV; they typically get tested frequently and tend to have low risk clients (mostly heterosexual men like you).  So the chance is very low your partner had HIV, probably under 1 in 1,000.  When a woman has HIV, the average transmission risk is about 1 chance in 2,000 for each episode of unprotected vaginal sex.  Together, those statistics suggest an HIV risk in the ballpark of 1 in 2 million.

Those comments address question 1.  As for oral thrush, you are correct that visual examination can be very misleading, and thrush is not the same as white coated tongue, for example.  In any case, thrush is actually not very common with new HIV infections; it is more commonly a problem in overt AIDS, i.e. people who have had HIV for several years.

Your comments about the reliability of HIV testing are about right.  You should stay away from the oral fluids rapid test, which may take a bit longer than blood tests (either rapid or lab based) to become positive.  A lab-based duo test would probably detect around 80% of HIV infections at 2 weeks.  See the thread linked below for more detailed discussion, as well as the other thread linked in that one.

http://www.medhelp.org/posts/show/1891685

Bottom line:  This was a low risk exposure with regard to HIV.  Stay relaxed while you await the results of testing.  However, I would encourage you to also be tested for gonorrhea and chlamydia, which are far more likely than HIV; and syphilis in a few weeks.  I expect those tests, as well as the HIV tests, to be negative -- but better safe than sorry.

A final bit of advice, in a single word:  Condoms!

Regards--  HHH, MD
Avatar universal
Thanks for the response doc.

I could be able to get tested tomorrow, just a couple of days shy of 2 weeks, would you recommend it?

I know that is very early but I can't stop thinking about it and would not get the results for a week or so which I could follow up with a rapid blood test (3 week mark).

I'm pretty sure in Canada they use the 4th generation duo/combo test for standard blood tests, would you know anything about that?


Avatar universal
I should add that I'm going to check my results for the STD testing which is why I could get tested tomorrow.

Also, if I come back negative for things like gonorrhea and chlamydia, do you think that lowers my chance of HIV (meaning the girl is clean) or is that just speculation?
239123 tn?1267647614
MEDICAL PROFESSIONAL
My advice is to follow the clinic's advice about HIV testing when you return for your STD test results.  If you have a 4th generation or "DUO" test (for HIV antibody and p24 antigen), a negative result will be around 60-80% reliable at 2 weeks.

Negative gonorrhea and chlamydia results will be reassuring in their own right, but you really can't conclude anything from them about HIV risk.
Avatar universal
Hey doc,

Just wanted to follow up with a few things. I got a call from the clinic informing me that everything came back negative however they did not draw enough blood for the syphilis test. They want me to come in today and I figure I may as well request the HIV lab test while I'm there (just shy of two weeks).

I also went to the dentist today and he had a look at my tongue and he believes its a bacterial infection. He gave me a spray and a tongue scraper and my tongue already looks much better. I figured thrush wasn't an accurate diagnosis because the anti-fungal hadn't done anything over 5 days as well as the fact that my case did not look like pictures I have seen online. Like you said visual examination is misleading, and I went to two doctors who told me the same thing.

My anxiety has subsided a bit, provided that this test comes back negative would my chances of infection be significantly lower or is it too early to tell?

239123 tn?1267647614
MEDICAL PROFESSIONAL
Yes, a negative result at 2 weeks will be reassuring -- not 100% reliable, though.
Avatar universal
Hey doc just checking in again.

So I have had a 12 day blood duo test come back negative. I also had a rapid blood test done at 19 days that also came back negative.

I am going for a retest today, which would mark the 34th day. On my local clinics website, it says that rapid blood test is 95% accurate at this point, would you agree? I know a combo test would be better however I really don't want to wait for the results.

I am worried that over the last few days I have had some HIV like symptoms. I had caught what I hope is a cold last week, which just seemed like a head cold, no fever at all. However over the last 2 days I have been bothered with diarrhea without any sudden changes to my diet. My temperature has also been a few degrees higher than usual (around 99/10) This is of a big concern to me.

What do you think the chance of testing positive at this point?
Avatar universal
Hey there, sorry to invade your thread but,

we're in the same boat, Im gonna go test today at 5 weeks (same as you) and that would be a very good indication.

as you know the weather here has been changing a lot, everyone is sick here, in the bus, office, malls etc, I do think I had a cold because of our anxiety we cant think of anything but HIV,

one more thing , Im not sure where you get that 1/120 figure of positive people in canada or in Toronto to be more specific but its waaay higher than it really is which I suspect to be less than 1,1000 for heterosexual population. Ask in your local clinic and they'll tell you how rare they will find a positive one encounter male.

lets get our test done today and hopefuly by 5 weeks this will be very, re assuring to back up the logic above, What do you think DR Handsfield?

239123 tn?1267647614
MEDICAL PROFESSIONAL
Yes, a negative rapid blood test at 35 days is almost 100% conclusive.  Your countryman's comments are accurate.

That should end this thread.  You can be sure any additional testing also will be negative.
Avatar universal
How did you make out pal? Good news?

Dr. Is really testing necessary at this point?
239123 tn?1267647614
MEDICAL PROFESSIONAL
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