risk potential of transmission from csw to man

[mexguide]

A couple of weeks ago, filled with loneliness I went to a local massage parlour.  Montreal has many.  I went for a massage and some hand work, but the worker was very turned on and she slipped a condom on me and then just straddled me.  Didnt charge, just found me sexy ( or so i want to believe) and hopped on board. She came. I didnt.  And so after several minutes of trying to manually release, she pulled me inside her...no condom.  it was a pretty heady and intoxicating sensation, but i managed to resist after about 20 or 30 seconds ( quite literally several  half-hearted thrusts). no ejaculation.   I pulled out and washed off, and asked her all the right questions, and she insisted on being clean and safe etc...but i knew even as I was entering her, that it was dumb, and that is why I was able at least in part to pullout as quickly as I did.  Two weeks-  no side effects except for  the psychologically induced paranoia, anxiety  and amplified feelings of fatigue and aches etc... a small rash from my rowing gloves ( dermatitis likely-- but is it  ARS? - in my head) all the chicanery  that such a head trip can play.  so my question is really for piece of mind ( knowing how stupid it  was to let this happen)-- what are the odds that I contacted HIV ( i have no signs of any other STD's) and is getting tested now a 14days, too soon for it to matter. Is it likely I contracted HIV from her, and when should i get tested.    very best, I have enjoyed reading your  (both Docs) replies on these forums.  signed Owadia.  Oh what a dummy I am!

[mexguide]

Thanks for your prompt and  sensitive response..   nice to know that there is sage advice out there when one really needs it

best
E

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your kind comments about it.

Bottom line:  there is little if any risk of HIV from this event, although there could be significant risk for other STDs -- especially if this sort of behavior is common for your partner.

The frequency of heterosexually transmitted HIV is low throughout Canada, including (as best I know) in Montreal.  That includes commercial sex workers.  In addition, people rarely lie about HIV status when asked directly and even when someone hasn't been tested recently, most people are pretty good at judging the likelihood they are infected.  Further, the chance of transmission through a single episode of unprotected vaginal sex, if the woman has HIV, averages somewhere around 1 in 2,000 -- equivalent to 5 years of daily sex before transmission might be expected, and perhaps not even then.  So considering the low chance your partner had HIV plus the exposure, the odds you caught HIV are extremely low.

As for your symptoms, they don't really nint at HIV.  The skin rash of ARS is body wide, but predominantly on the trunk and upper extremities, and usually doesn't itch.  You most likely have correctly diagnosed the source of your fatigue and aching -- and whenever someone suspects his or her own symptoms have a psychological origin, usually s/he is correct!

From a pure risk assessment standpoint, you don't even need HIV testing. However, most people with concerns like your ought to be tested -- not because I believe there is significant risk, but because a negative test result probably will be necessary to put your anxieties to rest.  If so, have a duo test (for both HIV antibody and p24 antigen) about 4-5 weeks after the event, or a stand-alone antibody test at 6-8 weeks.  (You'll find common advice to wait 3 months, but it's really not necessary to wait that long.)

Finally, as implied above, it would be a good idea to be tested for common STDs.  I recommend a urine test for gonorrhea and chlamydia, which can be done accurately at any time, and a syphilis blood test when you are tested for HIV.  You can expect all these to be negative, but better safe than sorry!

I hope this has helped.  Best wishes-- HHH, MD