Welcome to the forum.
An African American CSW in NYC, especially a street walker, is obviously at high risk of having HIV -- but even "high" leaves the odds in your favor, with maybe a 10% chance either or both women were infected (that's just a guess, however). If I correctly understand your question, you probably did not have unprotected vaginal (or anal?) sex -- but you are the only person who can make that call; I cannot and will not try. Since you are in doubt, HIV testing makes sense. Conceivably even post-exposure prophylaxis (PEP) with anti-HIV drugs would have been considered, but PEP isn't given more than 72 hr after exposure, so that's a moot issue at this time. To the specific questions:
1,2) Most people sufficiently anxious to ask about testing on this forum probably need to be tested, even if the risk is low. Usually verbal advice doesn't completely resolve the "what if" thinking and it's best just to know. I don't see that having a regular sex partner makes much difference in whether or not testing should be done. (However, if there is any doubt, you might decide to avoid sex with her or use condoms until tested in a few weeks.)
3) There is no measurable risk of HIV transmission in the absence of genital penetration. Fleeting contact, hand-genital contact, etc do not transmit HIV.
I hope this helps. Best wishes-- HHH, MD
Hi again, Dr. Handsfield. Thank you for the thoughtful response. Two quick follow-ups.
First, I was unclear about my recollection. I am NOT uncertain as to whether I penetrated the woman without a condom on. I definitely did not. (I am uncertain as to whether I penetrated her at all.) Given this, do you stand by your recommendations? (I ask to gauge my risk, not because I'm considering not getting tested. I certainly will get tested.)
Second, I was curious at the conservativeness of your response to my question, as compared to your response to many other superficially similar ones. For example, I believe that one person wrote you of an incident in which he was having protected sex with a prostitute in Europe and the condom broke. I believe that you told him that his risk is outrageously low -- and that it is probably not even worth getting tested. Is the only relevant difference between the situation that (you thought) that I described and the situation that I just mentioned that the person that (you thought that) I might have had unprotected sex with was at a high risk of having HIV? Wouldn't my risk still be extremely low, even if there had been unprotected penetration -- e.g. 1/000 x (the likelihood that the relevant woman had HIV)?
Sorry for being pedantic! Just trying to understand. Thanks again.
Second question first: You are exactly right about why your risk might be higher than other exposures on this forum. An African American street-walking sex worker in NYC is far more likely to have HIV than the large majority of other sex workers on which most forum questions are based.
Condom-protected penetration is virtually the same as no penetration at all. With this clarification, this was a low risk exposure even if the sex worker has HIV.
Thanks, again, Dr. Handsfield. That's helpful and reassuring.
I'm going to ask you one more question, though, of course, you should feel no obligation to answer it (you have certainly answered my fair share of questions already). In this message -- http://www.medhelp.org/posts/STDs/scared-of-hiv-after-sex-with-prostitute/show/245937
-- you tell someone who experienced a condom break while having sex with a sex worker, "Very low risk, even if you knew for sure your partner was HIV infected (which she probably wasn't). Get tested; 6 weeks is enough time for the test to become positive." Here you seem to be saying that *even if the sex worker had HIV*, the situation is not much to worry about. But you suggested that in my case, had I not been sure that I used a condom, getting PEP therapy might even be considered. Is there a relevant difference between the cases, or am I simply reading too much into wording at this point? (One potential difference that occurs to me is that I am uncircumcised, and the author of the aforementioned post is circumcised. I know that circumcision has been shown to significantly reduce the risk of female-to-male HIV transmission, though my understanding is that it is controversial how exactly this is to be explained.)
Again, just trying to understand. Thanks so much again.
Hi again, Dr. Handsfield. I take it back -- both my last question (that question *was* pedantic), and my promise not to ask any more.
At this point paranoia is creeping in, and can't help but run one new concern by you. It's been a little over 2 weeks since the incident that I described initially. About 5 days ago, I began developing a sickness. It began with a bit of fatigue and a mild sore throat, perhaps with a headache. Over the next few days, the sore throat went away and the fatigue lessened, and I just developed a lot of nasal congestion and corresponding head and sinus ache. I have not had any fever, rash, swollen lymph nodes (to my knowledge), body aches, chills, or any more flu or mono like symptoms. My symptoms are standard cold symptoms, and, indeed, the same symptoms that my friend is just now getting over. Am I correct to conclude that this is NOT any evidence that, after all, I did contract HIV and am now experiencing acute or primary infection?
Again, I feel as certain as one who got black-out drunk could feel that I did not have unprotected sex with the prostitute. But the mere fact that there are holes in my memory is likely to keep me on edge until 6 weeks has passed and I can get tested. (To emphasize, though there are holes in my memory, I cannot see how, given what I do remember, any unprotected sexual contact could have occurred. It's a bit like knowing that I was not in Boston that night. Though I can't remember NOT being there at certain times, the information that I do remember makes it all but impossible that I was there then.)
These symptoms do not suggest HIV. You have an allergy or caught a cold. But it is obvious that nothing I can say is going to resolve your anxiety. As I already said, it makes sense to be tested to help convince yourself you weren't infected. Unless and until you report a test result, I will have no other comments or suggestions.
OK, thanks a lot. And you're right, of course, about my anxiety. But this helps. Thanks again.
Hi, Dr. Hansfield. I have a test result to report. I just took a rapid HIV test at a public health clinic here in NYC. The result was negative. It has been about four weeks since the incident. Given what you know about the incident and the test, what is the upshot of this result? Should I still be worried?
Negative antibody test results at 1 month are around 90-95% reliable. Considering the low risk nature of the exposure, as we have discussed, this is a highly reassuring result that virtually guarantees you didn't catch HIV, and you definitely should not "still be worried". But for unequivocal proof, you need another antibody test at the 6-8 week mark, or you could have a combo test (HIV antibody plus p24 antigen) at any time, since that test is 100% reliable by 4 weeks.
Let's end this thread. It's past time for you to move on. I don't need to know the negative results of any additional testing you decide to do.
OK. Thanks a lot. This is all that I wanted to know.