Bad choice

[nmc240]

Hi Dr. I had an alcohol induced encounter yesterday. I had condom protected sex with a CSW in east africa. Before wearing a condom, i tapped my penis on her clitories but did not go close to the vagina. I then put on a condom. During sex I stopped to make sure the condom was intact and it was. I also changed to a new condom a couple of times and each time it was intact. I'm now anxious that I could have gotten HIV or an STI from this encounter. I asked her whether she has been tested and she said yes 3 weeks ago and was fine. She said if I'm still worried she can go test with me. But I'm now away from the town we met.
1. Please ***** my risk given the details of this encounter.
2. Please advice on what HIV tests I can take at this point. Do you recommend HIV PCR and how soon can I take it?
3. Regarding STI's what should I be concerned about and how soon can I test?
4. I'm worried about resuming sex with my regular partner. And of course I'm feeling quite guilty for this error. What is your assessment on this?

Thanks
3.

[Edward W Hook, MD]

I would not have expected the azithromycin to help your symptoms as there is no reason to think they are an STI. Rather, local itching of the sort you describe is most often a sign of anxiety.  You need not worry.  EWH

[nmc240]

Dr. Hook, since this encounter, I've had a slight burning sensation on the tip of my penis. I tried to ignore it reminding myself that I had condom protected sex and also from reading the many posts on this forum, no STDS present symptoms this early. However, anxiety got the better of me and I took 2gms of Zithromax 2 days after the encounter. I took this incase I had an incubating infection.
The slight burning sensation has continued today even after the Zithromax. What are the possible cause of this? I'm really worried as I wait for the 4 week mark for the DUO test.

[Edward W Hook, MD]

PEP is not typically recommended for condom protected exposures, even with high risk persons.  EWH

[nmc240]

Thanks for your response. I forgot to ask about PEP in my initial post. If I was your patient, would you recommend PEP given the encounter described?

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help.  You indicate that your encounter was condom protected.  Condom protected sex is safe sex with virtually no risk for HIV.  Interactions with your partner that do not involve penetration do not represent a risk for HIV.

1. Please ***** my risk given the details of this encounter.
See above.

2. Please advice on what HIV tests I can take at this point. Do you recommend HIV PCR and how soon can I take it?
We do not recommend PCR testing for HIV diagnosis. These tests are not recommended for HIV diagnosis.  The quickest you can get a definitive answer regarding your infection status is to be tested using a DUO (combined HIV p24/HIV antibody test) four weeks after your exposure. Results of your test at that time will be definitive.  

3. Regarding STI's what should I be concerned about and how soon can I test?
There is little risk for any STI from condom protected sex.  I see no need for testing. Theoretically, STIs such as herpes or syphilis can be transmitted without penetration but the risk of each is low.  Syphilis blood tests can be done if you feel the need about 6-8 weeks after exposure.  Herpes tested is not recommended- if you do not develop lesions, you should not worry further about syphilis.  

4. I'm worried about resuming sex with my regular partner. And of course I'm feeling quite guilty for this error. What is your assessment on this?
See above. this was a virtually no risk encounter.  

I hope these comments are helpful.  EWH