HIV Risk majorly worried

[nickn534]

I had 2 exposures!
1) 28th July- CSW in the red light district-amsterdam. A protected blowjob. asked her if she had a condom.I went on her bed.Usually after using the washroom the toilet paper sometimes causes my anus to bleed.also get some rash on my butt when i sit on the pot but have never noticed bleeding.Put a condom me -hoping it was new and not used.seamed to tear it of pack.started giving me oral -noticed not very rough.It was dark and i could not notice blood.she had her tongue pierced. act -oral, handjob along with me placing the penis between her breasts.There was no kissing, fingering i only fondled her breast and touched her body.climaxed while she was licking my penis.I did not notice any spill but i dint check the condom.She took some tissue and removed the condom and wiped me slightly.washed my hand,cleaned myself with a bit of water.took some tissue wiped and left.I am uncircumcised if that matters.
5th Aug- It involved deep kissing CSW twice about 3 mins max.there was tongue involved.I did not notice any blood or sores in my mouth but was hungover the day before and vomited for major portion of the day prior.We were standing and kissing
Risks!
1)It is possible for the bed to be contaminated by previous customer semen or blood and that could transmit to a wound on my butt?
2)If the condom was a used one from a previous client or the tissue was contaminated? If the condorn tore would that place me at any risk!
3)If CSW i kissed had mouth sores or blood or there was precum or semen from a previous client.
Symptoms:
Sore throat with flem day after kissing since a week - GP gave lorenges which dint help
heat boil on the thigh quite big - GP gave ointment hasent spread
skin irritation on hands and back - feels like a rash
pain in back below shoulders
joint pains
stiff neck
loss of appetite
temperature between 36.5 and 37.7
heavy head and sometimes short sighted
leaks after urination!
Is this seroconversion?
Please help! Very Worried.

[Edward W Hook, MD]

Your test result at 27 days is definitive. All further questions will be deleted without comment.  EWH

[nickn534]

Dear Doctor EWH,

First I would like to thank you for your advice commend the work you do to tirelessly respond to nervous and anxious people like me who are first stupid enough to put themselves in situations like this. I guess it is human nature to err and then repent and then fear of the worst. I have spent the last month doing nothing but living in fear, feeling anxious and thinking of all the worst possible senarios. I have finally tested multiple times to mention 4 in total hoping to reduce my anxiety but each time it was not reduced. Today was the 27th day of my second exposure which involved mere kissing and i even feared that and got tested to find a negative result. I have now decided to let go of the fear having read that the combo test is definitive at 4 weeks you would confirm that right?. I was 1 day short and im sure it shouldn't matter. I will now proceed to carry on with life as normal and hope and try to keep myself safe (i am confident i will as this has been the most torturous month of my life). Anxiety and fear is a very bad thing. Thank you once again and please keep up the fantastic work on this forum. I hope not to be here again but you can never say never.. :)

[Edward W Hook, MD]

I'll have nothing more to say.  This is strong evideence that your no risk event did not give you HIV.  I am confident that you did not acquire HIV but I was confident of this before you got tested.  EWH

[nickn534]

Thank you doctor, I have been a nervous wreck since the past few weeks and could not wait till 28 days so went and got myself tested. How reliable are the tests provided by manufactures as compared with laboratory testing? Could you also provide me an estimate on how accurate you would rate my test done at 22 days post exposure?  

[Edward W Hook, MD]

Your question does not offend me and does give me the opportunity to provide you and others with a few comments about testing.  We frequently get questions from clients who are tested prior to the time recommended for testing who then want help interpreting the results.  In gneral thi cannot be done and what results are available regarding early testing tend to be less precise estimates than the results of large studies that we cite here.  Thus while your combination test results at 22 days are strong evidence that you did not get HIV, particularly given the virtually no risk encounter you reported.  

1) How soon can the p24 antigen be detected post exposure?
This is not the right question to even be asking. While some persons may have positive tests as soon as a week after exposure, the important question is when will all people have positive tests.  As I have told you, results are definitve for the combinatation tests at 4 weeks.  

2) How accurate would you rate my test result?
This is good be not perfect laboratory evidence that you did not get HIV.  When that evidence is considered in combination with the sort of exposure you had, which was virtually no risk, you can be virtually sure that you did not get HIV.

3) How sensitive is the rapid combo test to the p24 antigen?
It is a good test for p24 antigen however not all people have detectable p24.  On the other hand, the combo tests definitive results at 4 weeks. The data on this are clear.

EWH

[nickn534]

Doctor EWH,

I did the rapid determine 1/2 combo test by alere at 22 days post my first exposure.. the result was negative no reaction to antigen and antibody.

I understand that the test is only conclusive at 28 days post exposure.
I have a few queries and i hope you can solve them.

1) How soon can the p24 antigen be detected post exposure?
2) How accurate would you rate my test result?
3) How sensitive is the rapid combo test to the p24 antigen?

I dont mean to offend you by asking such technical questions but would just like to have some information on the same!

[nickn534]

Thank you so much Doctor!

[Edward W Hook, MD]

I see no need for testing.  If you feel the need to test for your peace of mind, a combo test at 4 weeks will provide reliable results.  I am confident that if you test your results be show that you did not get HIV.  EWH

[nickn534]

Thank you doctor, I am a bit worried as you say almost certainly not ARS and no meaningful risk? I understand that it is not possible in medicine to be fully certain and i can only be sure on testing.. When would you recommend testing? is the combo test at 4 weeks good enough? Would you expect a negative result?

[Edward W Hook, MD]

Your symptoms are non-specific and could be due to any number of causes. Of the possible causes, ARS is almost certainly not a consideration and not something to worry about.  I suspect that your sore throat, etc. are due to something you picked up in the course of your normal activities but, because of your concerns about your exposure, you are linking them and perhaps even amplifying them with your anxiety over the exposure.  If the symptoms are really worrying you, you should see your doctor for a thorough evaluation however I suspect any relationship between them and the exposure you described is coincidence and nothing more. EWH

[nickn534]

Thank you for your response doctor and your advice. Just on the part of the symptoms that i am experiencing could i have your advice? I am more worried because of the way im feeling.

[Edward W Hook, MD]

Welcome to this forum.  I see that you have already asked some of these questions on the HIV Community site where the answers you received included a number of quotes from those of us who man the Expert Forums.  I agree with the advice you have already been given and will repeat or perhaps expand on some of them.  The bottom line however is that neither of the encounters you describe carry any meaningful risk for HIV, that there is no need for you to worry and that no testing is medically needed for the exposures you have described.

HIV is not transmitted by kissing, even when one or both people involved have mouth sores, pierced tongues, gum disease, or recent dental work.  Similarly,  while there are 1 or two cases of HIV which MAY have been acquired through performing oral sex on an infected partner, there are no substantiated cases in which receipt of oral sex- protected or not- has led to HIV.

In your own case, let me also point out that most commercial sex workers in Amsterdam are licensed and as a requirement for their licenses are tested regularly for HIV and other STDs. Further, I should point out that when CSWs use condoms, they are doing so to protect themselves from clients, not the other way around- thus your encounter in Amsterdam is probably lower risk than if you had picked up a new partner in a bar.

Let's address your specific questions:

1)It is possible for the bed to be contaminated by previous customer semen or blood and that could transmit to a wound on my butt?
No, HIV is not transmitted on soiled/dirty bed clothes or inanimate objects.  This is not a potential source of infection.

2)If the condom was a used one from a previous client or the tissue was contaminated? If the condom tore would that place me at any risk!
See above- no conceivable risk from used tissue.  As for condom failure, when condoms break, they break wide open making it obvious they have failed.  They rarely (about 1% of the time) break.  I would not be concerned that your condom failed.

3)If CSW i kissed had mouth sores or blood or there was precum or semen from a previous client.
see above- no risk.

I hope these response are helpful to you.  You need not worry.  EWH