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Fever & HIV Risk
Hello Doctor,
In the past month I’ve had two encounters with transsexual CSW in SE Asia. Both claimed to be HIV negative, and always used condoms, but hadn’t been tested for a while. The encounters were as follows:
(1) 26 days ago. Protected insertive and receptive oral (until ejaculation by me 2x), including me sucking her balls. I attempted protected insertive anal 3 times. I partially penetrated for 10-15 seconds each time but started to lose my erection (because I didn’t really feel safe). At some point she masturbated me with baby oil, which I wiped off. But I’m not sure if this was before or after the anal sex (I think before), so am concerned about the integrity of the condom (although it didn’t obviously break).
(2) 12 days ago. Protected insertive and receptive oral (until ejaculation by me 2x, she never ejaculated), including me sucking her balls. On the second time she assumed a 69 position. I kissed her penis through her panties and there was some precum. I then took her penis from her panties and put the head of the penis in my mouth twice, each time for 15-20 seconds. This was gentle, brief, it didn’t touch my throat or the roof of my mouth and there was no ejaculation (but some precum). I immediately washed my mouth with mouthwash & water.
Today I’ve come down with a temperature (37.7°C underarm) and a stomach ache – 12 days post encounter (2). I’ve no other symptoms (apart from run-of-the mill nasal congestion). I am, however, now extremely anxious and worried about infection. I plan to test with a locally manufactured rapid (USAID approved) antibody test 30 days after encounter one, and 16 days after (2) and then follow up with a 4th generation test at 30 days from encounter (1). I then wanted to resume relations with my wife.
Can you give me a risk assessment and advise me on my testing plan (I figured a negative at 30 days would reduce the probabilities for encounter 1 significantly).
Thank you.
In the past month I’ve had two encounters with transsexual CSW in SE Asia. Both claimed to be HIV negative, and always used condoms, but hadn’t been tested for a while. The encounters were as follows:
(1) 26 days ago. Protected insertive and receptive oral (until ejaculation by me 2x), including me sucking her balls. I attempted protected insertive anal 3 times. I partially penetrated for 10-15 seconds each time but started to lose my erection (because I didn’t really feel safe). At some point she masturbated me with baby oil, which I wiped off. But I’m not sure if this was before or after the anal sex (I think before), so am concerned about the integrity of the condom (although it didn’t obviously break).
(2) 12 days ago. Protected insertive and receptive oral (until ejaculation by me 2x, she never ejaculated), including me sucking her balls. On the second time she assumed a 69 position. I kissed her penis through her panties and there was some precum. I then took her penis from her panties and put the head of the penis in my mouth twice, each time for 15-20 seconds. This was gentle, brief, it didn’t touch my throat or the roof of my mouth and there was no ejaculation (but some precum). I immediately washed my mouth with mouthwash & water.
Today I’ve come down with a temperature (37.7°C underarm) and a stomach ache – 12 days post encounter (2). I’ve no other symptoms (apart from run-of-the mill nasal congestion). I am, however, now extremely anxious and worried about infection. I plan to test with a locally manufactured rapid (USAID approved) antibody test 30 days after encounter one, and 16 days after (2) and then follow up with a 4th generation test at 30 days from encounter (1). I then wanted to resume relations with my wife.
Can you give me a risk assessment and advise me on my testing plan (I figured a negative at 30 days would reduce the probabilities for encounter 1 significantly).
Thank you.
MEDICAL PROFESSIONAL
I'm glad to have helped.
MEDICAL PROFESSIONAL
I'm glad to have helped. Take care and stay safe.
Dr. Hansfield,
Just to let you know that I tested negative on a Duo at 30 days post the last exposure. Once again, thank you for your help and advice. Even though I knew that my exposures were low risk, the fever started putting doubts in my mind. Your prompt, non-nonsense advice certainly helped with the wait until test time!
Just to let you know that I tested negative on a Duo at 30 days post the last exposure. Once again, thank you for your help and advice. Even though I knew that my exposures were low risk, the fever started putting doubts in my mind. Your prompt, non-nonsense advice certainly helped with the wait until test time!
MEDICAL PROFESSIONAL
Of course I'm not surprised, but congratulations.
Tested negative on rapid home self (blood) test. Negative 30 days post exposure (1) & 16 days post exposure (2).
G
G
Dr Handsfield,
Thank you for the prompt response and reassurance. I haven't tested yet though - I will do the rapid ab test this Friday (30 & 16 days post exposure). I will post my results. The 4th gen test will be in 3 weeks time.
G
Thank you for the prompt response and reassurance. I haven't tested yet though - I will do the rapid ab test this Friday (30 & 16 days post exposure). I will post my results. The 4th gen test will be in 3 weeks time.
G
MEDICAL PROFESSIONAL
Noted; see above.
MEDICAL PROFESSIONAL
Welcome back to the forum.
The encounters you describe all were safe -- i.e. condom protected for anal sex, and HIV is rarely if ever transmitted by oral sex. And with partners who said they are HIV negative. Most people don't lie when asked directly, so you probably can rely on their statements.
So these encounters were sufficiently low risk that testing for HIV wasn't necessary from a medical or risk standpoint -- although I can understand your desire for reassurance by the negative results, even in low risk situations.
And indeed your test results so far are very reassuring. If I were in your situation, I would comfortably resume unprotected sex with my wife at this time (in fact, I never would have stopped). In any case, a 4th generation test at 30 days after the second will be more than "reduce the probabilities...significantly": the duo test is 100% conclusive any time more than 4 weeks after exposure.
As for your symptoms, I'm confident they aren't due to HIV. The fever wasn't high enough and cleared up too soon; and abdominal pain is not a usual symptom of ARS. Probably you just had a minor gastrointestinal viral infection.
So no worries. For defiitive reassurance, follow your plan for a 4th generation test 28-30 days after the last extramarital sexual exposure. You can expect a negative result.
Regards--- HHH, MD
The encounters you describe all were safe -- i.e. condom protected for anal sex, and HIV is rarely if ever transmitted by oral sex. And with partners who said they are HIV negative. Most people don't lie when asked directly, so you probably can rely on their statements.
So these encounters were sufficiently low risk that testing for HIV wasn't necessary from a medical or risk standpoint -- although I can understand your desire for reassurance by the negative results, even in low risk situations.
And indeed your test results so far are very reassuring. If I were in your situation, I would comfortably resume unprotected sex with my wife at this time (in fact, I never would have stopped). In any case, a 4th generation test at 30 days after the second will be more than "reduce the probabilities...significantly": the duo test is 100% conclusive any time more than 4 weeks after exposure.
As for your symptoms, I'm confident they aren't due to HIV. The fever wasn't high enough and cleared up too soon; and abdominal pain is not a usual symptom of ARS. Probably you just had a minor gastrointestinal viral infection.
So no worries. For defiitive reassurance, follow your plan for a 4th generation test 28-30 days after the last extramarital sexual exposure. You can expect a negative result.
Regards--- HHH, MD
I plan to test with a locally manufactured rapid (USAID approved) antibody test 30 days after encounter one, and 16 days after (2) and then follow up with a 4th generation test at 30 days from encounter (2) - ie in 3 weeks time
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