Risk Assessment

[damnworriedsick]

Dear Doctors,

I recently had protected oral and vaginal sex with a masseuse (she's from China, and not regulated to go for routine medical checks). I don't know her status. I was diagnosed with genital HSV-1 last July. I do not remember noticing any penile lesions during the encounter. I did not pay much notice to the condom, except to check for slippage upon withdrawal (it slipped a little). I did not check for breakage. And very soon after, the csw pulled out the condom from the top using a piece of tissue, so I didn't have the chance to check. I asked her later, and she told me she doesn't do vaginal sex unprotected (assuming she doesn't lie). Today is day 16 since the encounter, and I'm waiting to do a combo test. In the meantime, can you please assess my risk? Thank you.

[Edward W Hook, MD]

Welcome to the Forum. this was a no risk event.  Even though your partner may not get regular medical checks, the likelihood that she has HIV or any other STD is low.  Most commercial sex workers do not have HIV or other STIs.   Even more importantly however, your exposures were condom protected and condoms make you sex essentially no risk.  You condom did not break.  Condom breakage is easy to detect- if it had, it would have broken wide open and you would have noticed this.

If you had asked me before you tested, I would have told you that no testing was necessary.  I am confident that your tests will be negative.  Please don't worry about this exposure.

I hope these comments are helpful.  EWH

[damnworriedsick]

Dear Dr. Hook

Thank you for your assurance. Your advice certainly helped to calm my nerves a bit. But for a piece of mind I will go for a 4th generation test on the 28th day for a conclusive result.

However, as you may tell I'm still slightly anxious, so yesterday on the 19th day I went for a 3rd generation test - it was negative. May I ask if a 3rd gen test is meaningful on the 19th day? Thank you.

[Edward W Hook, MD]

At 19 days a 3rd generation test will detect over half of newly acquired infections.  EWH

[damnworriedsick]

Thanks Dr Hook. Today is the 27th day and I went for a 4th generation test - it was negative. I have read in this forum that taking the test 1 day shy of the recommended 28days should not have significant statistical difference and so for practical reasons this should essentially serve as conclusive. Would my understanding be correct? Thank you.

[Edward W Hook, MD]

Correct.  EWH