Concerned

[eyeamsam]

Thank you for this forum.  It is so helpful.  Here is the story.  Recenlty a female CSW was arrested for passing HIV on to two male clients.  It is unknow whether she used condoms or not.  I would assume that clients of one CSW might see others in the area exposing those CSW and thus those CSW could expose other clients.  

My status as of 6/1 was negative on all STD(excpect HSV 1 but I have had cold sores).  I did not see this CSW, but have been to a CSW just prior to 6/1 and then after.  Protected intercourse always.Recieved unprotected oral  and gave unprotected oral on one occasion.

I would typically think that without symptoms occuring in a week or two after an encounter, the chance of an STD was very low, inlcuding HIV.  I would test every 6 months just to rule all out.  No symptoms at this time.

I am dating a woman and this new wrinkle(CSW arrest) has given me concern.  Long term, I am incliend to change my practices,  Short term- how should I proceed?

Complete Abstinence for 4,5,6, weeks and then test?
Test next week to rule out and STD-s and then in 4,5,6 weeks to rule out HIV?
If the woman I am dating would like to have sex should I refrain and if so how long-
Does the arrest issue increase my risk?

[lasttales]

Hi--As a woman reading your post, I'd say that abstaining from sex with your girlfriend until you get a negative test at six weeks would be the right thing to do! I know doctors advise based on statistics, but I'm betting if you gave your girlfriend a choice she'd vote for a postponement of pleasure--just to be sure!

Good luck.

[Edward W Hook, MD]

You can test for the most common STDs (gonorrhea, chlamydia and NGU at any time more than 3 days following your last exposure).  HIV testing should wait for 6 weeks.  Regarding abstinence in the interval, my judgment is that given the scenario you describe your risk is only slightly higher than it was had the women you mentioned not been arrested, it is just that you have had a "wake up call".  Whether you abstain totally, use a condom (as you should always do with a new or unknown partner) or not is your call.

EWH

[eyeamsam]

just to clarify and not to be a pest

Refrain for 6 weeks?

Test at 6 weeks for HIV and all stds?

Correct

[Edward W Hook, MD]

Welcome to the Forum.  I fully understand your concern and agree with your plans for future testing.  In the interim, while I think your concern is reasonable, I wouldn't be too worried between now and at 6-8 weeks when you can get tested and put this behind you.  

Here are the reasons why I think you do not have too much to worry about:
1.  We both agree that CSW clients may go to multiple CSWs therefore within a "network of CSWs and their clients infections can spread from one to another.

2.  Most CSWs however do not have HIV.

3. For you to get HIV, a CSW that you contacted would have had to had a client who had contact with the infected women you mentioned AND gotten HIV AND transmitted it to the CSW who you were with who would have then transmitted it to you.  Thus it would require a chain of 3 transmissions for you to get infected.  In each instance, the risk of transmission at each step is about 1 transmission for every 1000 acts of unprotected intercourse.  thus, using this scenario, your risk becomes very, very low.

Bottom line, the arrest issue you mention brings your attention to the risk that is present with ANY new partner and is a good reason to use condoms for any casual contact or, for that matter any new relationship in which the partners do not know each others' infection status.  At the same time however, it is not a reason for you to be especially worried.  Hope these comments and perspective are helpful to you.  EWH