Potential Risks & Testing

[tr2811]

Good day Doctor(s). First of, thank you in advance for your time. My story: 25 yr old heterosexual male; In mid-August, I went on a business trip to Pennsylvania, had too much to drink one night and found myself at a strip club (it was in a busier part of the city, and on the classier side as they had famous pornstars perform there). I was in private room with one of the strippers (white female who appeared to be younger). I had asked if she was clean, and she told me she was as they get tested in order to work there (though it wasn't clear what they tested for). She proceeded to give unprotected oral, and then unprotected vaginal. After about a 1-2 min, I realized what I was doing and pulled out.

I've been waiting for the 3 month window to be absolutely sure that I did not catch anything, and am scheduled to get blood tests for STD's, including HIV tomorrow, and as would be expected, I am a little anxious.

For approx 2-4 weeks after exposure, I checked myself regularly for any irregularities and monitored by overall condition closely. I did not have ANY symptoms whatsoever during this three month period.

My questions:
1.What are my potential risks for catching HIV after a single act of unprotected sex with a female stripper? It would be helpful if I had a basis of comparison (i.e. winning lottery? or getting struck by lightning?)

2. Do most people who catch HIV experience ARS symptoms?

3. What are the risks that I caught another std, like herpes, and have not developed symptoms?

4. How often do people catch something, do not experience symptoms, but are found to have a serious STD.

5. Will I need another test after this one, if results come out negative?

Thanks, again for your time, and expertise.

[Edward W Hook, MD]

Your risk of having any STD is very low.  this includes HIV.  I would not stress about your test results, go and get them.  I am confident they will be negative.  Your major risk if from the unprotected vaginal exposure, not from oral sex.  Oral sex is an inefficient way to transfer STDs and the prevalence of oral infections is lower than the prevalence of vaginal infections.  With that as background, let's go straight to your questions:

1.  Most strippers/commercial sex workers do not have HIV.  Just for arguments’ sake, let’s go on the high side and say the chance that your partner had HIV is 1 in 10 (10%).  Then, the risk from vaginal sex is 1 in 1000 at most,  Thus mathematically, your risk of HIV, at most is 1 in 10,000.  This really is not something to spend a lot of time worrying about.
2.  Less than half of people who acquire HIV get the ARS.
3.  Very, very low.  Most STDs and you were on the lookout.  thus you would not have missed something that was even mildly symptomatic.
4.  Uncommonly.  Depends on the STD. In general most people who get STDs but do not know it do so because they attribute their symptoms to something else.
5.  NO, at this time you should have complete confidence in your test results, which I am confident will be negative.

Take care.  EWH

[Edward W Hook, MD]

Glad to help.  Indeed, your tests are completely negative for syphilis, herpes, hepatitis C and HIV.  Tkae care.  EWH

[tr2811]

Hi Doc, just had my results faxed to me. They are as follows:

Test Description:        Result:                 Reference:
HBcAB                      Negative               Negative
Hepatitis C Ab.          Negative              Negative
RPR                          Non-Reactive       Non-Reactive
Herpes I Ab. (IgG)     0.51                     <0.90
Herpes II Ab. (IgG)    0.31                     <0.90

Herpes Simplex Virus Types 1 & 2 IGM ABS (EIA) W/ REFLEX IFA
HSV Type 1       <0.8
HSV Type 2       <0.8

HIV 1/0/2 ANTIBODY   NON-REACTIVE       NON-REACTIVE
[Assay for Detection of Antibodies to HIV including Group 0 (HIV-1 + "0") and/or Type 2 (HIV-2) Manufactured by Siemens Healthcare Diagnostics]

[tr2811]

Hi Doc. I called and got my results. Everything (tested via blood for herpes hsv1&2, hiv, syphilis etc.) was NEGATIVE. It was exactly 102 days, or 14.5 weeks since the initial exposure. I haven't yet seen my results directly, but the nurse told me that everything is negative. Based on what you've written above and in the other posts in terms of time frames, am I correct to assume I do not need additional testing?

I'd like to sincerely thank you for the invaluable work you do here. You must get a lot of 'THANK YOUs', but I wanted to express my profound appreciation for your knowledgeable, and sober assessment, as well as your time. All the best to you.

[Edward W Hook, MD]

Even if your partner was a "high risk" partner, your risk would be low.  Most "high risk" persons still do not have HIV and any single exposure has little risk of transmitting HIV.   Thus like DR. Handsfield, I do not recommend testing following each individual exposure to "risky" partners.  On the other hand, as you point out, testing on a regular basis when a person ahs had multiple sex partners is an absolutely reasonable thing to do in the context of routine screening.  

Bottom line, you still have very little to worry about  EWH

[tr2811]

Doctor, please allow this follow-up, as I await my results. Would you consider this a highly risky encounter with a "high risk" partner that would warrant testing on it's own. Dr. HHH has said that he doesn't even recommend testing unless there was a confirmed exposure with someone who is known to have HIV, or unless was engaged in highly risky activity like Unprotected anal between gay men. I understand the need for routine "screening".

Also, I'm not sure about whether the stripper was an IV drug user, I don't recall seeing track marks. Thanks.