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Unprotected Sex With CSW
Dear Doctor,
Please answer my question as honestly as you can so that I can evaluate my risks properly. I understand my situation more or less after reading most of what the forums have to offer, but I just want to be definitively sure. Please excuse me if this post sounds like a plea for comfort but I'm really at a loss and I'm really panicking.
Last night I was very drunk and visited a prostitute. I am from Singapore. The CSW was Thai, and we had unprotected oral and vaginal sex. She first insisted on a condom but I asked her if she was okay without one. She seemed very flippant about saying yes, only asking that we used lubricant. I had unprotected vaginal intercourse with her thereafter for about 1 to 2 minutes before pulling out and requesting a condom after much regret. After a little dabbling, I was given a blowjob until I was done. Even with the condom on, the penetrative sex did not last for more than 5 minutes in total, and I'm being generous with that count.
I had asked her about her sexual history after the episode and she seemed very sure that she was not infected by any sort of STD. I do not know whether to trust her although she did not seem like she was lying. She mentioned that she had a child to raise, who was 4 years old, and that she recently donated her type AB blood to her uncle who was involved in an accident. I was thinking that this story was perhaps suspiciously elaborate, but I may be paranoid.
In your opinion should I take PEP, or whatever that drug is that helps in the first 48 hours after a risky encounter? It is very expensive in my country so your advise will greatly influence my decision. I'm prepared to be broke for what is one of the biggest mistakes in my life, but I do not mind.
Kindly advice sir.
Please answer my question as honestly as you can so that I can evaluate my risks properly. I understand my situation more or less after reading most of what the forums have to offer, but I just want to be definitively sure. Please excuse me if this post sounds like a plea for comfort but I'm really at a loss and I'm really panicking.
Last night I was very drunk and visited a prostitute. I am from Singapore. The CSW was Thai, and we had unprotected oral and vaginal sex. She first insisted on a condom but I asked her if she was okay without one. She seemed very flippant about saying yes, only asking that we used lubricant. I had unprotected vaginal intercourse with her thereafter for about 1 to 2 minutes before pulling out and requesting a condom after much regret. After a little dabbling, I was given a blowjob until I was done. Even with the condom on, the penetrative sex did not last for more than 5 minutes in total, and I'm being generous with that count.
I had asked her about her sexual history after the episode and she seemed very sure that she was not infected by any sort of STD. I do not know whether to trust her although she did not seem like she was lying. She mentioned that she had a child to raise, who was 4 years old, and that she recently donated her type AB blood to her uncle who was involved in an accident. I was thinking that this story was perhaps suspiciously elaborate, but I may be paranoid.
In your opinion should I take PEP, or whatever that drug is that helps in the first 48 hours after a risky encounter? It is very expensive in my country so your advise will greatly influence my decision. I'm prepared to be broke for what is one of the biggest mistakes in my life, but I do not mind.
Kindly advice sir.
MEDICAL PROFESSIONAL
Welcome to the Forum. Clearly you are regretful regarding this exposure. I'll try to provide some information to help you with your decision making.
We can put some numbers on your risk. Less than 10% of commercial sex workers in Singapore have HIV. The higher priced and more organized the setting in which you located your partner the lower the risk of HIV. It will be difficult to be more precise than this short of getting your partner tested for HIV. The risk of a single genital sexual exposure to an infected partner is less than 1 in 1,000. There are no data to tell us what role duration of exposure does to affect risk but common sense tells us that risk goes up with duration. Your exposure was brief. There is no risk of HIV, even if she was infected, from receipt of oral sex. Thus numerically, it is safe to say your risk for HIV is less than 1 in 10,000 - how much lower is hard to say.
As for PEP, I am sure that if you want PEP you can get it. Decisions about PEP are a personal decision in which one should consider the likelihood that infection will occur, the likelihood of drug side effects (moderate for most people), one's personal anxiety and the cost of the drugs (expensive, typically in the neighborhood of $1000). If you choose to try to find someone to provide you with PEP, please hold them accountable for all that goes with it (i.e. follow-up, answering your questions, etc). - we cannot provide appropriate post-PEP follow-up on line. If you choose to take PEP, the sooner you start, the more effective it is likely to be.
I hope these comments help. EWH
We can put some numbers on your risk. Less than 10% of commercial sex workers in Singapore have HIV. The higher priced and more organized the setting in which you located your partner the lower the risk of HIV. It will be difficult to be more precise than this short of getting your partner tested for HIV. The risk of a single genital sexual exposure to an infected partner is less than 1 in 1,000. There are no data to tell us what role duration of exposure does to affect risk but common sense tells us that risk goes up with duration. Your exposure was brief. There is no risk of HIV, even if she was infected, from receipt of oral sex. Thus numerically, it is safe to say your risk for HIV is less than 1 in 10,000 - how much lower is hard to say.
As for PEP, I am sure that if you want PEP you can get it. Decisions about PEP are a personal decision in which one should consider the likelihood that infection will occur, the likelihood of drug side effects (moderate for most people), one's personal anxiety and the cost of the drugs (expensive, typically in the neighborhood of $1000). If you choose to try to find someone to provide you with PEP, please hold them accountable for all that goes with it (i.e. follow-up, answering your questions, etc). - we cannot provide appropriate post-PEP follow-up on line. If you choose to take PEP, the sooner you start, the more effective it is likely to be.
I hope these comments help. EWH
MEDICAL PROFESSIONAL
Please take the remainder of this exchange to the HIV Community site. thanks. EWH
After reading this thread I will never ever go to CSW again !
In your situation of High anxiety it would be appropriate to take the Hiv DUO test which looks for both p24 antigen and antibodies at 4 weeks when the p24 antigen is at it,s peak.It is extremely accurate at that time frame.As the expert Doctor has advised,your risk is quite low.
I think I shall use this space as a chronicle describing my anxiety after my episode of unprotected sex with a CSW. I hope this will prove valuable for other forum readers.
I've been struggling with anxiety ever since that fateful occasion.
Been feeling for lymph nodes in neck and armpits, constantly prodding them. Over time some swelled up, some were painful and tender, some were hard.
I read that prodding anywhere on the neck structure would cause them to swell up. Felt more relieved after finding out this bit of information.
I've been feeling fatigued lately, and immediately attributed it to HIV seroconversion. I traced the history of my sleeping habits a few days back, and realised I've been consuming a fair bit of alcohol, which interrupts sleep, which in turn might explain the tiredness I feel.
I conclude that my fears are irrational in lieu of my low odds of infection.
Currently at Week 2 post exposure. Looking forward to a negative test result at the 8 week mark.
I've been struggling with anxiety ever since that fateful occasion.
Been feeling for lymph nodes in neck and armpits, constantly prodding them. Over time some swelled up, some were painful and tender, some were hard.
I read that prodding anywhere on the neck structure would cause them to swell up. Felt more relieved after finding out this bit of information.
I've been feeling fatigued lately, and immediately attributed it to HIV seroconversion. I traced the history of my sleeping habits a few days back, and realised I've been consuming a fair bit of alcohol, which interrupts sleep, which in turn might explain the tiredness I feel.
I conclude that my fears are irrational in lieu of my low odds of infection.
Currently at Week 2 post exposure. Looking forward to a negative test result at the 8 week mark.
Hi rnegoro,
Thanks for your encouraging comments.
Out of worry, I went for a Oraquick HIV test at a local clinic, and the results came back negative. Even though it's only 2 weeks from the exposure, I'm symptom free apart from some swollen lymph nodes in my armpit and neck.
I've been coming to terms with my situation.
Once again, thanks!
Thanks for your encouraging comments.
Out of worry, I went for a Oraquick HIV test at a local clinic, and the results came back negative. Even though it's only 2 weeks from the exposure, I'm symptom free apart from some swollen lymph nodes in my armpit and neck.
I've been coming to terms with my situation.
Once again, thanks!
Almost forgot , if you happen to be circumcised, that will lower the chance of you getting aids by another 50%. So supposing your partner has hiv, chances are 1 in 2000 that you get infected.
I told you to becareful about gonnorhoea because it's easier for gonnorhoea and syphilis to spread.
I told you to becareful about gonnorhoea because it's easier for gonnorhoea and syphilis to spread.
Seriously, I had an experience similar to yours, but mine was because i forgot to put on my condom, and inserted into the CSW then immediately pulled it out, I'm negative HIV tested 3 months after incident.
Actually I would like to ask you regarding the encounter,
1) Do you have any cuts on your penis ?
If you had no cuts, your chances of getting hiv is lower
2) Was the CSW discharging a lot of vaginal juice ?
If the CSW was not wet, you have a lower chance.
I would be more worried about diseases like gonnorhoea and syphilis.
Actually I would like to ask you regarding the encounter,
1) Do you have any cuts on your penis ?
If you had no cuts, your chances of getting hiv is lower
2) Was the CSW discharging a lot of vaginal juice ?
If the CSW was not wet, you have a lower chance.
I would be more worried about diseases like gonnorhoea and syphilis.
MEDICAL PROFESSIONAL
There are many other illnesses which can cause lymph node swelling. Swollen lymph nodes are a non-specific response to any number of stimuli including infections due to bacteria and viruses, allergic reactions and autoimmune disease. This is particularlyly true for nodes located in the groin. Of all persons with swollen lymph nodes only a tiny proportion of them have HIV. If you are concerned about swollen lymph nodes, the proper place to get evaluated is with a good internal medicine physician.
Your revised duration estimate does not change my assessment.
The thread is now over. EWH
Your revised duration estimate does not change my assessment.
The thread is now over. EWH
Thank you Doctor, you are certainly reassuring.
I have but one last question, and any question henceforth will be posted in a different thread, but that will be unlikely. Please bear with me for just one more time.
I am curious because I've had 2 swollen lymph nodes on the right side of my groin for about 2-3 months now. My worry is that the swelling of lymph nodes is now occuring on 2 seperate locations, even though they came up at different timings.
Also, I might have overestimated my situation. I've retraced the situation over and over again and I'm quite sure of this: my unprotected vaginal intercourse could not have lasted for more than 40 seconds. Would this change your opinion on my situation?
Yes, I am indeed shamelessly seeking reassurance. But there is no one to turn to for hard facts. I apologise for this insistence, and I promise this is my last post.
Warmest regards.
I have but one last question, and any question henceforth will be posted in a different thread, but that will be unlikely. Please bear with me for just one more time.
I am curious because I've had 2 swollen lymph nodes on the right side of my groin for about 2-3 months now. My worry is that the swelling of lymph nodes is now occuring on 2 seperate locations, even though they came up at different timings.
Also, I might have overestimated my situation. I've retraced the situation over and over again and I'm quite sure of this: my unprotected vaginal intercourse could not have lasted for more than 40 seconds. Would this change your opinion on my situation?
Yes, I am indeed shamelessly seeking reassurance. But there is no one to turn to for hard facts. I apologise for this insistence, and I promise this is my last post.
Warmest regards.
MEDICAL PROFESSIONAL
You are over reacting. Isolated swelling of a lymph node or lymph nodes in a single region is not a sign of early HIV. I know it's worrisome but do your best not to let your concerns get tthe best of you. The odds are VERY much in your favor. EWH
Hi Doctor,
It is now exactly 7 days post exposure. I believe this is about the time which the ARS symptoms would start to appear if, God forbid, I did indeed catch on to the infection.
A lymph node has started swelling up on the area under under my chin, and slightly above my adam's apple. I have not had any swollen lymph nodes before.
As I have gathered from the forums, any sort of symptoms is notoriously inaccurate in assessing a HIV infection.
However I am still quite worried and hence this question:
Are swollen lymph nodes a common sign in the early stages of seroconversion and/or one is undergoing seroconversion?
Thanks for your time Doctor.
It is now exactly 7 days post exposure. I believe this is about the time which the ARS symptoms would start to appear if, God forbid, I did indeed catch on to the infection.
A lymph node has started swelling up on the area under under my chin, and slightly above my adam's apple. I have not had any swollen lymph nodes before.
As I have gathered from the forums, any sort of symptoms is notoriously inaccurate in assessing a HIV infection.
However I am still quite worried and hence this question:
Are swollen lymph nodes a common sign in the early stages of seroconversion and/or one is undergoing seroconversion?
Thanks for your time Doctor.
MEDICAL PROFESSIONAL
As I said, decisions about PEP are yours and yours only. Your risk of infection is quite low. EWH
Doctor,
Thank you for the prompt reply.
I concur rationally with your encouraging response, and I thank you greatly for providing the figures. However a man in anxiety would feel no safety even with numbers.
The place where I had the intercourse can safely be termed as 'dodgy'. Certain areas require that the prostitutes undergo routine check-ups, and I know where those are. However, the one I went to is very unlikely to follow such procedures.
Given that it is very unlike that the CSW I encountered does not undergo check ups, which makes her HIV status unknown despite what she told me, in your opinion, should I still go for a PEP course? It costs $2500 for the medication prescribed by a HIV specialist along with all the follow-up shennigans. It is costly because I am still a university student. This is a big decision to make, and I'd like to decide with as much information as I can gather while I'm still in the 72-hour window. I am skeptical because I feel I am still slightly irrational about this entire event, given that my emotions are inhibiting proper decision making.
Kindly advice Sir.
Thank you for the prompt reply.
I concur rationally with your encouraging response, and I thank you greatly for providing the figures. However a man in anxiety would feel no safety even with numbers.
The place where I had the intercourse can safely be termed as 'dodgy'. Certain areas require that the prostitutes undergo routine check-ups, and I know where those are. However, the one I went to is very unlikely to follow such procedures.
Given that it is very unlike that the CSW I encountered does not undergo check ups, which makes her HIV status unknown despite what she told me, in your opinion, should I still go for a PEP course? It costs $2500 for the medication prescribed by a HIV specialist along with all the follow-up shennigans. It is costly because I am still a university student. This is a big decision to make, and I'd like to decide with as much information as I can gather while I'm still in the 72-hour window. I am skeptical because I feel I am still slightly irrational about this entire event, given that my emotions are inhibiting proper decision making.
Kindly advice Sir.
Hi doctor,
Adding to what I've already written, she also mentioned that she was tested a week earlier, although her credibility seemed very dubious to me. While she does not have an agenda to lie to me, I remain skeptical.
Perhaps this additional piece of information might help in your evaluation.
I thank you for your time.
Adding to what I've already written, she also mentioned that she was tested a week earlier, although her credibility seemed very dubious to me. While she does not have an agenda to lie to me, I remain skeptical.
Perhaps this additional piece of information might help in your evaluation.
I thank you for your time.
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