Anal and Oral receiptive Sex with a She-male with condom on

[mek123]

Dear Doctor:
I am male. I had oral and anal sex with a sex worker who was a She-male on April 18th very early morning after being very drunk. Both of us used condoms (changed them after oral, anal sex). She inserted her penis in my anus with condom on (and lube was used) for a very brief period ( Probably less than a minute) at which point I stopped her (him...) I believe condoms worked properly ( However I was drunk and my perception was not at 100%).  She massaged my anus with her finger  before she inserted her penis.  She was very careful when putting the condoms on and when taking them off. We also gave oral sex to each other with condoms on. I do not believe he came in my mouth or anus (with condom). When he was close to coming he pulled his penis out (of my mouth) and took the condom off and masturbated himself until he came. After that he continued to give me oral sex, and at one point I recall I had a finger in his rectum (which he pushed away and did not let me). I asked her several times of her STD status: HIV, syphilis etc. She said many times that she is very sure she does not have an STD. I asked her when she was last tested she said December. She did ask my status as well and would not let me touch her penis without a condom on.  The questions I have are:
1) What are the risks of HIV infection given what I described?
2) Three days after this I came down with slight fever, slight sore throat and night chills. I am not sure if these are indication of acute hiv ( I can not get a clear information when these symptoms can start; can they start 3-4 days after exposure?)  or my anxiety or some other infection?
3) I will get tested at 6 weeks, but do you recemmond earlier testing with RNA/DNA type tests; if yes how long should I wait for those?

I do not need to tell you the level of anxiety I am in. Your help will be appreciated very much.
Regards

[Edward W Hook, MD]

Your risk is very low.  Condom protect and sex is safe sex and despite being drunk, it sounds as though you were careful to take precautions.  In addition, your partner indicated they were "safe" and without STD?HIV, thus, they probably were (most people tell the truth).  Even if your partner was infected (and he was probably not), and even if the condom broke (it did not), you chances of infection would be less than 1 in 100.  Putting all of this together, your risk is miniscule.   Do not worry.

As for your specific questions:

1.  Very, very low
2.  Irrelevant.  You are wondering about ARS.  Read any series of posts on this site and you will see  that we NEVER endorse symptoms as an indicator of HIV risk, no matter what they are.  In addition, the timing of your symptoms fits poorly with ARS.
3.  OK, get tested, but with a regular serological blood test..  We recommend against the RNA PCR tests.  The have a higher false positive rate than the standard blood test and are not recommended for this purpose.

Hope this helps.  EWH

[Edward W Hook, MD]

1.  Your gum surgery had begun to heal well by the time of your exposure (no matter how your mouth felt) thus this does not increase your risk.
2,  Plese re-read my comments about symptoms.  I do not know how to be any clearer.  Symptoms are are an unreliable indicator or ARS and an unreasonable indicator for HIV testing.  I will not get into a debate with other sites. As you no doubt know, you can find sites on the net that will tell you just about anything you want to (or don't want to) hear about the ARS etc.  You have to decide who you wnat to believe.  My assessment is unchanged.  EWH

[mek123]

Doctor, thank you very much.
If I may follow up ( I will not make a habit of this) with a bit more information/question:
1) I had gum surgery 2 days prior to this event; I do not know if that made my "mouth" more vulnerable or not...
2) My symptoms: fever, sinus problems, stuffiness, sore throat, ear "ache" has been getting worse ( it started about 3 days after). I understand your point on the timing "early"; yet I have read in many places it starts "few days" after the event; is this correct? I understand there is no absolute number of days but are there known cases (at least in your experience) that these symptoms exhibit 3-4 days after the event?
I am sorry to bother you again on this.
Thanks much Regards.