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Worried about sex with CSW
Dear Doctor,
I’m quite concerned about the consequences of recent visit to a CSW at a massage parlor in the Philippines.
About 5 weeks ago, I had one episode of protected vaginal intercourse with a CSW at an upscale massage parlor/brothel in the Philippines. We took a bath together and I massaged the outside of the girl’s vagina with my finger (which was wet with vaginal fluid). We did not have oral sex. Intercourse lasted about 10 minutes and the girl was on top of me. The condom did not slip off and appeared to be intact the whole time. During sex, some of her KY jelly -- perhaps mixed with vaginal fluid -- leaked out on top of me. The CSW was 20 and mentioned that she had only been on the job for a week, though I’m not sure how credible this is.
About 3 weeks after this incident, I noticed the occurrence of a persistent, dry cough and occasionally runny nose (both are now a little better but still haven’t disappeared). More recently, I have had mild diarrhea in the morning. I have been taking my temperature routinely during this period and have always been normal (or even below normal). Generally, my body temperature tends to run around 97.6-98.6 F. I should note that some of the symptoms appeared after I took a trip to Vietnam in the interim (no sexual activities there).
I have been quite anxious and had ELISA and P24 tests after 9 days. Both were negative, though having read through your forum, I know that ELISA is rarely accurate at 10 days. I should also mention that I have had ELISA tests roughly every three months for the past two years (as well as several P24 tests) and have always been “non-reactive”.
In your view, should I get tested again for either P24 or ELISA? Does the negative P24 after 9 days eliminate any risk of HIV infection? I have read on the Mayo Clinic website that P24 is usually accurate between 1 and 3-4 weeks after possible infection – is this true?
Thank you so much for your time.
I’m quite concerned about the consequences of recent visit to a CSW at a massage parlor in the Philippines.
About 5 weeks ago, I had one episode of protected vaginal intercourse with a CSW at an upscale massage parlor/brothel in the Philippines. We took a bath together and I massaged the outside of the girl’s vagina with my finger (which was wet with vaginal fluid). We did not have oral sex. Intercourse lasted about 10 minutes and the girl was on top of me. The condom did not slip off and appeared to be intact the whole time. During sex, some of her KY jelly -- perhaps mixed with vaginal fluid -- leaked out on top of me. The CSW was 20 and mentioned that she had only been on the job for a week, though I’m not sure how credible this is.
About 3 weeks after this incident, I noticed the occurrence of a persistent, dry cough and occasionally runny nose (both are now a little better but still haven’t disappeared). More recently, I have had mild diarrhea in the morning. I have been taking my temperature routinely during this period and have always been normal (or even below normal). Generally, my body temperature tends to run around 97.6-98.6 F. I should note that some of the symptoms appeared after I took a trip to Vietnam in the interim (no sexual activities there).
I have been quite anxious and had ELISA and P24 tests after 9 days. Both were negative, though having read through your forum, I know that ELISA is rarely accurate at 10 days. I should also mention that I have had ELISA tests roughly every three months for the past two years (as well as several P24 tests) and have always been “non-reactive”.
In your view, should I get tested again for either P24 or ELISA? Does the negative P24 after 9 days eliminate any risk of HIV infection? I have read on the Mayo Clinic website that P24 is usually accurate between 1 and 3-4 weeks after possible infection – is this true?
Thank you so much for your time.
MEDICAL PROFESSIONAL
This initial reply is after reading the first sentence of the second paragraph. Condom-protected sex means no risk for HIV. Whatever you say in the rest of the question is unlikely to override that simple fact.
Now I have read the rest. If you will read just a few threads on this forum, you will find that symptoms never are a useful indicator of new HIV infection. The nature of the exposure is a much more effective predictor. And your symptoms don't suggest HIV anyway.
It is true that most people with new HIV infection would be positive on the duo antibody/P24 antigen test at 9 days, so that result is reassuring. But not definitive.
The chance you have HIV is astronomically small, assuming you don't have other exposures you haven't described. But if you want to pursue it further, have an antibody test 6-8 weeks after the event. It will be negative.
Final comment: It seems you have an inflated view of HIV risks from heterosexual exposure. It is a waste of money, time, and energy to be having HIV testing every 3 months, unless your risks are much higher than the rest of your message implies. Maybe if you were an injection drug user who shares injection equipment, of a gay man with multiple episodes of unprotected anal sex with many partners. Otherwise an antibody test every couple of years makes more sense. But it's your money, so feel free.
Best wishes-- HHH, MD
Now I have read the rest. If you will read just a few threads on this forum, you will find that symptoms never are a useful indicator of new HIV infection. The nature of the exposure is a much more effective predictor. And your symptoms don't suggest HIV anyway.
It is true that most people with new HIV infection would be positive on the duo antibody/P24 antigen test at 9 days, so that result is reassuring. But not definitive.
The chance you have HIV is astronomically small, assuming you don't have other exposures you haven't described. But if you want to pursue it further, have an antibody test 6-8 weeks after the event. It will be negative.
Final comment: It seems you have an inflated view of HIV risks from heterosexual exposure. It is a waste of money, time, and energy to be having HIV testing every 3 months, unless your risks are much higher than the rest of your message implies. Maybe if you were an injection drug user who shares injection equipment, of a gay man with multiple episodes of unprotected anal sex with many partners. Otherwise an antibody test every couple of years makes more sense. But it's your money, so feel free.
Best wishes-- HHH, MD
just to note, philippines has one of the lowest HIV prevalence rate worldwide at <0.001%
MEDICAL PROFESSIONAL
Last paragraph: That's supposed to be "or a gay man", not "of".
You are reading content posted in the HIV - Prevention Forum
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Frequency of HIV testing depends on your risk.
Post-exposure prophylaxis (PEP) may help prevent HIV infection.
