Please Advise on recent stupid HIV possible encounter

[dodablue101]

Dear Doctors,

I am a mid 20's male with a serious girl friend and only sexual active with her (until this past weekend).  Well anyways, this past weekend I probably did the single most stupid thing in my life.  I went to an erotic massage parlor late Saturday night in downtown Dallas with some buddies and we were all really drunk. I ended up in a room with a Korean who looked in mid to late 20's and ended up (not to be graphic, but want to give all details) doing her from the back (don't remember if condom was on at this point or not, since I was pretty drunk) for maybe a minute before she ask me to lay on back, after laying on my back for maybe a minute I looked up and saw condom on penis but do not remember when she put it on me.  I want to say she put one on me after I laid on back, since I was the one who initiated the move to have her on knees (I know I am stupid).  Please advise what your take is on the matter, cause I am really afraid that she could have given me the horrid HIV. I mean I know I had a condom on the second go around, but the first one I don't remember. I don't know if it matters, but I ended up not even relieving myself since I was so drunk. I am really afraid of my mistake. I mean why is it she put a condom on me w/o me even asking me, is it because she has something and doesn't want to give it to me maybe?

I ended up going home afterwards and showering and being sure to clean whole genital area (I have no cuts or open wounds there). I have all ready scheduled to have 72 hour post STD test this Wednesday to detect bacteria STD's with a local clinic. Is there anyway of determining sooner than three months whether or not I have HIV or Herpes? Please advise because I can't eat, work or sleep because I am so concerned.

Should I go see doctor about PEP? Does it even work?

What are my chances you think of contracting an STD from this encounter?

What do you advise?

[H. Hunter Handsfield, M.D.]

You're overthinking this.  Your encounter was a relatively low-risk one, not high risk.   None of the additional information changes my opinion or advice, and some of your questions have been asked and answered repeatedly; you can use the search link to find the discussions (or just scan almost any 10-20 threads).

1) I agree.
2) Rough estimate, less than 1 chance in 1000.
3-5) HSV-2 symptoms generally start in 3-10 days.  The first symptom is the genital blisters or sores, not body aches.  Symptoms cannot start the next day after exposure.
6) I answered the testing question above.  You don't need testing for HSV-2 and I recommend against it.

That will be all for this thread.

[dodablue101]

I have a few more questions concerning my recent high risk encounter the other night that I was hoping you could help me with.

1. The first go around where I think I was not wearing a condom I remember her feeling really wet, how does this effect my odds of contracting HIV or HSV-2? I have heard I have a better chance of getting hit by car driving home from work today than I do of contracting HIV from this one risky encounter. Accurate?

2. From this encounter what are the odds of contracting HSV-2? Does the fact I took hot shower with soap within 30 mins of possible exposure help my chances?

3. If I did contract HSV-2 what percent of people show initial signs of it shortly after exposure? What are they? And when can I start to expect to see them?

4. If I did contract HIV what percent of people show initial signs of it shortly after exposure? What are they? And when can I start to expect to see them?

5. The morning after the encounter the whole left side of my body was sore; I have been told this is an early sign of HSV-2. Is it possible to see symptoms so early?

5. From my encounter what types (if any) of tests would you suggest if I was your patient?

Thanks in advance for your response. It will help me through this very stressful time. I am just hoping all this stress is just for nothing.

Also if there is any other insight that you could give me since you see stories like mine all the time I would be extremely grateful.


Thanks Again,
dodablue

[H. Hunter Handsfield, M.D.]

Although the details differ every time someone tells a story like yours, the essense of the exposure is just like hundreds of others on this forum and my response is the same.  Statistically, it is unlikely the stripper/CSW had HIV; most do not.  Even if she did, the risk of transmission, even without a condom, was quite low (average once for every 2,000 episodes of vaginal sex).  With a condom, your risk was zero for practical purposes.

When CSWs use condoms routinely, it does not indicate they are infected and trying to protect their customers.  The opposite is usually true:  usually they know they aren't infected and intend to stay that way.  (In general, CSWs are at higher risk from their clients than vice versa.)  This in turn means that if she applied a condom the second time, she probably did so the first time as well.

Since you are nervous, I agree you should be examined and tested, as you plan to do.  A 72 hour visit is fine for gonorrhea and chlamydia testing, but blood tests for HIV and syphilis need to be delayed at least 4-6 weeks.  (If you visit a public health department STD clinic, you can definitely rely on their advice.  But don't let a non-expert clinic or provider talk you into expensive tests you don't need, like herpes, hepatitis, or others.)

Finally, you do not meet most agencies' recommendations or guidelines for PEP; the risk is too low.  But I cannot say what the guidelines are in your community, which might vary depending on local knowledge of HIV epidemiology.

Best wishes--  HHH, MD