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Assesment of Risk and Testing
Hello Doctor,
I was vacationing in Ibiza, Spain and one night(I believe the date was July 11th or 12th) I was intoxicated I was stopped by a CSW on the street and asked if I wanted to have sex. I obliged and we had protected oral and vaginal/anal sex(I do not recall if it was anal or vaginal because I was intoxicated but I believe it was vaginal). She seemed to take extra care using a tissue to cover the bottom of my penis while giving me oral. We were having intercourse when she must have noticed the condom broke and she immediately pulled out(I assume she noticed it quickly, I did not, and I was also told that CSW are trained to notice when a condom breaks). She seemed more upset about the condom breaking than me at the time so I do not know if that’s reassuring or not?
If it makes any difference she was of African descent although it did appear as I described above she seemed extra careful, more than I would normally think a CSW, about performing oral and intercourse would be, though I don’t know if that’s a good sign or bad. I did an HIV/Syphilis test when I got back(roughly 10-12 days after incident) both negative and I am aware that that may have been to early.I did a Chlaymida and Ghannorhea test this past Monday and am still awaiting results from that, not sure how long those results usually take.
1)Based on all the details of the event and my HSV-1(albeit when I got tested for it roughly 3-4 years ago they only found small traces and labeled it as dormant) would you even have recommended testing at all?
2)If I were your patient would you be satisfied with a test at 6-weeks?
3)In regards to the testing, what are your thoughts on the Oraquick? Do I need an appointment for public clinics in general? Or it’s different for each public health care center?
I also suffer from anxiety, see a therapist well before this incident and am fully aware that any possible symptoms could be do to anxiety it's self.
Thank you for your time.
I was vacationing in Ibiza, Spain and one night(I believe the date was July 11th or 12th) I was intoxicated I was stopped by a CSW on the street and asked if I wanted to have sex. I obliged and we had protected oral and vaginal/anal sex(I do not recall if it was anal or vaginal because I was intoxicated but I believe it was vaginal). She seemed to take extra care using a tissue to cover the bottom of my penis while giving me oral. We were having intercourse when she must have noticed the condom broke and she immediately pulled out(I assume she noticed it quickly, I did not, and I was also told that CSW are trained to notice when a condom breaks). She seemed more upset about the condom breaking than me at the time so I do not know if that’s reassuring or not?
If it makes any difference she was of African descent although it did appear as I described above she seemed extra careful, more than I would normally think a CSW, about performing oral and intercourse would be, though I don’t know if that’s a good sign or bad. I did an HIV/Syphilis test when I got back(roughly 10-12 days after incident) both negative and I am aware that that may have been to early.I did a Chlaymida and Ghannorhea test this past Monday and am still awaiting results from that, not sure how long those results usually take.
1)Based on all the details of the event and my HSV-1(albeit when I got tested for it roughly 3-4 years ago they only found small traces and labeled it as dormant) would you even have recommended testing at all?
2)If I were your patient would you be satisfied with a test at 6-weeks?
3)In regards to the testing, what are your thoughts on the Oraquick? Do I need an appointment for public clinics in general? Or it’s different for each public health care center?
I also suffer from anxiety, see a therapist well before this incident and am fully aware that any possible symptoms could be do to anxiety it's self.
Thank you for your time.
MEDICAL PROFESSIONAL
Here in the Forum we try not to argue with other health professionals but when they are mis-informed or when your understanding of what was said is incorrect, I must correct this. Several of the things you said above are incorrect. Addressing them in order:
1. The Clearview assays are good, reliable tests. Believe the result.
2. She is incorrect about oral sex and sounds as though she is trying to provide counseling by scaring you. There is virtually no risk from receipt of oral sex. We are firm in the data supporting the statements made on this site.
3. There are no effective vaccines for HIV. PEP is effective if taken within the first 72 hours following exposure to a partner known to have HIV. It is not recommended for general use as it is very expensive and there are a number of medication-related side effects which are pretty common. It would be unlikely that PEP would prevent ALL HIV infections following exposure but it is clearly highly effective.
Hope this helps. I stand by my original suggestions. EWH
1. The Clearview assays are good, reliable tests. Believe the result.
2. She is incorrect about oral sex and sounds as though she is trying to provide counseling by scaring you. There is virtually no risk from receipt of oral sex. We are firm in the data supporting the statements made on this site.
3. There are no effective vaccines for HIV. PEP is effective if taken within the first 72 hours following exposure to a partner known to have HIV. It is not recommended for general use as it is very expensive and there are a number of medication-related side effects which are pretty common. It would be unlikely that PEP would prevent ALL HIV infections following exposure but it is clearly highly effective.
Hope this helps. I stand by my original suggestions. EWH
I apolize point # 1 should read September 10th, not August 10th.
Hello Dr. Hook,
I hate to be one of the many people "uselessly" bumping up an old thread, but I went to do an HIV test yesterday and I had a few comments.
1)I did not take the Oraquick… I believe it was the Clearview HIV 1 / 2 Statpak test where they ***** your finger with a needle and take your blood. Result was negative. This test was done nearly 2 months after possible exposure(July 11th, test was done August 10th) does the result satisfy you?
2) She asked me if I had any knowledge of HIV and I told her more or less what I know from these forums and then she said that yes you can get HIV from oral sex, cuts and sores, etc everything that you and the other Dr. have stated that up to this point there is not scientific evidence proving otherwise.
3) She said she recently heard on the news of some “new” Hiv-vaccine when if taken within the first 72 hours of possible infection it will prevent HIV. She said she did not believe it was true and that you could probably end up with HIV from taking that vaccine. I remember reading about that here in the forums, is that the PEP test(?) she was referring to? Is it really that new? She went on to say that she doesn’t believe in that stuff that she only believes in God.
Hearing her say all that only struck fear and concern that I may have been in the wrong place because the way she talked about HIV was as if it was the “most contagious dangerous” disease known to man… so instead of feeling content with my HIV-Negative test I was wondering if it were really reliable at all. The free-HIV clinic center was in a poor-bad neighborhood, but I would hope that shouldn’t be cause for concern as it is State sponsored?
Thanks for your time once again, I hope you can give me some reaction to the above.
I hate to be one of the many people "uselessly" bumping up an old thread, but I went to do an HIV test yesterday and I had a few comments.
1)I did not take the Oraquick… I believe it was the Clearview HIV 1 / 2 Statpak test where they ***** your finger with a needle and take your blood. Result was negative. This test was done nearly 2 months after possible exposure(July 11th, test was done August 10th) does the result satisfy you?
2) She asked me if I had any knowledge of HIV and I told her more or less what I know from these forums and then she said that yes you can get HIV from oral sex, cuts and sores, etc everything that you and the other Dr. have stated that up to this point there is not scientific evidence proving otherwise.
3) She said she recently heard on the news of some “new” Hiv-vaccine when if taken within the first 72 hours of possible infection it will prevent HIV. She said she did not believe it was true and that you could probably end up with HIV from taking that vaccine. I remember reading about that here in the forums, is that the PEP test(?) she was referring to? Is it really that new? She went on to say that she doesn’t believe in that stuff that she only believes in God.
Hearing her say all that only struck fear and concern that I may have been in the wrong place because the way she talked about HIV was as if it was the “most contagious dangerous” disease known to man… so instead of feeling content with my HIV-Negative test I was wondering if it were really reliable at all. The free-HIV clinic center was in a poor-bad neighborhood, but I would hope that shouldn’t be cause for concern as it is State sponsored?
Thanks for your time once again, I hope you can give me some reaction to the above.
thank you for your prompt reply.
MEDICAL PROFESSIONAL
Welcome to the Forum. Before I address your questions, I will make a comment on your observation that your partner appeared to be concerned when the broken condom was noticed. It is worth remembering that most CSWs do not have STD (including HIV) and wish to avoid them. Thus their use of condoms is typically designed to protect them from clients rather than the other way around. Thus I would take her interest in proper condom use as a good sign. Now for your specific questions:
1. If you have not had a herpetic outbreak, I would not suggest testing for herpes. The risk from a single, partially protected exposure is low and at this time, while a herpes blood test might tell you if you have had HSV or not, it would not allow you to know where or when you got it. In the absence of outbreaks, for situations such as yours, I would not recommend the blood test.
2. In your situation I would have complete faith in tests for all STDs, including syphilis and HIV.
3. The Oraquick is a good, highly reliable test. As for public clinics, they vary. Some offer testing on a walk-in basis, others offer appointments. BTW, when you get tested, don’t be surprised if they tell you that you need a follow-up test at 3 moths; this is the overly conservative “party line” but in your situation is not the case.
Hope this helps. EWH
1. If you have not had a herpetic outbreak, I would not suggest testing for herpes. The risk from a single, partially protected exposure is low and at this time, while a herpes blood test might tell you if you have had HSV or not, it would not allow you to know where or when you got it. In the absence of outbreaks, for situations such as yours, I would not recommend the blood test.
2. In your situation I would have complete faith in tests for all STDs, including syphilis and HIV.
3. The Oraquick is a good, highly reliable test. As for public clinics, they vary. Some offer testing on a walk-in basis, others offer appointments. BTW, when you get tested, don’t be surprised if they tell you that you need a follow-up test at 3 moths; this is the overly conservative “party line” but in your situation is not the case.
Hope this helps. EWH
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