CSW Incident & Test Accuracy

[Clueless99]

Good Day Dr.,

Back in late June I was had an incident with a CSW that provided me with an erotic massage where she only masterbated me.  There was no oral or vaginal sex involved (that I can recall.  Was drunk unfortunately).  Now I know there is no risk involved in masterbation, which is considered to be a safe sex practice.  Nonetheless though I still decided to go for a routine checkup about 4 weeks (26 days) later, which included blood and urinalysis testing for HIV and Hepatitis B.  Fortunately both tests came back "negative".  The test used was a HIV 1&2 Antibodies 3rd generation.  My test also included red and white blood cell count.  
Now, I know that testing is only considered to be more or less conclusive between 6-12 weeks post exposure.  However, in the event that there was an actual "risk" involved could one take reassurance in a 4 week negative result?  Once again, I know masterbation is considered to be a safe sex act, but my anxiety is forcing me to believe that more might've happened and I somehow would've blanked out.
My fear also comes from the fact that a few weeks later my girlfriend (whom I engage in unprotected sex with) started to experience intense upper abdominal pain that lasted for about 2 weeks and even required her to pay visit to the emergency room.  They did a wide variety of blood and urine tests in order to find the root of the problem, as well as ultra sound and electro cardiogram and found nothing wrong.  I have no idea if any STD tests were included in her testing though.  Needless to say, I started to fear in the back of my mind that perhaps this is a sign of ARS-related symptoms.  
Lastly, the night of my test I was experiencing some rather intense upper abdominal pain as well.  I haven't experienced anything else that may be potentially ARS related (fever, flu symptoms, etc.). Had these symptoms been "ARS related" though it would've shown up on my blood tests I'd imagine, since it occured on the same day?

Thank You

[Clueless99]

Hello Doctor,

Just an update.  I took a second HIV antibody test at the 8 week mark, which based on the info provided by both my GP and on the info provided on this forum is relatively conclusive.  Therefore I am accepting my negative result and gladly moving on with my life.  I'm dealing with my anxiety, coping with it, and I am looking to help others that are also suffering from the same type of anxiety.

Just want to thank you for all your hard work and reassurance that your provide on this forum on a daily basis.  You are doing a tremendous job and it is greatly appreciated by all that post here.  

Thank you again.

[Edward W Hook, MD]

Correct.  EWH

[Clueless99]

I think the doctor was speaking in general terms, meaning that the chances of those types of symptoms being associated with STDs in general is a fraction of 1%.  

[4ad]

I'm sorry to chime in, but since I had a similar encounter/risk, I would like to ask:
On your first answer you said " In your case, following a no risk encounter, the chance that her symptoms were due to an STD or HIV transmitted by you are a small fraction of 1%." How can his girlfriend have even "a fraction of 1%" risk of having and STD  or HIV transmitted to her by him if he had no risk to begin with?
I hope you can clarify that.
Thanks.

[Edward W Hook, MD]

No, I would not consider gastritis to be a symptom of the ARS.  EWH

[Clueless99]

Hello again doctor.  Out of curiosity would you consider gastritis or gastritis-like symptoms to be a probable ARS-related symptom?  

[Edward W Hook, MD]

I think you are worrying too much.  That said, an HIV antibody test at 4 weeks will detect over 90% of recent HIV infections.

For persons who regularly perform oral sex on partners of unknown HIV status, the risk is quite low.  Unless there is a specific reason to do so, I would recommend at least annual testing for HIV, perhaps more if persons have lots of partners over a given period of time (i.e. more than 4-6 partners in the past 4-6 months).  EWH

[Clueless99]

Thank you Doctor.

Last post from me (sorry to burden you so much).  

Her symptoms went away as soon as she started to take a type of anti-depresent drug, so I suppose it's safe to say that it may have been something stress related in that case...

Hypothetically speaking, in the event that there is a legitamate risk invovled, how reliable would a post exposure test at 4 weeks be?  I've read that it hovers somewhere around 90%.  Can you confirm this based on your knowledge and the type of test that was used?  I have a follow up scheduled in about 3 weeks time, just to put my mind at ease...

As for the whole oral sex dilemma, would you recommend someone who performed oral sex (ex. a "bj") to even get tested?  I know that receiving one isn't a risk, but in the case of someone giving, would you suggest getting tested for HIV?  

Thanks for answering my final questions.

[Edward W Hook, MD]

sorry, I overlloked that her symptoms were still going on.  I am sure however that her doctors should have considered STDs as a potential cause.  Early HIV symptoms would not last for two weeks however so that is even less possible.,

As I said,the COMBINATION of the type of exposure and your test results shoudl give you complete confidence you did not get HIV.

There are a handful of cases of HIV which MAY have been due to performing oral sex but none which have been proven to be related to receiving oral sex.  The 1 in 10,000 figure (think of it, this is equivalent to having oral sex daily with an infected partner for over 27 years) is an estimate and probably a conservative one.  I really would not worry. EWH

[Clueless99]

Hello Dr.,

Thank you for your prompt reply.  When you say her symptoms would be "continuing", what do you mean by that?  As I said they persisted for about 2 weeks or so, with some days having been worse than others.  Diahrrea and nausea weren't much of an issue, but her pain was rather intense.   In the case of my abdominal pain it actually took place the day/night of my blood test, so if it was ARS related it would've surely shown up on my results, correct?

Also, once again, I can place full confidence in the negative result I received at 4 weeks (26 days)?  

Lastly, as far as oral sex is concerned for the receptive partner (person doing the sucking) are the risks associated negligble in the event that the insertive person (person being sucked) does have HIV?  I often see "1 in 10,000" thrown around concerning the risks associated with oral sex.  Does this apply the same to someone performing a bj as well? Especially if there was no ejaculation involved and she didn't swallow?  I read that saliva can actually render the virus inactive during oral sex...

THank you again for your help and reassurance.

[Edward W Hook, MD]

Welcome to the Forum. My advice is to not worry that your GF's abdominal discomfort was due to HIV or any other STD acquired during your erotic massage.  Abdominal discomfort of the sort you describe is quite common and STDs including HIV are very low on the list, in general as causes.  Further, if her symptoms were due to an STD, they likely would be continuing which does not sound to be the case.   In your case, following a no risk encounter, the chance that her symptoms were due to an STD or HIV transmitted by you are a small fraction of 1%.  

It sounds as though you feel guilty about your exposure.  I understand this but do not allow it to override your common sense.  The chance that you got an infection is virtually zero and is now confirmed with a negative test.

There is no reason to think that your symptoms last night wer realted to the massge either. EWH