Aa
High Risk?
Was drunk and visited 2 csw’s in the high HIV prevalent red light area while travelling in Mumbai (India). Had unprotected oral sex repeatedly for long durations throughout the day.
1. Found out that 85% of csw’s are HIV + in that area, so safe to assume that I was exposed to HIV.
2. Found out later that the first prostitute had some really bad ulcerative problem in her mouth (the second csw informed me of this as she refused to touch my penis until I washed it as a result of this). So safe to assume I was exposed to ulceration and blood in the mouth and/or some STD.
3. I had a yeast infection on the head of my penis for a week prior to this (was applying miconazole cream) and it was not fully healed (some parts where skin was red and not intact).
4. I am not circumcised and 48 hours later, my penis is still red/sore from this and skin seems to be sloughing off (like when rubbed too much).
1. Given the extenuating circumstances (which probably can’t be any worse when it comes to insertive oral sex), did I put myself at risk for contracting HIV? Or is it still zero risk (can any circumstance increase risk)?
2. Do I need to test based on this incident?
3. My understanding is that saliva can’t transmit HIV no matter the amount - correct? That leaves only blood, so how much blood is required to effectively transmit HIV this way – i.e. invisible amounts, small visible amounts, or large copius amounts? Whatever problem it was that the csw had in her mouth must have been really bad given the second csw’s response. Plus, fresh blood would not be able to be "deactivated" by saliva before it touched my penis, right?
4. A dr. Here gave me 2 gms Zithro and 400 mg cefixime the day after as STD p’laxis, but I had severe diarrhoea one hr after taking it (took it on an empty stomach). Would the medicine have been absorbed fully by then or do I need to retake?
5. Will the medicine cure incubating STD’s like LGV & syphilis?
1. Found out that 85% of csw’s are HIV + in that area, so safe to assume that I was exposed to HIV.
2. Found out later that the first prostitute had some really bad ulcerative problem in her mouth (the second csw informed me of this as she refused to touch my penis until I washed it as a result of this). So safe to assume I was exposed to ulceration and blood in the mouth and/or some STD.
3. I had a yeast infection on the head of my penis for a week prior to this (was applying miconazole cream) and it was not fully healed (some parts where skin was red and not intact).
4. I am not circumcised and 48 hours later, my penis is still red/sore from this and skin seems to be sloughing off (like when rubbed too much).
1. Given the extenuating circumstances (which probably can’t be any worse when it comes to insertive oral sex), did I put myself at risk for contracting HIV? Or is it still zero risk (can any circumstance increase risk)?
2. Do I need to test based on this incident?
3. My understanding is that saliva can’t transmit HIV no matter the amount - correct? That leaves only blood, so how much blood is required to effectively transmit HIV this way – i.e. invisible amounts, small visible amounts, or large copius amounts? Whatever problem it was that the csw had in her mouth must have been really bad given the second csw’s response. Plus, fresh blood would not be able to be "deactivated" by saliva before it touched my penis, right?
4. A dr. Here gave me 2 gms Zithro and 400 mg cefixime the day after as STD p’laxis, but I had severe diarrhoea one hr after taking it (took it on an empty stomach). Would the medicine have been absorbed fully by then or do I need to retake?
5. Will the medicine cure incubating STD’s like LGV & syphilis?
MEDICAL PROFESSIONAL
The PCR test is not a "substitute" for the antibody test. However, the negative result is strongly reassuring. It is pretty much impossible to have HIV with a negative PCR test at 10 days.
Your new questions are simply asking the same things you did originally, asking me to repeat myself. I haven't changed my mind. I already told you that this exposure does not warrant HIV testing at all, based on risk assessment -- but that you should be tested for psychological reassurance. It seems clear that you're going to need to know "for sure" you weren't infected, beyond any advice I can give. But it's up to you.
It seems clear you are under the care of a knowedgeable physician. Continue to follow his advice about further testing. To me, it seems reasonable for you to have an antibody test at 6 weeks. Until then you should not be worried at all. You didn't catch HIV.
That will be all for this thread. I won't have any further advice.
Your new questions are simply asking the same things you did originally, asking me to repeat myself. I haven't changed my mind. I already told you that this exposure does not warrant HIV testing at all, based on risk assessment -- but that you should be tested for psychological reassurance. It seems clear that you're going to need to know "for sure" you weren't infected, beyond any advice I can give. But it's up to you.
It seems clear you are under the care of a knowedgeable physician. Continue to follow his advice about further testing. To me, it seems reasonable for you to have an antibody test at 6 weeks. Until then you should not be worried at all. You didn't catch HIV.
That will be all for this thread. I won't have any further advice.
Hi Dr. Handsfield,
Just to follow up, I had severe symptoms from days 3-12 (still ongoing) and a doctor here advised me to take a qualitative HIV-1 PCR RNA test, which I did, 10 days post exposure. Equipment was COBAS Ampliprep and COBAS TaqMan with sensitivity of 20 copies/ml and detecting Group M and O subtypes.
Just got the result and it was "Not Detectable"
I know this is not a substitute for an antibody test, but given that: (1) you advise no need of testing for insertive oral sex, (2) the CDC says that viral load can be detected 9-11 days post exposure, and (3) I have a negative result, can I close this chapter and not need to test anymore (i.e. assume I definitely do not have HIV), or do I still need the 6 week test?
Thanks!
Just to follow up, I had severe symptoms from days 3-12 (still ongoing) and a doctor here advised me to take a qualitative HIV-1 PCR RNA test, which I did, 10 days post exposure. Equipment was COBAS Ampliprep and COBAS TaqMan with sensitivity of 20 copies/ml and detecting Group M and O subtypes.
Just got the result and it was "Not Detectable"
I know this is not a substitute for an antibody test, but given that: (1) you advise no need of testing for insertive oral sex, (2) the CDC says that viral load can be detected 9-11 days post exposure, and (3) I have a negative result, can I close this chapter and not need to test anymore (i.e. assume I definitely do not have HIV), or do I still need the 6 week test?
Thanks!
MEDICAL PROFESSIONAL
Regardless of what I would do, you should be tested. Most persons with the level of concern you express will not be fully reassured by any objective analysis and need the additinoal reassurance of a negative test result in order to move on.
That said, given the premises you state, I would have a single HIV antibody test at 6 weeks. But I wouldn't lose any sleep while awaiting the result.
That said, given the premises you state, I would have a single HIV antibody test at 6 weeks. But I wouldn't lose any sleep while awaiting the result.
Dear Dr. Handsfield,
Thank you for your reply. I am not trying to make things appear worse than they are. Normally I wouldn't have paid much attention, but it just felt like the perfect storm in terms of other factors. What worried me the most was the high HIV prevalence in the red light area, coupled with the fact that one of them had oral ulceration and probably wasn't on medication due to the economic plight of the csw's in the area.
I am a little unclear as you say you are happy to agree that I am at risk, and then you mention that I should test even though the risk is low, if any. If you were in my position, would you feel the need to test based on this isolated incident? I value your opinion, and that's why its important for me to get your feedback on where I stand.
I know it was a mistake and I hope to learn from it. Just hope it's not too late.
Thx.
Thank you for your reply. I am not trying to make things appear worse than they are. Normally I wouldn't have paid much attention, but it just felt like the perfect storm in terms of other factors. What worried me the most was the high HIV prevalence in the red light area, coupled with the fact that one of them had oral ulceration and probably wasn't on medication due to the economic plight of the csw's in the area.
I am a little unclear as you say you are happy to agree that I am at risk, and then you mention that I should test even though the risk is low, if any. If you were in my position, would you feel the need to test based on this isolated incident? I value your opinion, and that's why its important for me to get your feedback on where I stand.
I know it was a mistake and I hope to learn from it. Just hope it's not too late.
Thx.
MEDICAL PROFESSIONAL
It seems pretty obvious you have decided you are at high risk for HIV and are working very hard to find corroboration of that viewpoint, both here and on the commmunity forum. You slant your question very strongly in order to make me agree you are at risk. OK, I'll be happy to agree. But why is it so important to you to believe it?
Be clear: What is known is that there are few if any scientifically documented cases of people acquiring HIV by oral to genital transmission, but there are no data to prove that oral sex doesn't transmit HIV, and we have never said that on this forum. We generally conclude that the risk is low enough to be ignored, and often that translates to "no risk" for verbal shorthand. Also, there are no data to prove that saliva is never infectious; probably it is, sometimes. And of course it is possible that a yeast infection or other inflammatory condition of the penis could increase the risk of HIV transmission if exposed. However, since we know that oral sex rarely if ever transmits the virus, even though various minor inflammatory conditions of the penis, or oral sores (herpes, other) sometimes are present, those factors seem to have little influence on transmission.
1) I am exceedingly skeptical that there is any neighbornood or group of CSWs in India, or anywhere else, with an 85% prevalence of HIV. However, if that were true, and given the other circumstances you describe, I agree that there could have been some risk of HIV.
2) Given your premises, it is reasonable to get tested, if only for the reassurance factor from the negative result. However, your risk of HIV remains very low, if any.
3) There are no scientific data by which to answer these questions.
4) Azithromycin often causes transient diarrhea exactly as you describe. This does not affect drug absorption and both antibiotics remained and fully effective.
5) LGV is an impossible consequence from these events; chlamydia is uncommon in the oral cavity and LGV is not known to have been transmitted by oral sex. The drugs would definitetly prevent syphilis, gonorrhea, and chlamydia/LGV, if there were any risk for it.
HHH, MD
Be clear: What is known is that there are few if any scientifically documented cases of people acquiring HIV by oral to genital transmission, but there are no data to prove that oral sex doesn't transmit HIV, and we have never said that on this forum. We generally conclude that the risk is low enough to be ignored, and often that translates to "no risk" for verbal shorthand. Also, there are no data to prove that saliva is never infectious; probably it is, sometimes. And of course it is possible that a yeast infection or other inflammatory condition of the penis could increase the risk of HIV transmission if exposed. However, since we know that oral sex rarely if ever transmits the virus, even though various minor inflammatory conditions of the penis, or oral sores (herpes, other) sometimes are present, those factors seem to have little influence on transmission.
1) I am exceedingly skeptical that there is any neighbornood or group of CSWs in India, or anywhere else, with an 85% prevalence of HIV. However, if that were true, and given the other circumstances you describe, I agree that there could have been some risk of HIV.
2) Given your premises, it is reasonable to get tested, if only for the reassurance factor from the negative result. However, your risk of HIV remains very low, if any.
3) There are no scientific data by which to answer these questions.
4) Azithromycin often causes transient diarrhea exactly as you describe. This does not affect drug absorption and both antibiotics remained and fully effective.
5) LGV is an impossible consequence from these events; chlamydia is uncommon in the oral cavity and LGV is not known to have been transmitted by oral sex. The drugs would definitetly prevent syphilis, gonorrhea, and chlamydia/LGV, if there were any risk for it.
HHH, MD
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