Protected sex with CSW. What's my risk?

[sbanxious]

Hi Doctors,

About 3 weeks ago I had sex with a female CSW. I'm male.

Vaginal sex was protected with a latex condom. Condom was intact afterwards. Didn't seem to slip. I am confident it did its job. I filled it with water afterwards and there were no leaks. No idea if that's a valid or reliable test but did that anyway.

Prior to the sex we had protected oral with the same condom.

Please let me know your thoughts on this in terms of risk and what I should do in terms of testing if necessary. I am in a relationship so should I abstain until clear or what?

Thanks

[Edward W Hook, MD]

Welcome to the forum and congratulations on your practice of safe sex.  . The event you describe was a no risk event.  Most commercial sex workers do not have HIV and even most unprotected sexual exposures to infected partners do not lead to transmission of infection (the infection rate for unprotected genital sex with an infected partner is about 1 infection per 1000-2000 exposures).  In your case the use of a latex condom throughout sex transforms this exposure to a virtually no risk exposure.  There is no reason for concern and no medical reason for testing.

I hope my comments are helpful.  EWH

[Edward W Hook, MD]

Glad to help. Take care. EWH

[sbanxious]

Thanks Dr. Hook. You've been very helpful.

[Edward W Hook, MD]

This will be my final reply.  At three weeks an HIV test using oral fluids would be expected to detect over half, but not all, recent HIV infections.  EWH

[sbanxious]

Just a follow up, Dr. Hook. I hope you don't mind. Yesterday was day 21 post exposure. I did a saliva antibody test (oraquick in- home). It was negative. I know you said no need to test but I was getting a bit anxious. I understand that a more conclusive test will be down the track but is this negative result at three weeks with this Ab test something to feel good about? Thanks again.

[Edward W Hook, MD]

Great.  I'm glad I could help. EWH

[sbanxious]

Thanks again Dr. Hook. I appreciate your answers to my questions--they are reassuring. I'll take your advice and not worry about testing for this encounter and will get on with life (admittedly, this has been a bit stressful for me). I'll also get the white tongue checked out if it doesn't improve. Probably was the antibiotics. Thanks!

[Edward W Hook, MD]

Thrush can sometimes follow use of antibiotics but the tongue can become sore and take on a white appearance for a number of reasons.  My advice would be to see if it gets better. If it does not, you might want the doctor who prescribed you antibiotics to take a look.  i would not worry that this is a manifestation of any STI, including HIV

EWH

[sbanxious]

Thanks Dr. Hook. One final question. I've had for the last five days what's best described as a sore tongue. It hurts a bit but not when eating or drinking. Also a white coating. I had been on a course of antibiotics that stopped about a week before this tongue issue started. Should I be concerned about this. I've read about oral thrush. This started about 16 days post exposure. I realize you said that this is a no risk encounter so perhaps this is coincidence? Or anxiety? Thanks again.

[Edward W Hook, MD]

You are correct.  No reason to abstain from unprotected sex with your regular partner.

As long as condoms are worn throughout sex (from beginning to end) and do not break, they represent safe, virtually no risk sex.  EWH

[sbanxious]

Thanks Dr. Hook for your fast and reassuring reply. I really appreciate it. In my question I asked about sex with my regular partner. You didn't answer directly but I assume you think it would be fine for me to continue (unprotected) sex with her. Can you please let me know? Thanks.

One last question (if you don't mind). Is the only time using a condom won't give adequate protection (that renders intercourse "virtually no risk") when it breaks? Curious to know for future reference. Thanks.