Oral Exposure

[ishab]

Dear Doctor,
I have never had vaginal or anal sex other than with my long term partner.

I recently visited a massage parlour (which i occasionally visit). The lady was of oriental background. She looked like she was sufering from flu like symptoms. After a back massage she asked me to turn around. She put a condom in her mouth and rolled it around a few times and then directly put it on to my penis using her mouth. I asked her to stop after a few 'sucks' as I felt uncomfortable with the episode. She then proceeded to use her hands to masterbate me to orgasm.

1 week after the episode I developed groin pains, and aches and pains. My symptoms have continued and it is now 3 weeks. The groin pain has settled but aches and pans in my arms and legs remain. I have had pain in my fingers and wrists and feet as well as the back of my neck. I had a fever for one day, and a minor sore throat for a week. I may or may not have a very faint macular pink rash. I have a single mouth ulcer. I have had intermittant nausea from week 2-3. No phlegm or cough. No obvious lymphadenopathy.

I am 32 and am normally fit and well. I feel ill although have managed to go to work. But i am aware of my symptoms. I learnt about ARS only after my symptoms. Now i am convinced I have HIV. I know the risk is very very low from my readings on multiple we bistes but I am convinced I am the one unlucky person. This is amplified because a person I know clams to have become HIV positive from insertive oral without a condom. He was told the receptive partner (lady) must have been recently infected and had a high viral load.

I want to have a day 28 test but I am scared. Please help and advise.

[Edward W Hook, MD]

As I told you, there was no risk of HIV to start with.  Repeat testing is a waste of time.  EWH

[ishab]

Doctor, my HIV result came back as neg at 30 days.
The nurse said its 80 percent accurate at 30 days.
I believe it was antibody test.
Is it worth retesting??
20% chance false negative?
Thanks.

[ishab]

I will do. Thank you for your calm and considered response.
In the meantime Take Care.

[Edward W Hook, MD]

You need to relax.  Lymph node swelling is a non-specific finding and can be cause by lots an lots of things including mono, other causes of sore throat, dental and gum isease, etc.  This represents a great example of the power of the internet not only to inform but also to mislead.  While there is much useful information available on the internet, much of it is also taken out of context or a bit unbalanced and some of it is just plain wrong.  Please don't let the internet fuel your anxieties.

You are welcome to post again about your results when you have seen your doctor.  Until then I won't have further comments.  EWH

[ishab]

I am sorry to bother you again. I have lymph nodes up to 1cm in both post triangles 2-3 each side. Internet says are ominous and my DR also says needs investigating. I'm having test next wk. on the Internet says HIV can cause it

[Edward W Hook, MD]

Because the condom was in your partner's mouth and there may have been saliva on the inside of the condom from being there, this is technically an exposure, although a virtually no risk one.  Take care.  EWH

[ishab]

Thanks for your reply, Only just got a chance to digest it.

Please Can i clarify (finally) because your answer did not clear this up for me.
Is my episode of having a condom rolled in the mouth and then put directly onto my penis for oral classified as an exposure?? even if a tiny exposure given that oral without a condom is a very low risk exposure?

Thanks i wont post again.

[Edward W Hook, MD]

Theifigures I mentioned were derrived for men who were circumcised and those who were not, thus any mucosal changes that may be present do no change my comments or recomendations.  Again, I urge you not to worry.  

Nothing more to say beyond this.  EWH

[ishab]

Thank you for your prompt reply,

I am hoping as you state that a combination of anxiety, guilt and some other sort of viral infection is causing my symptoms.

The end of my urethra is turned out on 1 side so is always exposed although the mucosa looks slightly different to that of the urethra in situ (if that makes sense). I guess my worry was of infected saliva getting in and on my mucosa. If my symptoms and timings were not as they are i would have felt so much more reassured.

I agree with your sentiments about HIV amongst CSW. However here in the UK the 'Asian scene' has a sterotype of 'exploiting girls'. I tried to chase the girl to find out but she had moved on and when I relayed my concerns to the head lady she told me to **** off.

Any last reassuring words would be welcomed (make them really reassuring), and I guess I'll get tesed at sme point to put my mind at rest.

[Edward W Hook, MD]

Welcome to our Forum. In preparing to address your concerns I reviewed your earlier interactions on the HIV Community site and agree with all that was said there.  The exposure you describe did not put you at risk for HIV.  The fact is that few commercial sex workers have HIV and that there is no scientific evidence that HIV is transmitted by receipt of oral sex.  Persons who are being conservative say that the risk of getting HIV from oral sex is about 1 infection for every 10,000 exposures to infected partners but as I said, there is no scientific basis for this estimate.  Neither of us have seen ourselves, nor heard of either in the medical literature or in talking with other experts of anyone getting HIV form oral sex.  In fact, the risk is so low that we see no medical reason for HIV testing if one's only exposure is oral.

Symptoms are a terribly unreliable indicator of HIV.  Even when person have classical manifestations of the ARS 9which you do not), fewer than 1% turn out to be due to HIV.  In your case your symptoms, which began a week after your exposure began too soon to be compatible with the ARS and represent some but not all of the symptoms which are used to define the ARS.  I suspect that your symptoms are a coincidence and nothing more.

You state in other posts that you are anxious and I believe you.  All I can do is tell you that there is no reason related to the exposure you describe to be worried about HIV. I hope my comments help.  EWH