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Avatar universal

Unprotected sex in Thailand

Hi Doc,

Three days ago I had unprotected sex with two different girls on the same night in Bangkok, Thailand (I know this is incredibly STUPID and out of character and I was so drunk it seemed like a good idea at the time but never again).  One was a sex worker, and the other I met at a club along with her friends.  I'll say it again: STUPID.  The contact to me was vaginal and oral from both, and there was also some kissing involved from both.

Now I am coming down with a sore and inflamed throat and threw up this morning, and I am wondering if this is a probable symptom of STD's or something else.  I did have a bit to drink last night due to new year though, but not that much really.  A lymph node at the base of my ear is also inflamed.  I also have what appears to be a pimple on my penis at the base of my glans (looks exactly like a zit you'd get anywhere else on your body).  I've gotten this before, but I thought i'd mention it any way.  

What are my risks and what do you think I should do?  Also note that I am single now but I might be getting back together with my ex soon also, I don't want to risk her being infected by anything but for obvious reasons I'd prefer not to mention this to her if I can safely avoid doing so.

Thanks so much!
5 Responses
936016 tn?1332765604
MEDICAL PROFESSIONAL
Hi Nick,

You describe unprotected vaginal sex with both girls and also receiving oral sex from them.

It is not possible for the symptoms you describe to be HIV early symptoms as they are simply far far too early.

HIV infection clearly is a possibility, particularly from the sex worker and you need to take this possibility seriously. I think on balance it is unlikely but a possibility.

You need to take local medical advice and consider whether Post Exposure Prophylaxis (PEP) is appropriate for you. You are just on the edge of the time frame for starting PEP so go and talk to a local doctor.
http://www.freedomhealth.co.uk/sexual-health/hiv-pep-post-exposure-prophylaxis-london-clinic/174/


It is very likely also to be too early to test for sexually transmitted infections with great accuracy but I would still do it.

I would also consider with the doctor you see there whether taking prophylactic antibiotics to deal with possible infection with chlamydia, gonorrhoea and syphilis might be appropriate even though it is too early to test with accuracy.

If you do not take PEP then you can test for HIV from around seven days post exposure using a PCR HIV test or at 28 days using an HIV DUO test.

http://www.freedomhealth.co.uk/sexual-health/hiv-test-hiv-testing-london/125/

If you do take PEP then testing will be delayed.

I would in any event recommend you go see a local doctor in Thailand and discuss urgently. The clinics there are good and the doctors very used to your situation.

Best wishes, Sean
Avatar universal
Thanks for your reply Sean.  

I post this reply for a bit of follow-up information for others who may be in my situation, as I hate reading a related thread only to find that the asker goes AWOL taking with them the information you want...

Any way, I did go and see a doctor here in Bangkok at Bumrungrad Hospital, but since it has now been over 72 hours since the initial exposure she said it was unlikely PEP would be now effective if the virus was present, and may have some nasty side effects.  Therefore, I decided not to take it.  

According to the doctor I saw at Bumrungrad, about 99% of HIV tests of people in my situation come out clear.  So that is some form of relief, but she was unwilling to give a statistic on what the risks of contracting HIV in Bangkok are.  From what I understood, a potential HIV infection in my circumstance is unlikely but significant enough to follow up on.  

I kind of wish I chased it up earlier to get on PEP for peace of mind, but she at least prescribed me Zithromax for my sore throat and other symptoms, which should also be effective against NGU, gonorrhea and chlamydia if they are present.  The symptoms I have, like what was mentioned in the answer above, are too early to be from HIV.  

She advised getting a HIV test around the 3-week mark, then follow up at 3 months.  Hope this helps others out there!
936016 tn?1332765604
MEDICAL PROFESSIONAL
Hi Nick,

Thanks for that - I agree - we never dicsover what actually happens to lots of people but get inundated with rather irrelevant data from others!

I think her advice is fine. I would encourage people in your position always to take local advice. The Thai doctors are very competent and very determined where possible to reduce infection and they are well educated and trained - so definitely a good idea to take local advice.

I would agree with her regarding testing - I would vary the advice somewhat and say that you might want to take an HIV DUO = 4th generation test at 28 days or an HIV RNA PCR and HIV DUO at 21 or so days. Note that the HIV PCR should be RNA and not DNA. Many private labs around the world provide an RNA PCR test - but remember RNA not DNA.

Best wishes, Sean
Avatar universal
I appreciate your support Sean.  Here's another update...

I saw a specialist in my home town and he had me take battery of STD tests including an HIV test of some sort (I think Q-RNA or something) at day 9.  The test results all show negative.  He says he wants me to do a test again at 4 weeks and then at 3 months.

I am still concerned though, that sore throat I talked about before still persists, and seems most painful when I swallow.  The fever is long gone though.  It is also associated with bloody yellow mucus in my nose that seems worst in the morning, and the throat is sorest on the side I slept on the night before.  I've seen 2 doctors about it, and have been on a 5-day course of antibiotics and even thrush treatment (pure speculation, as I take asthma medication known to cause it), and nothing seems to help.

Do you think I should I be worried about this being related to HIV?

Kind Regards,

Nick
936016 tn?1332765604
MEDICAL PROFESSIONAL
Hi Nick

Overall I think things are looking good for you. The negative PCR - even though we are unsure as to the exact description is reassuring.

I would go with the other advice - obviously your local doctor is familiar with the tests he has available to him - and he will guide you accordingly.

My feeling though is that all will be well. I do not belive what appears to be a simply upper respiratory tract infection/sinusitis is related to HIV infection.

best regards, Sean
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