Hep B - possibly HIV

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To summarize, I had safe sex (in that I wore a condom every time) over 4 days with 3 sex workers on business trip in Singapore.  The condom(s) never came off and from what I could tell did slide up partially on the shaft (but never more than 1/3) during withdrawl.  I did use several condoms per session just to be sure that they did not wear out.  That being said, I have only been vaccinated once out of the three times for Hep B and since this occurred I'm a bit concerned.  Have been feeling a bit unwell 48 hrs past the last episode, but this may just be guilt on my part.  How adequate are condoms in protecting against Hep B.  One of the sex workders kissed me as well which also has me a worried.  The only thing worth mentioning was I had very bad diarrhea 2 days after my last episode.  Stomach was bad for approximately 48 hours.  That's about it.  Please give me your thoughts.  I plan on getting the second vacination when I get back to the U.S. tomorrow.  I think I am past the window to leverage the Immunin Globulin for Hep B, but let me know.  Am very anxious.  

[H. Hunter Handsfield, M.D.]

Re-read the first part of my original reply:  Since you could not have acquired HIV or HBV, they cannot be causing your symptoms--assuming you have had no other exposures you didn't mention.  Kissing is irrelevant, and so is fingering, and you are reacting emotionally, not objectively, and you can expect the tests to not show HIV or HBV.  Anyway, you're now under a doc's care.  Follow up with that; I can't help.

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In rethinking the whole episode there are a couple of things that have me nervous - one girl kissed me (deep kiss -- i.e. tongue involved), two (condom slipping on shaft of penis) and lastly, I did use my finger on one occasion several times for stimulation purposes (cannot clearly remember if I used saliva for obvious reasons).  Am very stressed.  Assuming the worst, would Hep B or HIV symptoms show up in three weeks?

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Just wanted to update you.  It's been approximately 3 or so weeks since I have returned.  Earlier this week (Tues) I got really sick -- very bad nausea/stomach/stomach pains (some sharp), headaches, head congestion, etc. Lasted through the week.  Am still under the weather.  The nausea has to be by far the worst.  Comes and goes, but when it comes, wow.  Really bad.  So I went to see my Dr. on Friday who checked me out + ran some tests (including Hep) which he should get back on Tuesday.  This HIV/Hep issue has me really distracted.  I am seeing a psych + taking sedatives to get me through this.  One of my worries is that the condoms that I used the last night were local, more snug, thus had the tendenancy to roll back up.  I kept on having to check to be certain that they were doing their job.  Am worried.  Just have to wait it out.

[H. Hunter Handsfield, M.D.]

Stopping after the first 2 sentences:  You could not have acquired HIV or HBV.  Condoms are 100% protective against both.

Now having looked at the rest of your message:  Your symptoms don't suggest either HIV or heptaitits, and in any case neither of those infections can cause symptoms less than a couple of weeks after exposure.  Hepatitis prevention isn't my specialty, but I believe you are beyond the immune globulin window, but you don't need it anyway based on your exposure history.  Just complete the vaccine series.

Good luck--  HHH, MD