Worried and anxious

[miles8]

Dr. H:

Recently had sex with a csw, hiv status unknown (she only said "i am very clean about what I do").  She put the
Condom on me and we had protected oral and vaginal.  No condom break.  I took
The condom off when we were done and flushed it down the toilet.  I do not think any area on the condom touched my uretha as I was pulling it off.  The condom
That she used did not have a tip.  As I had never seen one of these before I was
Concerned that it may have been a lamb skin or something.  I have since come to
Learn that they make latex condoms without a tip as well, correct?  Anyway, about
30 min to an hour later after I had rejoined my friends,  I know that I rubbed my gums
Several times with one of the fingers that I had used to remove the condom.  My fingers
Were dry but I don't remember if I washed them or not.  If I rubbed my gums
Several times (say I were to rub sugar or some other substance on my gums) would
This be a potential exposure?  When I returned home I was so worried I had
My doctor start me on PEP 80 hours after the exposure.  I also had an RNA PCR
test (blood drawn a a out 80 hours after the event) which was negative (undetectable,
<20 copies/ml).   How concerned should I be?  Does my negative RNA test
Have any real diagnostic value at 80 hours post exposure?.  I also took a round of
Prophylactic antibiotics just to safe from other STDs.  Thank God, I have
Had no symptoms.  Still very worried.   Will never put
Myself or my marriage in this position again.  

[miles8]

Thanks doc.  I appreciate the advice

[Edward W Hook, MD]

this will be my last response. You are getting into the realm of "what if" questions which do you no good.  Protected sex is protected sex, I don't care who your partner is.  you did not need to worry or to test.  EWH

[miles8]

One last question, from a demographic standpoint,
If she were a black csw from miami, would that change
Your recommendations?  Met her at an upscale hotel
Did not carry herself as one who did IV drugs (but I guess
Who does).   Her rate for those she charges is around $350.
Thanks!

[miles8]

Thanks so much Dr. H.

[Edward W Hook, MD]

As I already said, you have no reason for testing. if you feel you must be tested, RNA PCR is not a recommended test for HIV.  The combination of an RNA test PLUS a standard antibody test or a combination HIV p24 antigen/HIV antibody test are the tests for HIV that give reliable results most quickly and they do so at 4 weeks.  EWH

[miles8]

Thanks again Dr. H.  When is an appropriate window to get an RNA-PCR test?  If I were to get a standard antibody test for my peace of mind, is four weeks an appropriate time frame?  

[miles8]

Thanks again Dr. H.  When is an appropriate window

[Edward W Hook, MD]

There is a spectrum of types of CSWs and with that variation there is a variation in risk.  The risk (in any city) is higher if your partner is a "street walker" who is having sex to fund a drug habit than if a high priced escort.  By and large however, the more discrete, higher priced CSWs are interested in maintaining their clientele and, to that end, STIs are bad for business.  As a result, they are checked regularly and use condoms to protect themselves.  There is likely some geographic vraiation from city to city but the amount is, in general, likely to be small.  EWH

[miles8]

Thanks for the response.  I realize I have overreacted,
But such is the nature of guilt and shame.  I guess
I shouldn't  con guilt with objective risk.  I do
Have one more question.  You said that CSWs
Have low incidence of hiv/stds.  Does that hold true
Across rhe board of is ones risk significantly greater
In New York, LA OR Miami vs.  Oklahoma City?  Thanks
Again

[Edward W Hook, MD]

Welcome to the Forum.  My sense is that you have over reacted.  As you point out, you do not know the status of your partner and the fact is the most commercial sex workers do not have HIV or other STIs.  Further, you used a condom, which was almost certainly a latex or polyurethane condom, a practice which transforms "low risk" exposures for all practical purposes to no risk events.  

STIs, including HIV are no transmitted through transfer of infected material on a person's hands to other parts of the body. the organisms do not survive.  Further, even if you placed your partner
s genital secretions directly into your mouth immediately during sex (you did not) the risk for infection, even if she were infected would be close to zero.  

There is no known value to having tested for HIV, even with an RNA PCR so soon after exposure.  Based on the exposures you describe there is no reason for future testing either.  

Had you been my patient, I would have urged you not to have tested, and certainly not to start PEP or preventative antibiotics.   There was no risk to start with.,  All I can say at this point, beyond that you have wasted your money, is that I hope you will not have side effects from the medications you are taking.  EWH