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HIV Risk in Thailand
Last month I took a vacation to Thailand, and I ended up receiving unprotected oral sex from four different sex workers and I had semi-unprotected vaginal sex twice with the same sex worker. All were female. I say semi-unprotected because the condom broke at some point during intercourse and I didn't notice both times, but for practical purposes I'll just say it was unprotected sex. How long I was having unprotected sex for, I'm not sure. In any case, this probably should have worried me more than it did, but I read the female to male HIV transmission risk is low so I enjoyed my vacation and didn't stress too much.
However, about a week after those incidents (they were about a day apart) I noticed pain in my testicles and penis, and I also had a discharge. I was diagnosed with and treated for gonorrhea at the local clinic. I was tested for both gonorrhea and chlamydia but only tested positive for gonorrhea. No more symptoms, although the rest of the week I was feeling a bit under the weather and overall generally sick. Sore throat, perhaps a light fever (I never checked my temperature), but not much else. This was about 1-2 weeks after possible exposure. The doctor advised me to stay away from sex workers for the duration of my trip and I complied.
I know that HIV is more prevalent in Thailand than in the States, which has started to worry me. I will get tested but I'm giving it some time so I can be assured that the test is accurate and not have to worry further (hopefully). So, this brings me to my question. How much, if by much at all, does gonorrhea increase HIV infection assuming one or more partners are infected with gonorrhea? Of course, I could have received the gonorrhea through the unprotected oral sex which was the local clinic doctor's opinion for some reason, I don't know why he concluded that. I know that gonorrhea can increase the risk of HIV infection, but by what margin? Am I significantly at higher risk for HIV infection?
However, about a week after those incidents (they were about a day apart) I noticed pain in my testicles and penis, and I also had a discharge. I was diagnosed with and treated for gonorrhea at the local clinic. I was tested for both gonorrhea and chlamydia but only tested positive for gonorrhea. No more symptoms, although the rest of the week I was feeling a bit under the weather and overall generally sick. Sore throat, perhaps a light fever (I never checked my temperature), but not much else. This was about 1-2 weeks after possible exposure. The doctor advised me to stay away from sex workers for the duration of my trip and I complied.
I know that HIV is more prevalent in Thailand than in the States, which has started to worry me. I will get tested but I'm giving it some time so I can be assured that the test is accurate and not have to worry further (hopefully). So, this brings me to my question. How much, if by much at all, does gonorrhea increase HIV infection assuming one or more partners are infected with gonorrhea? Of course, I could have received the gonorrhea through the unprotected oral sex which was the local clinic doctor's opinion for some reason, I don't know why he concluded that. I know that gonorrhea can increase the risk of HIV infection, but by what margin? Am I significantly at higher risk for HIV infection?
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.
Sorry you were unlucky and got gonorrhea from the broken condom exposure. However, you remain at very low risk for HIV. First, it is statistically unlikely your partner had HIV; it is true that HIV is more prevalent in sex workers in Thailand than in most parts of the US, but still probalby under 1% (certainly under 5%) of sex workers there have HIV. Second, gonorrhea does raise the risk, but probably only by double or thereabouts. "Double" may sound like a lot -- but the average HIV transmission risk by vaginal sex is around once for every 1,000 exposures. Doubling the risk makes it 1 in 500 -- i.e. the odds are very strongly in your favor.
I agree it is possible you acquired the gonorrhea by oral sex. If so, your risk of HIV is even lower, since the virus is rarely if ever transmitted by oral to genital exposure. However, you can't be certain about which exposure resulted in transmission.
You definitely should be HIV tested in a few weeks. However, it is very unlikely you were infected and you can expect your test to be negative.
I hope this has been helpful. Best wishes-- HHH, MD
Sorry you were unlucky and got gonorrhea from the broken condom exposure. However, you remain at very low risk for HIV. First, it is statistically unlikely your partner had HIV; it is true that HIV is more prevalent in sex workers in Thailand than in most parts of the US, but still probalby under 1% (certainly under 5%) of sex workers there have HIV. Second, gonorrhea does raise the risk, but probably only by double or thereabouts. "Double" may sound like a lot -- but the average HIV transmission risk by vaginal sex is around once for every 1,000 exposures. Doubling the risk makes it 1 in 500 -- i.e. the odds are very strongly in your favor.
I agree it is possible you acquired the gonorrhea by oral sex. If so, your risk of HIV is even lower, since the virus is rarely if ever transmitted by oral to genital exposure. However, you can't be certain about which exposure resulted in transmission.
You definitely should be HIV tested in a few weeks. However, it is very unlikely you were infected and you can expect your test to be negative.
I hope this has been helpful. Best wishes-- HHH, MD
Thanks for your help doc.
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