Penis Cut by CSW

[marcus524]

Dear Doctors,

Thank you for your assistance in advance - I appreciate your good work on this forum as it continues to provide a good referral source of information for sexually active people.

My background:
Asian male, uncircumcised, 30 years of age, otherwise good health, regular smoker.

My Exposure:
Two weeks ago I attended a massage parlour in Australia (workers there are not regulated and do not require mandatory HIV testing).

The CSW was roughly 20 to 25 years of age and of  Thai / Vietnamese ethnic origin. I am unsure whether she engages in actual sex with clients but would guess this to be the case.

She performed unprotected oral sex on me (me being penile insertive partner) for roughly five minutes followed by masturbation and anal fingering.

I felt mild physical discomfort (say 5/10 with 10 being most acute pain) at the time but so no indication of obvious bleeding. When i returned home for a shower I felt acute pain when pulling back my foreskin to wash with soap. Later that night I urinated and felt an acute, stinging pain that would be indicative of a cut caused I think the CSW caused from oral sex as I felt no discomfort beforehand.

My Questions:

1. Is the event sufficiently risky to catch HIV and do I warrant testing?
I have researched other threads and would not have worried about oral exposure, but the cut on my penis leads me to worry.

2. I attended a hospital within 24 hours and was refused NPEP - would you have done the same?

3. Exactly two weeks post exposure I woke up with night sweat indicative of fever breaking. However both before and after going to sleep for FOUR HOURS ONLY i took my own temperature and recorded no fever (oral temp range 35.9 to 37). Is this indicative of a fever one would experience during "ARS"? I also have a mild sore throat.

Thank you again for your assistance.

  

[marcus524]

Hi doctor

To give you an update I did a HIV duo test (abbot ab/ag combo) after 30 days and received negative results

Let me say that I did trust your advice and didn't lose a night if sleep in the last few weeks. I only got tested for peace of mind, not because I doubted your advice

Just a question though - how accurate is the test I received 30 days post exposure?

Lastly - you and Dr H really do an amazing job.

I'm a commercial risk analyst - people ask me whether big dollar business decisions are good ideas. In my field's jargon you and doctor H are courageously giving "hell assessments", meaning you're asked to give quantitative advice (% and x/10000) from purely qualitative data ("I did this with a csw, friend, etc) that differs case by case

We usually avoid such difficult jobs  for fear of liability even when we have fair ideas to make a judgement call. That you are willing to put your reputation on the line pro bono is really kind to say the least

Please accept my appreciations and keep up the good work

Kind regards

Marcus

[Edward W Hook, MD]

Thanks.  We appreciate your comments and are pleased to be able to help.  :)  EWH

[marcus524]

Thank you for your advice doctor.

To let both you and Doctor H know, I and others have been using this resource for reassurance and there's generally nowhere better to get advice and peace of mind.

That we can access individuals such as yourself and Doctor H really does show how amazingly the internet connects people. I would have to travel far and wide and go from referral to referral before being able to put into contact with a subject matter expert.

Kind Regards
Marcus

[Edward W Hook, MD]

Welcome to our Forum.  I'll try to help.  This was a virtually no risk exposure.  Most commercial sex workers do not have HIV (even unregulated ones) and the quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.   As for receipt of masturbation including anal fingering, there is no risk for HIV from these activities either, even if your partner's genital secretions were transferred on her hands.


As for your specific questions:

1. Is the event sufficiently risky to catch HIV and do I warrant testing?
I have researched other threads and would not have worried about oral exposure, but the cut on my penis leads me to worry.
No, I would not worry and see no need for testing.  Further, since you apparently did not see one, I doubt that there was cut.  A friction rub is more likely.  Either way however, this does not change my assessment or advice.  

2. I attended a hospital within 24 hours and was refused NPEP - would you have done the same?
I definitely would not have recommended PEP for you.  

3. Exactly two weeks post exposure I woke up with night sweat indicative of fever breaking. However both before and after going to sleep for FOUR HOURS ONLY i took my own temperature and recorded no fever (oral temp range 35.9 to 37). Is this indicative of a fever one would experience during "ARS"? I also have a mild sore throat.
Your temperature was not sufficiently high enough to be considered compatible with the ARS. Such temperatures are typically more than 38 degrees.  When such illness have been thoroughly studied substantially less than 1% of "typical" ARS symptoms turn out to be due to HIV, the remainder typically being due to the sorts of community acquired, non-STD viral illnesses that most people get from time to time.  

I hope these comments are helpful.  EWH