Sexual encounter with female escort... very troubling and wondering about the risk of HIV

[mhuser911]

Hello.
Last night I spent an hour with a female sex worker.  The experience began with a 5 minute handjob.  Then, when I asked if she allowed kissing, she said no because she just "got pneumonia."  She reported that "she got it from someone else, and now had it so she didn't want to give it to me."

Then the experience continued protected oral sex over a condom.  After 10 minutes of that, the escort took the condom off and performed unprotected oral sex on me for 20 mins.

ThenI spent the next 10 minutes vigorously fingering her vagina with fingers on my right hand (my fingers were dry and slightly cracked, also had been using topcial steriod cream on them while masturbating vigorously with my left hand.  My penis had some abrasions and visible (cracks were visible revealing deeper layers of skin/tissue)… there was no visible blood (though there were some scabs, and it was a little sore in spots)... I wasn’t sure if this made normally-“non-risky” activites (such as unprotected oral sex and fingering) higher risk because of vulnerability of the body to penetration by live virus.

I felt very "dirty" on the way home, and applied benzalkonium-cl wipes/liquid a couple times at home before shower.

Here are my questions:

1.  Based on escort’s self-report of pneumonia and coughing, does that mean someone of her profile likely is HIV-positive?

2.  Escort said—when asked—she is HIV-negative and gets tested every month, and engages in “safe practices.”  

3.  Due to abrasions and significant cracking on the skin on my penis, is my risk higher?

5.  The friction with her saliva on my abraded penis (and her vagina on my dry/cracked fingers) was VERY intense… does that increase risk virus is forced into body?
6.  What is the real risk with my described situation?

7.  Should I just go sign up for Post-exposure-Prophylaxis" therapy in the next two days at a clinic to get the PEP treatment and be safe?

8.  any other STDs I should be tested for?

[Edward W Hook, MD]

Please realize that governmental agencies such as the CDC which have to provide recommendations for virtually everyone without the sort of interactions such as those you get with your doctor or on personalized sites such as this one, feel the cannot "afford" to be wrong and therefore make recommendations and guidelines which leave most people unnecessarily nervous.  As I said, there are NO convincng cases of HIV being spread through oral sex.  

You can believe whomever you wish and test as much and for as long as you wish.  I see no need for testing and I am confident that no matter how long you test for, you will find that you did not get HIV from the exposure you describe. Take care EWH

[Edward W Hook, MD]

Welcome to our Forum.  I have not yet read your questions but, before I do, let me tell you that there is not risk of HIV form the encounter you describe.  Your activities include masturbation of each other and receipt of oral sex.  Neither is associated with acquisition of HIV.  That you have sores, scrapes or cuts on your hand do not change this.  With this as background, let's now work through your questions:

1.  While persons who have HIV are more likely to have get pneumonia than persons who do not have HIV but most people who get pneumonia do not have HIV.

2.  Most people tell the truth.

3.  See above, the abrasions on your hands and penis do not change your risk.  When people have genital ulcers due to STDs the risk of HIV through vaginal sex is increased.  The same is not true when the abrasions or sores are due to other causes.

5.  No, no increase in risk.

6.  See above, zero.

7.  No, absolutely not. It is unlikely your partner had HIV and even if she did, your exposure was no risk.  Your risk of side effects from PEP is far, far higher than your risk of HIV.  

8. Your risk is primarily due to receipt of unprotected oral sex.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.   If you had gotten gonorrhea or NGU you will most likely develop symptoms of urethritis (penile infection). within a few days of exposure. The risk of any STD however is, as I said, low.

I hope these comments are helpful to you. Take care. EWH  

[Edward W Hook, MD]

1.  No
2.  Yes, the rapid oral tests are just as good as the lab-based tests.  The reasons they are not more widely used is that they are not efficient and cost more than the lab-based tests.
3.  Yes I do.  That is not to say that precautions are not needed but I believe that the stigma associated with HIV and other STDs is a huge barrier to efforts to control them. It hinders and delays health seeking.

Take care. EWH

[mhuser911]

I have three last quesitons, and then you can close this thread if you wish (brief answers are fine).  (1) Does the presence of unusual symptoms at 14-16 days, and lasting days after that change your opinion on whether I should get testing?

(bad headache--unusual for me--rash (not sure if maculopapular), one day of fever and night sweat, some joint/muscle pain, and possible neck and groin lymph node enlargment)... overall though I'm not sure if I considered any of this "flu-like," with the exception of the headache at day 14-16.

(2)  If I do get testing at six weeks is the quick oral test sufficient?  (it would be less expensive and more convenient than the dual p24 and ELISA blood test)

The last question is (3): do you think that, because of the stigma and severity of HIV, the public has a misconception about how easy (or hard) it is to actually get HIV?

[mhuser911]

Ok, I appreciate your comments; they were very helpful.  In the last week (2-3) weeks post exposure, I have had a headache, more-than-normal muscle/joint aches, and just today noticed mild malaise and possible swollen tissue in my neck.  I also have a light rash around my navel (seems to be there all the time lately), and other itchy rashes which come and go.

So I think I'm going to get a test at six weeks.... simply because I NEVER get headaches (and all of a sudden at day 14-16 I got bad headaches)... I suppose the rashes, neck thing, and aches I've had before and could be other things, but the headache thing is weird.

I shall report back if I did indeed get HIV from this exposure.

[mhuser911]

(just added this post b/c I left out "To" in above post, in case it would get directed to you that way)

[mhuser911]

The CDC website (and other anecdotal evidence referenced other places) says that there IS a risk of HIV from oral sex... it said a small number of new cases were related to oral sex.  Also, often times it is said that "cuts" "scrapes" etc increase the risk in otherwise non-risky activities.

So if you could just comment on the above, that would be helpful... I suppose I'm a little concerned about the cuts/abrasions (which did not show visible blood--they were not "fresh," but which still fit classification of "open wound."

I suppose my concern is heightened due to the person's comments about "getting pneumonia."  Perhaps that isn't true (given context of saying that) or even if it is true it is a consequence of the persons smoking habit and not advanced HIV.  But I realize that shouldn't be a consideration.  The CDC website is actually the biggest thing that alarmed me.

Still, with this in mind, do you think I should get tested at 3 months for MEDICAL reasons?  (I'll probably go anyway just to clear my mind, but one way or the other getting that test will be an inconvenience).