HIV transmission risk, symptoms, testing, for Dr HHH

[scaredwoman1409]

This question is about HIV for Dr. HHH.

My potential exposure was 11 days ago.  My husband and I experimented w/ a threesome with another woman.  We learned after sex this woman regularly attends sex clubs, and has had many, many unknown partners.

During sex w/condom, she started her period. She inserted a tampon.  Maybe 30 min later, I gave her oral briefly (few minutes), just clitoral.  I don't know if there was any dried blood on her.  I also performed annilingus, and she had something very strange looking around her anus--maybe a raised ring of skin?  I later realized that might have been an external hemmoroid.  I do not think it was bleeding but it was dark so not sure.

The next day I developed a dry cough, then by day 2 or 3, a moderate sore throat.  Then a headache by the following day that has persisted.  I also have had unusual night sweats, occasional very brief chills, loose stools, and a tremor feeling in my legs and maybe torso.  No fever.  No rash. I realize ARS symptoms usually do not develop that soon.

So my questions:

--what is the likelihood of contracting HIV from licking dried blood?

--what is the likelihood of contracting HIV from licking an open wound or cut (assuming without knowing hemmoroid might have been open/bleeding)?

--is it *possible* that I could have developed ARS after 1-3 days?

--Back in 2005, you said:

"Few have positive tests before 10 days; at 11-14 days it's about 40%, but by 17 days it's almost 100%.  In other words, slow trend through 2 weeks, then almost everybody gets a positive test over the next 3 days."

Then just yesterday, you said:

"If you want early reassurance, I would recommend 2 duo tests, the first at about 10 days (instead of RNA) and a second at 4 weeks."

So do you recommend testing 10 or 17 days?  And is this from date of onset of symptoms or from date of potential exposure?  And what percent would show positive by this time?

[Edward W Hook, MD]

Our space to answer questions is limited.  This will be my final response.  A small amount of genital herpes occurs on parts of the genitalia that are nor covered/protected by condoms however the vast majority of HSV occurs in areas which are covered by condoms. Conservative estimates are that proper use of condoms reduces risk for HSV by over 60%.

A final comment.  I hope that you appreciate the inherent disconnect between consideration of a swinging lifestyle and your concerns about HSV and other STIs.  

This will complete this thread.  EWH

[scaredwoman1409]

I'm so sorry but this even includes HSV 1 & 2?  Is this just another Internet myth (that you can get HSV 1 & 2 even with protection)??!

[Edward W Hook, MD]

Intact condoms, used throughout intercourse of all forms reduce the risk for infection to essentially zero.  EWH

[scaredwoman1409]

Thank you.  Do you mean condoms reduce risk to essentially zero for oral and vaginal sex?  Or just oral sex?  Sorry just not clear on your answer.

Thanks so much.

[Edward W Hook, MD]

If your symptoms had beed due to HIV, your test would hav been positive.  Believe your test results.

Oral sex is relatively low risk for all STIs.  Low risk is not no risk.  Wearing condoms will make potential exposures essentaily zero.

I hope this helps.  EWH

[scaredwoman1409]

Thank you Dr. Hook.  I was tested yesterday and confirmed negative results--thank GOD.  I will test again to confirm but this relieves my concern that these symptoms were caused by HIV.

Please tell me if this is going beyond what is permitted in these questions, and I will pay again to ask again, but my husband and I are considering "swinging" as a lifestyle.  We have read a good bit about HPV and HSV-1 & HSV-2 transmission.  So we know these are possible, that there are vaccines, etc.  But I'm wondering--if we only perform oral sex with or without penetration, are we statistically likely to acquire one of these diseases?  And what about penetration while wearing a condom?

I'm basically just trying to assess whether the risk with protection and/or only oral is minimal, or whether statistically speaking this type of lifestyle poses a relatively high risk, even with protection, of acquiring an illness that you can't treat and/or is serious.  I already understand where HIV lands on this spectrum...

Thank you!!

[Edward W Hook, MD]

There are no data that sex (of any sort) during menses is associated with increased risk- that is an internet fueled myth.

If your symptoms were due to HIV, a standard test for HIV antibodies would be positive 5-7 days after then began.  If you test now that will prove (to you) that these are no HIV symptoms- I am already confident that they are not.  

Oral gonorrhea is tyically asymptomatic. the only way to diagnosis it is with a swab test taken from the throat.  

I doubt that this an STD of any sort but rather a rather severe, coincidental summer viral sore throat of the sort that peole get from time to time through their activities of daily living.  EWH

[scaredwoman1409]

Thank you.  As I said in a follow up comment, I apologize for asking for Dr. HHH.  I did not realize that there were only two docs answering here.  I thought he knew about HIV and wasn't sure other docs would.  But obviously you do -- so I am grateful for your advice, too.  Your credentials are impressive so I truly apologize and did not mean any offense.

This is very good news.  I read that performing oral during menses increased risk.  But I am going to trust--do you still think I need testing?  Would testing today (11 days after exposure; 10 days after symptoms started)--be definitive that these symptoms not HIV?

Can you think of any other STD this might be?  Oral gonnorhea (sp?)

This just doesn't feel like a cold bc of the night sweats, unusual headache (I don't normally get headaches even with colds), and the tremors are completely freaking me out.

Thanks so very much.
  

[Edward W Hook, MD]

Welcome to the Forum.   As you probably know, Dr. Handsfield and I share the forum according to our availability.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.

That your female partner has had many other partners does somewhat increase her likelihood of having HIV, after all numbers of partners do impact risk, however the odds are still very high that she does not have HIV.  Further, there is no meaningful risk from your oral sex.  Even the most conservative estimates, which refer to performing fellatio on an HIV infected man, place the risk for acquisition of infection at less than 1 in 10,000.  The risk for cunnilingus or analingus is lower still.   Like the doctor who saw you in the emergency room, I would not recommend PEP for you.  

I have not read the exchange from yesterday that you mention.  My guess is that Dr. Handsfield was trying to help someone through a bout of anxiety.  At two weeks, even standard antibody tests are positive in about 50% of persons who have recently acquired HIV.  With a combination test, the rate is almost certainly to be higher still although just how much higher is unknown.  At 4 weeks the results of combination tests which test for the virus (either with a p24 antigen test or a PCR) and antibody to HIV at the same time do provide definitive results.

In answer to your specific questions:
--what is the likelihood of contracting HIV from licking dried blood?
Very low- less than 1 in 10,000 I would estimate (there are no studies).

--what is the likelihood of contracting HIV from licking an open wound or cut (assuming without knowing hemmoroid might have been open/bleeding)?
Same as above.

--is it *possible* that I could have developed ARS after 1-3 days?
No.  The ARS results from production of antibodies early in infection which then react with the virus to cause symptoms.  Antibodies are not produced that quickly.

Please do not worry. this was a low risk exposure.  I suspect your symptoms are an everyday summer cold or other non-STD viral infection.  EWH

[scaredwoman1409]

Sorry just one more comment: I have had some nasal crustiness and sneezed maybe once or twice a day.  My understanding, which could be wrong, is that these are not ARS symptoms.  They are also very slight so might be unrelated.  They give me hope that this is NOT ARS but not sure they should.  Hubby has kissed me numerous times since then--and he has not developed a cold.  I do NOT think this is just anxiety or in my mind.  All anxiety coming from fear of HIV and dry cough, sore throat came before fear of HIV.  Night sweats, headache, chills and tremor came after I read about symptoms.

I have already been to ER seeking PEP (where I was told risk was low but to get tested).  I am completely terrified.  I would greatly appreciate answers to my questions.

[scaredwoman1409]

Also we shared no sex toys and hubby did not go into her, then into me, either orally or vaginally.  The only concerns are those I expressed regarding my performing oral on her.  Sorry to be so graphic but I'm terrified.  I also don't think I'm anxious about what happened, other than this terror about HIV.  I wasn't concerned until symptoms started--not the other way around.  Thanks.

[scaredwoman1409]

Also sorry to direct my question to one of two doctors.  I didn't realize there were only two.  I just asked for Dr. HHH bc he had quote re: time frames for testing.

Also I didn't realize that there was an STD and an HIV forum when I posted question.  I hope that HIV questions can be answered here.  Or please let me know if I need to pay again in the HIV forum.  Thank you both.