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Did I dodge a bullet? A potentiall dodgy sexual encounter in Africa
Aug 1, 2010

Dr. Frascino,

I have particularly enjoyed visiting your forum. I wish it was under different circumstances, but I have greatly appreciated your care, intention, and humor in dealing with sensitive questions from your readers.

I am working in Africa this summer and had a potentially risky sexual encounter. I received unprotected fellatio from an African women that was of unknown status. I later found out that she is a sex-worker, when upon leaving, asked me for money.

I have read much of the information on this site and others and realize my risk is low - being that it was only receptive oral, but like many others that have posted questions, i am greatly concerned by symptoms that are correlated with this sexual encounter.

8 days after i began to feel a slight irritation in my urethra. It got more irritating as the days passed, though was unconcerned about HIV, because i didn't think this was a symptom and was "sure" that HIV isn't transmitted orally. Upon researching the subject I found out about the small chance of transmission via oral sex and became worried that HIV was my problem.

Since the event I have felt pain in my groin and abdomen, had a night of vomiting (perhaps anxiety) and weeks fo diarrhea (perhaps something I ate in Africa). 13 days after the event I visited a doctor.

I was given Urine Analysis, malaria smear Hb, WBC, Widal Test (typhoid), VDRL. all cam back normal. Even though i tested normal I was proscribed Doxycycline (100mg, 1 every 12 hrs) Ciproflozxacin (500mg, 1 every 12 hrs) and Paracetamol (500 mg, 2 every 12 hrs) for the symptoms; particularly the urethritis.

The next day (me being the worry that I am) I convinced the girl to go with me to the hospital to be tested for HIV and other STI/STDs. We both came up negative for HIV and Syphillis, though both had levels of 5-8 white blood cells in our urine analysis. The doctor noted this was a bit high and could be caused by a fungus or bacteria - a potential cause of the irritation in my urethra.

I was at this time feeling irritation in my groin, and thought it was possible swelling in my lymph nodes. The doctor assured me this was not the case (note: two weeks out from the event).

The next two weeks I developed other worrisome symptoms, including what feels like muscle soreness in the front of my neck and in the back of my neck. I am not a doctor so can not say if there are swollen nodes are not. It feels more like "stringy" muscle tension than marbles or oval shaped nodes. I was also feeling fatigue and general muscle soreness. I was experiencing brief period of pain in my chest and arm pits, though no noticeable swelling - except when I could have sworn i found a node under my right armpit.

Around this time, after finishing the prescriptions i developed thrush in my mouth - a white film that is coating my tongue and making my teeth feel slimy and dry. I realize this might be a side effect of the antibiotics, though still gave me a bit of a panic, as symptoms of HIV keep appearing.

It is also around this time I became convinced that the pain in my neck and groin most definitely is caused by swollen lymph nodes. Although the pain does come and go - some days I have more irritation in the groin and neck than others.

Lastly it is important to note that throughout I have had no fever. In fact, have probably averaged 98.0. I usally have a relatively low temperature.

So, my questions are:

1. Is my concern of possibly having HIV unfounded?

2. Is it possible the test from the hospital are unreliable? (I am in one of the most undeveloped countries in Africa, with little medical infrastructure and potentially competence)

3. Could she have tested negative and still transmit HIV if she was exposed with in the 3 months prior to being tested?

4. I will be back home and have scheduled an appointment to get checked out the day after I get back (9 days from now). I don't want to spend this time the way i have the last two weeks - depressed and constantly reading about symptoms. Would there be any benefit to getting tested again here before i go home? Or should ask the girl if she would mind getting tested again? Would there be any benefit? or, should I just wait to get home?

Again, thank you for all you do. Your personal story and commitment to the effort to combat this disease is inspirational. I hope to one day find the same inspiration and lead the same committed life that you are a shinning example of.

All the best,

Johnathan D. Oe

Response from Dr. Frascino

Hello Johnathan,

1. Yes, absolutely.

2. No, HIV-antibody tests are essentially foolproof!

3. Yes, but the odds of this are extremely remote (statistically speaking).

4. No. The result will undoubtedly be negative for both you and your partner. I would recommend waiting until the three-month mark for a definitive test. I'm very confident the result will be negative.

Dr. Bob



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