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Concerned from possible exposer with CSW
Aug 15, 2011

Hello Dr. Bob, I am a male who had insertive vaginal safe sex with sex worker (CSW) in Cape Town South Africa that I found out might of been HIV positive as per saying from another sex worker that told me several days after my encounter. I used a condom at all times, also I did not ejaculate during vaginal intercourse. The CSW and I French kiss a little and no oral sex took place. Once we were finished I properly removed condom and condom was still well intact. My main concern is that the base of my penis was wet due to the sex workers vaginal fluids which I assume. If the sex worker was HIV positive what are my chances of being exposed to HIV into my body if I had a condom on and my head of my penis was protected at all times by the condom, also, what are the chances of HIV transmission from a HIV positive female to a negative male during French kissing (open mouth). I have been stressed with anxiety and have lost all social inters as I been having what I think is ARS symptoms. On the 10th day post exposer my upper right thigh had leg pain/soreness just where my thigh meets my pelvis and pain works a little towards the buttock, also the rest of my right leg fells heavy. That lasted (5) days then went away. From the 10th day and till now I have very stressed out and fatigue, also different symptoms. (see below) On day 20nd my friends seen that I was looking down and stressed so they took me to a Disco in town and I started feeling better/healthy and even was able dance and drink till 5:00 a.m. in the morning. Next day I was worn down, etc as I woke up at 8:00 a.m. I am currently at day 27th of possible post exposer and I been having below symptoms since most of the last (2 weeks).

-Muscle aches and soreness, back of neck is tense and sides of neck and shoulder and upper arms. Plus legs get sored and weak at times. Muscle aches and soreness switch around in all parts of the body at different days and do not all happen at once. -Mild sore throat ( -Very mild night sweats for the past (3) days. Just the upper chest, back of neck and head and T-shirt is slightly damp in areas. -Chills -Dizziness and weakness (loss of strength) -Very fatigue when and I am active, but not when I am sitting at the desk. -Insomnia, average about 5 to 6 hours of sleep for the last (14) days and wake up several times in the night and first thing I do is check for night sweats wetness, fever and swollen nodes. -Redness of sclera in eyes (Blood Shot Eyes) in the morning and throughout the day. -On day 23rd I developed a canker sore on my lower gum, then on 25th day I developed a second canker sore.

I currently and never had in the past 27 days no symptoms of fever, no swollen lymph nodes, and no rash, but a few (6 ea.) small flat red bumps (little pimps) on one side of my back for the past 3 to 4 days.

I have been much stressed and anxiety level has been maxed out due to the possible exposer, also the current job project that I am currently working on in a third world country has caused some stress. I have also started taking anti-malaria medication Malarone about 14 days ago due to the area I am currently working.

Are above symptoms related to ARS or they are part of being stressed out with anxiety (worry well) and/or due to on Malarone side effects?

Again, thank you for your time and all your expertise input on the matter. You have an excellent web site for all who have concerns about HIV/AIDS. I will make a donation to the foundation.

Response from Dr. Frascino

Hello.

Your HIV-acquisition risk is negligible. French kissing is not considered a significant risk for HIV transmission/acquisition without extenuating circumstances (such as both individuals having active bleeding in the mouth). Protected sex is "protected", assuming the latex condoms are used properly and don't break. HIV cannot permeate intact latex. It also can not permeate intact skin. Your symptoms are not worrisome for HIV acute retroviral syndrome. They are much more consistent with anxiety. A single HIV-antibody test at the three-month mark is all that's recommended. The statistical odds are astronomically in your favor that you did not acquire HIV from your Cape Town hooker hook-up. You might benefit from anti-anxiety medication during the three-month window period. You should follow up with your general medicine doctor to evaluate any persistent medical problems you may be experiencing. (It's extremely unlikely these are HIV related, but you could have a non-HIV illness.) You could also discuss anti-anxiety medication and/or a referral for counseling with your general medicine doctor at that time.

Thanks for your support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). In return I'm sending you my good-luck karma that you are now and will forever be HIV free.

Good luck. Be well.

Dr. Bob



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