Assessing HIV Risk After Intercourse with a Sex Worker: Key Considerations

Sexual intercourse with sex workers?

First of all, thank you, doctor, for answering my previous question.
Since the other party keeps insisting that they are not sick, I am unsure about the possibility of infection.
I have been operating under assumptions and doubts, but afterward, I went to the hospital to get a prescription for preventive medication.
I took the first dose of Cabotegravir 68 hours after the high-risk behavior.
Therefore, I would like to ask the doctor: assuming the other party has a possibility of infection, what is the likelihood of contracting HIV if I took the medication within 72 hours? Additionally, is it necessary for me to undergo a PT-PCR test within 7-10 days?

K, 20~29 year old female. Ask Date: 2017/06/06

Dr. Hong Yuanbin reply Internal Medicine

Hello, if you engage in unprotected sexual intercourse with an individual infected with HIV, the likelihood of contracting the virus depends on the severity of their condition, particularly their viral load and CD4 immune cell count.
If the individual is infected but has a low viral load, sufficient immunity, or is on antiretroviral therapy, the risk of transmission is low.
Conversely, if the viral load is high, the risk of infection is significantly increased.
However, if you are taking pre-exposure prophylaxis (PrEP), the chances of infection are greatly reduced.
If you are still very concerned, RT-PCR testing is indeed a viable option to consider.
Thank you for your question.

Reply Date: 2017/06/06

More Info

When assessing the risk of HIV infection after engaging in sexual activities with a sex worker, several key factors must be considered. These include the type of sexual activities performed, the use of protection, the timing of post-exposure prophylaxis (PEP), and the window period for HIV testing.

1. Types of Sexual Activities: Engaging in unprotected oral sex (fellatio) and unprotected vaginal intercourse significantly increases the risk of HIV transmission. While the risk of contracting HIV through oral sex is generally lower compared to vaginal or anal intercourse, it is not zero, especially if there are cuts or sores in the mouth or if the partner is HIV-positive. The risk is further heightened if ejaculation occurs during unprotected vaginal intercourse.

2. Use of Protection: Using condoms during vaginal intercourse greatly reduces the risk of HIV transmission. However, if the condom is not changed after oral sex and is used for vaginal intercourse, there is a potential risk of transferring any bodily fluids that may have been present on the condom from the oral sex. It is always advisable to change condoms between different types of sexual activity to minimize risk.

3. Post-Exposure Prophylaxis (PEP): You mentioned that you took PEP medication within 72 hours after the exposure. PEP is highly effective at preventing HIV infection when taken correctly and promptly after potential exposure. The standard recommendation is to start PEP as soon as possible, ideally within 72 hours, and to continue taking it for 28 days. The effectiveness of PEP decreases the longer you wait to start it after exposure.

4. Timing of Testing: After potential exposure to HIV, it is crucial to get tested. The HIV testing window period varies depending on the type of test used. For instance, the HIV Ag/Ab combo test can typically detect HIV infection within 18 to 45 days after exposure. However, if you are considering a PT-PCR test, it can detect HIV earlier, usually within 10 to 14 days post-exposure. Given your concerns and the timing of your exposure, it would be prudent to consult with a healthcare provider about the best testing strategy for you.

5. Psychological Impact: It is important to acknowledge the psychological stress that can accompany potential HIV exposure. Anxiety and fear of infection can lead to significant emotional distress. Seeking support from healthcare professionals, counselors, or support groups can be beneficial in managing these feelings.

In conclusion, while the risk of HIV transmission exists, especially with unprotected sexual activities, taking PEP within the recommended timeframe significantly reduces that risk. It is essential to follow up with appropriate testing and to maintain open communication with healthcare providers about your concerns and symptoms. Regular testing and practicing safe sex can help mitigate the risk of HIV and other sexually transmitted infections (STIs) in the future. Always prioritize your health and well-being by seeking medical advice and support when needed.

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