转译medhelp:KJ感染hiv、性病的风险性

哒哒马蹄

第一篇帖子说了KJ感染hiv的风险分析，国内和国际专家有一致的看法：没有风险，或者说只有理论风险，现实中没有遇到（尤其是被动方）。
这篇帖子转翻medhelp专家 H. Hunter Handsfield的一篇回复(http://www.medhelp.org/posts/STD ... Africa/show/1943206)。大部分专家认为WTKJ对性病传播存在很小的风险，但是这位权威专家把这个风险看的更低。
2013-5-7
Dr,

I am a married man and six weeks ago i was drunk and found myself in a situation where a prostitute in Western Africa french kissed me a couple of times and performed 30 secs of unprotected oral on me（接受了一个西非籍法国人30秒的WTKJ）. I also had a mouth ulcer at the time she kissed me.  Worried about the situation i managed to see a Dr 60 Hours after the event who wouldn't consider PEP for HIV but did give me a booster for HEP B. I saw the Dr again 2 weeks later because of discomfort of the Urethra, he performed a Urine Dip test and said everything was fine. The discomfort has since gone away, probably anxiety focussed. I have had no other symptoms besides a sore throat which i still have. Due to my location i am unable to have an STI test until next month but i am seeing my wife next week.

I am concerned about HEP B. I have had all 3 shots in the past but learnt that they are only effective in 90% of people. My wife has never been vaccinated against it. Is this a cause for concern?

Should i be concerned about HIV? I know it's never been documented but a risk is a risk right? I might be able to get a rapid test at a centre next week, should i do this?

What is your advice? Should i use protection with my wife, as we usually don't?

Thanks

回复1：
Welcome to the forum.  Thanks for your question.

First, a comment on HIV and PEP:  I agree with the advice you were given.  HIV is rarely if ever transmitted by either oral sex (especially in the oral to genital direction), so even if you knew your CSW partner had HIV -- which of course may not be the case -- PEP would not be warranted.  You don't even need HIV testing, except perhaps for the reassurance value of the anticipated negative result.

Like HIV, hepatitis B virus (HBV) also is rarely if ever transmitted by oral sex or kissing.  In addition, you can safely assume you are in fact immune due to your past immunization.  The 90% effectiveness figure you found would be more appropriately stated as "ast least 90%"; most experts agree the true effectiveness is closer to 95-99%.

Of course no distant online expert can guarantee you don't have either of these infections -- but if this is your only potential exposure to HIV or HBV, you can consider yourself to be at essentially zero risk.  If I somehow found myself in your situation, I would not be tested for either infection and would continue unprotected sex with my wife without worry of infecting her.

I hope this has been helpful.  Best wishes--  HHH, MD

回复2：
HBV vaccine boosters are sometimes given in situations like yours, but I am unaware of any data that they make any difference in infection risk.  I doubt they do, but it's sort of a chicken soup approach -- it might help and can't hurt.

Gonorrhea:  true, if you had acquired urethral gonorrhea almost certainly you would have had obvious symptoms. （淋病：正确，如果你得了**淋病，几乎可以确定的是你会有很明显的身体反应）

The rates of syphilis indeed are higher in parts of Africa than in most of the US, but syphilis by kissing would still be a very rare outcome in situations like this.（  You can safely assume your oral lesion isn't syphilis.  You might avoid kissing your wife while you have it, out of caution in case it's oral herpes (unrelated to your extramarital exposure) -- but otherwise I wouldn't worry about it.  


回复3：
There is no useful blood test for gonorrhea, and the chlamydia blood test is unreliable（没有可用的血液检测适用于淋病，***血液检测也是不可信的）; it's never used for STD diagnosis in the US, UK, Australia, or other countries with the strongest STD expertise.  However, you are at little or no risk for either infection, especially chlamydia -- so I don't see testing as a high priority anyway.  Don't worry about it. （然而，你有极少风险或者说没有风险感染上述两种疾病，尤其是衣原体，所以不管怎样我不认为去检测是一个优先的考虑）。别再担心了。

That will end this thread.  Take care




H. Hunter Handsfield，看看他的从业经历和任职经历就知道他有多权威了
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