[Question #10463] HIV Exposure
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22 months ago
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Hello Drs,
I engaged with a female sex worker.
Started with protected vaginal sex, but my condom wasn't rolled all the way down (more than 50% was covered). I pulled out after a short time and rolled the same condom down all the way to the base of the penis and resumed with the vaginal sex (What if some of her fluids got on my uncovered part of penis and now under condom?). After, I received unprotected blowjob for about 2 minutes, during which i ejaculated in her mouth. She then spat all of it on my penis, I couldn't see any blood coming out of her mouth. 12-13 days after the exposure I took a HIV/HBV/HCV Screen by PCR/NAAT (10 days post exposure). The results read as: HIV 1/2: Not Detected and also Not Detected for the other 2. I didn't get any noticeable symptoms within 30 days after the exposure.
What is my HIV risk?
What is the accuracy of the test I took, given that I took it 2-3 days after the expected 10 days?
This initial message doesn't allow me to ask all of the questions I need to know answers to.
Thank you
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22 months ago
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1. What is hiv risk, if some infected fluids got on the penis before i pulled out and rolled the condom all the way down, now covering the said fluids? Could they have traveled to the top of the penis? Would the hiv in fluids immediately die after pulling out? What is HIV risk with penis coming into contact with vaginal fluids which were outside for over 10 seconds?
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22 months ago
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2. Am I wrong to state, that it is impossible to get HIV via Insertive oral sex? Does ejaculation make difference? Does her spitting everything out on my penis make difference? What if she had any blood or any sores in her mouth? Does she need to be actively, thus visibly bleeding to make a difference or zero risk?
3. I didn't get any symptoms apart from mild Athlete's foot after 30 days and mid itchy rash, immediately after swimming in the sea, which always faded away within an hour or 2. What is the % of HIV infected people experiencing severe ARS symptoms? Is ARS rash intense and doesn't go away for long time?
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22 months ago
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4. What is the accuracy of my test? I was told It's 98% accurate at exactly 10 days after, but gets less accurate after. Is the window period for both HIV 1 and HIV 2 the same at 6 weeks with the 4th generation test? I read that HIV 2 can take long time to show up positive on the test, is it true, what is the most reliable test and timeframe to rule out all the HIV types with a negative test? Do you by any chance have a recommendation which clinic or laboratory to take tests at in London, UK?
5. Has anyone ever tested positive for any HIV type after 90 days after numerous 4th generation hiv tests or other reliable tests? I read a term "elite controllers", can they be undetectable for a long time past window periods on the tests?
Thank you very much for taking your time have a look into my matter, I appreciate that a lot!
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H. Hunter Handsfield, MD
22 months ago
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Welcome. Thank you for your confidence in our services. I'm glad to help.
You were at little or no risk of HIV, even if your partner is infected -- which is unlikely, since most female sex workers are not infected. If she was an escort (i.e. expensive female sex workers by appointment) the chance she has HIV is especially low.
It is entirely normal for condoms to cover only part of the penis. Protection against HIV (and other STIs transmitted by fluids, like gonorrhea and chlamydia) if the head of the penis and urethral opening are covered. Even with complete condom coverage, almost always there is some skin contact, which is why condoms are less effective against STIs transmitted by skin contact (herpes, HPV, syphilis). You will want to be on the alert for these STIs, but you should not worry at all about HIV. As for mouth contact and saliva, there is little risk for any STI at all, and near zero risk for HIV in particular. There has never been a proved case of HIV transmitted mouth to penis -- but here too there were risks for some other STIs, more about which below.
1. The negative HIV NAAT at 10 days is around 90% reliable. That does not mean there is a 10% chance you have HIV: if your risk was say 1 chance in 10,000, the odds drop to one in a hundred thousand. Near zero. Still, for more conclusive proof you could have another NAAT at about 14 days, and/or an AgAb test (i.e. 4th generation blood test) at 4 weeks (98-99% conclusive) or 6 weeks (100%). HCV was zero risk -- almost never sexually transmitted between males and females, even lower risk than HIV. HBV was also very low risk -- and zero risk if you have been vaccinated. But if you want 100% reliable test results, have them again at 6 weeks. I would also recommend a syphilis blood test at that time.
2. Symptoms make no difference in regard to HIV, HBV and HCV. Having no discharge from your penis or penile sores means it is unlikely that you were infected with gonorrhea, chlamydia, herpes, etc. However, for reassurance you could consider a urine gonorrhea/chlamydia test.
All in all this was a very low risk event. What additional questions do you have? In the meantime I hope these comments are helpful.
HHH, MD
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H. Hunter Handsfield, MD
22 months ago
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Your follow-up questions were posted while I was writing my reply. Going to them now:
1. HIV risk: Already discussed.
2. It's not impossible to acquire HIV mouth to penis, but as discussed above there are no proved cases. There must have been millions or billions of such events in the presence of sores in the mouth etc, and still no known cases. This is very close to zero risk despite these and any other "what if" questions that might come to mind.
3. These symptoms do not suggest ARS. Probably about one third to a half of people with new HIV experience ARS symptoms. This information does not change my judgment that there is almost no chance you have HIV.
4. Test accuracy is discussed in my reply above. AgAb (4th gen) tests detect HIV2 at 6 weeks. You can trust any test done in London and probably at any London lab.
5. No, not once. There has never been a case of someone taking more than 45 days to test positive with the AgAb tests. Elite controllers test positive with all tests, with the standard window periods. (They have strong immune responses, which are easy to detect with standard tests!)
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22 months ago
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Thank you for your answer, Doctor.
I am still not completely certain on few issues., that are bothering me.
1. I didn't properly highlight my concern with the condom issue. My question is: is there any HIV exposure, after the unrolling of the condom all the way, to cover the area of the penis that was uncovered and was potentially exposed to the vaginal fluids, so those fluids were trapped inside of the condom now? They would have been exposed to air for at least good few seconds for sure. Is it not possible for those fluids to travel to the urethra, because condom is designed to be tight, preventing this?
WIth oral sex, it's established that it is 1 in 10,000 HIV risk, given that one person is HIV positive. I want to understand this statement. I have to assume, the only possible way for HIV to be transferred from mouth to penis would have been if there was blood present, since it isn't transferred via saliva. But given, these low of a odds, does it mean that there has to be a lot of blood actively pouring, that is easily noticeable and that even a little amount of blood present poses 0 risk as the virus would have been deactivated with saliva and that's the only possible way, there is risk of infection?
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22 months ago
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2. You said "The negative HIV NAAT at 10 days is around 90% reliable". I actually did that test at 12.5 days post exposure, which showed HIV 1/2 PCR at "Not Detected". The nurse taking the blood said, the test's accuracy is around 98% at exactly 10 days and gets less accurate from that point, (which seems a very small window). On the laboratory website it says, the test I took for HIV specifically is HIV1 and HIV2 (RNA).
Is HIV RNA the same as HIV PCR/NAAT? Is this test accurate for both HIV types?
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22 months ago
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3. I want to double check the ARS questions with you. Would you say, that 99.9% of newly infected people with HIV would start experiencing the ARS symptoms only within 28 days post exposure? Anything past that timeframe shouldn't really be a symptom of the acute HIV? For the past 2/3 days (35 days+) I've been experiencing strange itchy rash after taking off trousers at the end of the day. It only affects my calves and one thigh. the rash on the calves is quite itchy and not very visible from distance. The rash on the thigh is in the shape of linear streaks and pinkish in colour. They are both warm to touch and both fade away within an hour or 2 hours maximum, until the next time. It only appears at the end of the day after taking the trousers off and there's nothing happening during the day. Apart form that I haven't had any other ARS symptoms, been feeling well physically.
I will be taking the 4th genereation HIV test next week.
Thank you very much!
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H. Hunter Handsfield, MD
22 months ago
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I'm afraid you're overreacting and you're seriously overthinking the details. There is virtually no chance you have HIV.
Rolling a condom back over vaginal fluids on the shaft of the penis is not likely to create any significant risk.
Blood exposure must be particular large to transmit HIV, and the blood must get into the exposed person's bloodstream. Even with blood present, oral sex is believed to be very low risk, still around one chance in 10,000 for the oral partner exposed to a penis; and 1 in 20,000 for a penile exposure to a partner's mouth.
RNA, PCR/NAAT, and similar terms all are the same; sometimes people just using improper terminology. Technically, it's a nucleic acid amplification test (NAAT) that detects HIV RNA. But it doesn't matter what names people used: it's all the same test.
Most people with new HIV never get ARS symptoms, but if there ARE symptoms, they nearly always start within 2 weeks of exposure. I've never heard of it taking 28 days.
Your negative PCE AT 12 days probably is a bit more certain than at 10 days. Most experts do not agree with your nurse's advice about 98% accuracy at 10 days, and it certainly is wrong that the test becomes less accurate after that. Probably you misunderstood her.
Both AgAb (4th generation) and the RNA tests detect HIV2 as well as HIV1. Disregard information to the contrary that you can find online.
Your symptoms do not even hint at HIV: you do not have it and I am confident your upcoming AgAb test will be negative. Feel free to post a final follow-up comment when you have the result. I will answer no further questions until then. Do your best to stop worrying in the meantime. You had a near zero risk exposure. (In the 20 years of this and our previous forum. not one person has actually tested positive for HIV. You aren't going to be the first.)
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