[Question #10471] HIV Exposure

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22 months ago

On 6/24/23, I(33 year old heterosexual male) had an HIV exposure with a gay male.Was  drunk and I have no recollection of it.Didn’t know he was HIV positive then.He said that I received oral (had his mouth on my penis apparently) and said I tried to “put it in his ass” but apparently he didn’t let that happen.I tested negative for everything on 7/14/23.negative for HIV, negative for syphillis(serum), etc.So about 20 days later.The weekend after Labor Day he said that he’s HIV positive but has been undetectable and untraceable.I tested negative again for HIV (4th generation) and syphillis (serum) on 9-21-23.Think about 89 days post exposure.CDC says 18-90 for rapid blood test.Should I test since it’s been over 90 days now?Is there an ethical obligation to notify past, in between, current or future partners of this exposure?I’m on black market anabolic steroids (trenbolone acetate and testosterone cypionate).Anyway that would interfere with the results or cause a false negative?

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H. Hunter Handsfield, MD
22 months ago
Welcome back to the forum. In a way, I'm sort of glad to see this question since -- in contrast to some of your prior ones -- it addresses what understandably might have been a high risk situation for HIV. In fact it was zero risk, but for reasons that are not necessarily common knowledge. That said, although you describe yourself as heterosexual, this is the second time you have asked about potential or certain sexual activities with other men. So this seems an opportunity to bring you up to speed on some issues that all MSM should know about HIV risk.

Presumably your HIV infected partner is "undetectable" because he is on effective HIV treatment with antiretroviral drugs (ARVs). (I don't know what "untraceable" means. Maybe he said "untransmittable"?) When ARVs result in undetectable virus in the blood, there is zero risk of sexual transmission, no matter what practices may be involved (anal, oral, etc) -- perhaps you've seen the TV ads that make this point in their direct to consumer marketing ARVs. Undetectable virus is so safe that it is entirely safe for regular couples, in which one person has HIV, to entirely dispense with condoms.

 Accordingly, you were not at risk for HIV and did not need testing. That said, many men would have tested anyway, and I certainly would not fault you for testing even if you had been aware of all this. In any case, negative results with the AgAb (4th generation) blood tests are conclusive any time more than 45 days after the last possible exposure. If CDC indeed advises 89 or 90 days for the rapid blood tests, so be it -- but even with the rapid test, if AgAb 45 days is fine. Of course this assumes partner was truthful, but people rarely lie when asked directly about HIV status. It would have been appropriate (and a kindness!) for him to have told you about this before the sexual exposure.

On top of all this, it seems there was probably little if any HIV risk anyway, since anal penetration apparently didn't occur. (Oral sex carries almost no risk of HIV, even without HIV treatment.)

There are no medications of any kind that significantly alter the timing or reliability of HIV blood tests, and that includes anabolic steroids.

I'm glad to hear your syphilis blood test also was negative. You don't mention gonorrhea/chlamydia testing. Assuming no symptoms (discharge from your penis, painful urination) you can safely assume you didn't get gonorrhea, and chlamydia is very rare following oral sex. Still, you could consider having a urine gonorrhea/chlamydia test if not yet done.

For the reasons obvious above, there is absolutely no need to say anything to past or future sex partners about any of this.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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