[Question #13581] Threesome HIV risk

2 days ago

Last night, I (32M) met a couple (36MF) from a swinger website. In the heat of the moment, I had unprotected vaginal sex with her to completion followed by him doing the same. I never had any sexual contact with the male or his fluids.

They said they had been tested recently but they also suggested no condom. They indicated they hadn't played with anyone outside of their marriage since back in February. I reached out for further details about their testing but haven't heard back.

My concern is HIV (though I will test for others). I hate to think that one stupid decision could be so life altering. I understand that the transmission rate from a single instance of unprotected vaginal sex is very low even if they are infected. Should I consider seeking PEP? Or should I just get an RNA PCR test at 11 days?

H. Hunter Handsfield, MD

2 days ago

Welcome to the forum. Thank you for your confidence in our services.

This is an exceedingly low risk scenario for HIV. The chance either person in this couple has HIV is zero for all practical purposes. If somehow I were in your situation, I would not be tested, would not be worried, and would continue unprotected sex with my wife knowing I could not harm her. You should not seek PEP in this situation and from a medical/risk perspective, there is no need even for testing for HIV. Of course you are free to be tested anyway -- reassurance alone is a valid reason. If you do it, you definitely can expect a negative result.

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

HHH, MD

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2 days ago

Thank you, Doctor Handsfield. I appreciate what you do here and have often used this forum to educate myself.

Based upon reading other replies, I thought this may be your response. However, I think my anxiety is getting the best of me here. I knew forgoing the condom was the wrong decision but I was willing to do so in the heat of the moment and that scares me. I am recently single and newly exploring and have used a condom during other experiences. The fact that these folks were enthusiastic about me not using a condom, told me about other promiscuous things they have participated in before, and didn't reply to me when I asked for more details on testing bothers me and makes me think this is high risk (probably higher than it actually is). Even if she was infected, I understand the chance that I contracted HIV would be somewhere around 1/2500. Normally, I think I'd be happy to have those odds but I'm still concerned.

Having said that, I think I'd like to be tested for my own peace of mind if nothing else. When would the HIV RNA PCR test be conclusive? It looks like 11-12 days is what I'm seeing in other posts followed by a duo test at 28 days for certainty. Aside from that, I'm planning to be tested for Chlamydia/Gonorrhea after about a week and am debating whether I care to bother with syphilis at 6 weeks. Thoughts?

H. Hunter Handsfield, MD

11 hours ago

I'm glad to see you understand the basis of my evaluation and advice. As I said above, reassurance alone is a valid reason for testing -- and yes the RNA PCR test is conclusive after 11 days. Adding an AgAb (4th generation, "duo") test after 4 weeks really isn't necessary, but is commonly done. As for other STIs, your plan to test for gonorrhea and chlamydia makes sense (although you can be nearly 100% certain you don't have gonorrhea if by that time you don't have dripping pus and painful urination). Syphilis is by far the next most dangerous STI apart from HIV, so if you're going to test for anything at all, I suggest you include a syphilis test at 6 weeks.---