[Question #13738] Vaginal Sex and Testing Window

1 months ago

Hi Dr,

I hope you had a Merry Christmas and a happy new year. On Jan. 5 I had unprotected vaginal sex with a Korean CSW here in the bay area. About 5 days later I felt some very slight body aches, but had no fever, no sore throat. The body aches were so slight that it didn't affect my daily routine. However I was a bit paranoid so I did an HIV, Hep C, and Syphilis test on Jan. 14 at the local county clinic and all 3 tests were negative. I know I'm still in the window period but what are my current odds of contracting HIV? I assume the odds are more strongly in my favor with this initial negative test. I will test again when i'm out of the window period. Thank you again for your guidance.

H. Hunter Handsfield, MD

1 months ago

Welcome back. Happy new year yourself and thank you for your confidence in our services.

I'll start by encouraging you to get out of a possible growing habit of asking us about every new sexual exposure. You've learned enough from Dr. Hook's three previous replies that you should now know that even entirely unprotected, vaginal sex is low enough risk that testing isn't necessary after every such event. (But of course you're free to be tested whenever you need the reassurance of negative test results.) Dr. Hook also advised you that symptoms rarely are a valid indicator of new HIV infection. Also, I have to wonder about your choices to enjoy the services of sex workers without consistent condom use. What's with that, for goodness' sake?

As for your current test results, indeed they were too soon to be meaningful -- unless the HIV test was a PCR for viral RNA. If so, that test is 100% conclusive any time 11 days or more after exposure. Also, hepatitis C virus testing always is a waste of money in situations like yours. The ONLY proved and common sexual transmission scenario for HCV is potentially traumatic anal sex practices among men. The virus is NOT heterosexually transmitted: the frequency of HCV is no higher in the same-sex partners of infected persons than in anyone else. Also, I find it interesting that you don't mention urine gonorrhea/chlamydia testing -- by far the greater and more important risk than HIV, HCV or syphilis in this situation.

Finally, it seems you already understand your trivial symptoms were meaningless.

Since you're already started down a testing pathway, it makes sense to continue until enough time has passed for conclusive results -- i.e. final syphilis and an HIV AgAb test at 6 weeks. Forget repeating HCV test; you were at zero risk and it would be a waste of money. But do consider adding a urine gon/chl test (which is valid any time more than 4-5 days after exposure).

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

HHH, MD

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1 months ago

Thank you for the fast and candid response Dr. Handsfield. I will also look into getting tested for Chlamydia and Gonorrhea and be more vigilant on consistent condom use. I will indeed do a follow up HIV test in 4 weeks, which will conclude my window period. I know HIV is very low risk for this but sometimes my mind overthinks and doubts what I already know. I apologize for the multiple inquiries.

H. Hunter Handsfield, MD

1 months ago

No apology necessary -- but I doubt you have learned much from my reply beyond what you already know. Perhaps something to consider.---