[Question #13745] How to learn to think about risk like ID specialists

 
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30 days ago

Hello Dr. HHH and Dr. Hook, I trust your advice.  Thank you for all you do. I'm not in a committed relationship, and I probably have some degree of health anxiety, which is why I'd like to hear your opinion about my most recent encounters. Also, how to approach risk assessment more scientifically so as to assess it more objectively and less anxiously. Recent encounters - 1) three instances of unprotected oral sex/fellatio, which I (a woman) was giving to a heterosexual man. I didn't swallow the ejaculate. That was a few months back. 2) Most recently, with a new man, one encounter of a mostly protected sex with a condom, and a brief midway episode of condomless penetration for about 1-2 minutes, several thrusts, no ejaculation, and then we continued to have a condom-protected sex. It has been 4-5 days from the most recent encounter. 

I am a heterosexual woman in my 40s and my most encounters are w/ hetero men in their 40s. We reside in Canada. I asked ChatGPT and it said that given the prevalence of HIV in Canada, multiplied by risk per one encounter, the risk for that brief condomless sex without ejaculation is 1/several millions. Is that the correct risk assessment/math? Is it true that the risk is much lower due to absence of an ejaculation? Is the risk much higher for things like chlamydia and gonorrhea or still low given how brief it was?  Is there a difference between a theoretical risk and a real-life, biological risk? Thinking about the risks numerically helps me understand them better and it lessens the concern. ID MDs don't generally worry about such encounters because while theoretically possible, there are no documented real life cases of transmission during single encounters, no ejaculation PIV, or oral sex but no swallowing? Please weigh in and thank you. 



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H. Hunter Handsfield, MD
30 days ago
Welcome back to the forum. However, looking back at your many previous questions -- by my count, this is your tenth (not the forum record but you're getting close) -- most if not all these questions have been answered previously. In reply to your request for a numerical/statistical calculation, please look at 7104, in which I wrote one of my occasional "blog-like" replies on this subject. As that term implies, the purpose of such advice is to serve as a resource in reply to additional questions on the topic, for other readers and for the original questioner. I would also advise you to look back at all your previous questions and the replies:  everything you ask now is covered -- or at least the answers should be obvious -- in those discussions.

Also, you should understand that there are almost no truly scientific data by which to accurately calculate the per-exposure risks of HIV or other STIs. It's all educated guesswork and mathematical logic, which often can be entirely wrong about specific exposures people might be concerned about. And remember that AI sources typically are not scientific; they're based mostly on the frequency of things that can be found online. I like to think ChatGPT's replies about HIV risk in Canada or anywhere else come in part from our own comments on this forum. But you cannot rely on such information as scientific or necessarily reliable. That said, I would generally agree with the low risk you found in response to your ChatGPT query.

1. Within those limits, I agree with the mathematical risk you cite.
2. It is logical to assume the risk of HIV from receptive vaginal, anal or oral sex would be higher with ejaculation than without it. But I am unaware of any data on this and cannot endorse the risk as "much lower" without ejaculation.
3. If a partner has gonorrhea and chlamydia, the risk of infection from unprotected vaginal sex -- with or without ejaculation -- is very much higher than for HIV. I have no comment about biological versus "real life" risk estimates for these STIs.
4. I'm not confident that ID specialists are less likely to worry (or to advise their patients to worry) about individual exposures than we are on this forum. Maybe so, but I really can't generalize about ID versus other specialists -- except that physicians and clinics who regularly mange HIV or people at risk for STIs probably are more likely to have accurate understandings of the risks than non-specialists in these area.

If you're worried, get tested. Even if the risk is nil, reassurance alone is a valid reason for testing -- and no amount of speculation can lead to 100% certainty about risks in potentially exposed individuals.

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

HHH, MD
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13 days ago
Thank you for your reply. Dr. HHH. I have re-read reply # 7104 and it is a "blog-like" answer which can be read and re-read as needed. You're right in that I have plentiful information about assessing risk, and I should probably reframe my relationship with risk as it pertains to STIs. I tested with a 4th generation combo on day 17 post PIV exposure and all test results (blood+ urine sample, viral and bacterial) came back non-reactive/negative. I will most likely repeat the tests on day 28 or after. 
These interactions also lead me to think I should have a different benchmark for selecting partners, perhaps those I trust more. That's something I have been pondering more and more. 
Thank you for answering my questions, sharing your knowledge, and in part helping ChatGPT come up with answers based on information provided on this forum. A big thank you.