[Question #1678] Hiv concern

43 months ago
Hi there.  I had posted in the past regarding an uncertain partner.   We ended up ending the relationship before testing.  As it was oral, I was not worried after the reassurance but had tests with my yearly pap etc.  We got back together a month ago, he said he was tested and clean and would show me the results.  We had unprotected Intercourse twice and then he ended it.  He admitted he never did get tested for HIV etc.  He is heterosexual and active and non drug using.  It turns out he is very promiscuous with women (I actually know now from others who have been with him).  I'm in Canada so I know it is not high risk.  Still considered low risk situation these days?  I don't know whether to get tested again in a few weeks or just relax.  Thanks so much. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome back to the forum.

You understand that statistically it is unlikely your partner had HIV. Obviously he's not at zero risk, but the large majority of HPV infections in the US and Canada continue to occur among gay men, and even among men with your partner's apparent lifestyle, on average the odds any particular person has HIV probably are around one chance in a thousand. And during any single episode of unprotected vaginal sex, the average transmission risk is around one in a thousand. Combining those odds, we can estimate your chance of having been infected is on the order of one in a million (1/1000 x 1/1000 = 1/1,000,000).

Should you be tested? Probably yes. Not because the risk is high -- it would be entirely reasonable to disregard this risk. However, you are uncertain enough to be here, asking the question -- and many such persons will continue to worry, regardless of the most expert, reasoned, science based analysis of probabilities. If so, wait until 4 weeks have passed and have a 4th generation (antigen-antibody) HIV test, which will be conclusive at that time. But in the meantime, stay mellow. Almost certainly it will be negative.

That covers HIV. Although you didn't ask, I would also recommend testing for gonorrhea and chlamydia, which requires a vaginal swab or urine specimen; the chance of these is much higher than for HIV. Also consider a syphilis blood test (conclusive at 6 weeks, although a negative result at 4 weeks would be nearly conclusive) (the chance of syphilis is almost as low as for HIV, but still recommended in such situations).

I hope this information has been helpful. Let me know if anything isn't clear. Best wishes and stay safe--   HHH, MD

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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Forgive the first line typo:  HIV, not HPV.

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43 months ago
Thanks so much.  This is very helpful.  I will definitely get the other tests as well.  Do you know if Vancouver, British Columbia, Canada uses generation 4 tests now or still 3?  The other times I have been tested I have never had the choice of which generation. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
By chance,  recently I had reason to enquire of a colleage at BC public health (British Columbia CDC, BCCDC) about HIV testing policies in Canada. From her reply:  "All jurisdictions in Canada provide 4th gen Ag/Ab tests and have done so for a number of years."

That doesn't necessarily mean all clinics do it routinely:  "provide" could mean 4th gen testing is available if needed, but not necessarily done in all cases. But the third generation (antibody only) tests are equally accurate at 6+ weeks, so the worst case scenario is waiting 2 weeks longer. That may also make sense on account of the desired 6 week inverval to conclusive syphilis test results.

Thanks for the thanks. I'm glad to have helped.

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