[Question #2524] Risk exposure to single encounter to HIV poz undetectable partner?

46 months ago
Dear Dr,I'm a bisexual guy&I've been HIV neg since 07/30/17.On early of 07/30/17,I had an sexual intercourse with a guy who turned out to be HIV poz undetectable after we were done having sex.This was the 1st time we had sex with each other.He told me that he has been poz undetectable for 3years,his last test 2weeks ago also undetectable since he is currently on med.We had both oral&anal intercourse.We used condom for anal intercourse where I was the insertive partner,I ejaculated inside his anus but when I checked,the condom did not break&I did not see any signs of rectal bleeding from the condom when I pulled it out.We then had unprotective oral intercouse where I was the person who received the BJ&I ejaculated inside his mouth.Throughout the whole intercourse,I did not see much fluid coming out of his penis,&I never touched it either.He said he had no ulcers/bleeding gums.So given this situation,what is my risk of exposure to HIV?Should I seek for PEP treatment in this case as I am still in 72hour window?The whole situation really scared me out.Hopefully I could hear back from you soon.Thank you!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Welcome to the forum. Thanks for your question.

First, congratulations on having only safe sex. No worries at all about HIV from these events.  Even entirely unprotected sex would have been free of HIV risk, or nearly so; and you also used condoms for the only parts of the exposure that carried any HIV risk, i.e. anal sex. Being on anti HIV treatment with undetectable virus in the blood is so safe that some people advise such persons that no protection is ever necessary. I wouldn't go quite that far, because condoms also are necessary to prevent other STDs, but they can be considered optional to prevent HIV in this situation. Oral sex is little or no risk:  even with no HIV treatment and high viral loads, there has never been a proved case of HIV transmission mouth to penis, and only rare ones penis to mouth. So you don't need testing for HIV on account of this event and for sure should not take PEP.

You don't mention other STDs, for which there likely was some risk from the oral sex component. STD testing usually isn't recommended after single exposures of this sort, but it might be something to consider if you have had other potentially risky exposures in the past year or so.

I hope this information is helpful and reassuring. Let me know if anything isn't clear. Best wishes and stay safe--

HHH, MD

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46 months ago
Dr Handsfield,thank you for your  medical clarification/explanation.About STDs,the other guy claimed that he was clean.About me,I have HSV2 but been taking Valtrex 1g to suppress it.I didn't have any outbreaks when we were having sex&Im sure that I took Valtrex several hours before sex.Does this mean the risk of contracting hiv from oral sex is greater?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
It is true that having HSV2 raises the risk of HIV if sexually exposed, but not by much, and probably only for genital or anal exposures. So this makes no difference in my advice above.

It sounds like the biggest STI risk during your recent exposure was infecting your partner with HSV2, if he hasn't previously been infected. Taking valtrex and using condoms reduce that risk, but his chance of getting HSV2 was still a lot higher than your risk of catching HIV from him. Transmission of HSV2 does not require a visible outbreak. If you didn't tell him of your herpes before the exposure, you might do so at this time. (Don't get me wrong:  the risk was very low, so informing him is optional. But still something to consider.)
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46 months ago
Dr Hansfield,I know that you told me I had little risk from my exposure. However, today 08/04/17 I just came in for my annual physical exams. My PCP ordered lab and found that my protein levels is a little bit high (9.1) vs normal(8.2). I read online that elevated protein levels might be caused by infections (HIV in this case)?I started panicking again. What is your opinion on this? My PCP wanted me to follow up with her in 2months
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
46 months ago
Elevated total protein levels may be more common in people with HIV. However, this would never be the only manifestation of a new HIV infection. And obviously your PCP doesn't suspect HIV; if she did, he would recommend testing and would want to see you a lot sooner than 2 months. This isn't anything to worry about, but if you remain concerned, discuss it with your PCP. (Of course you told her of your exposure and concerns about HIV, right. If not, do that now. She cannot provide proper care without knowing the full picture.

That completes the two follow-up questions and replies included with each initial question, and so concludes this thread. Do discuss all this with your PCP. Best wishes and stay safe.

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