[Question #3095] Should I test?

39 months ago
On Thursday evening I unknowingly had unprotected intercourse. I thought the man had a condom on already and sat down on him. Needless to say he pushed me off and we ended it there. He did not ejaculate inside me bc he ended up “finishing” on my stomach. He insists he is tested regularly as I immediately started to panic given my recent scare but I have not seen the results personally. 
1) If you were my gyn/GP, would you recommend I test for HIV in six weeks? I’m anxious all over again.  Thank you in advance!
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
Welcome back to the Forum.  I'll be glad to comment.  Your new exposure puts you at very low risk for STIs with your risk for common, curable STIs like gonorrhea and chlamydia being slightly higher than your risk for HIV.  The easiest and most direct way to make sure there was no risk would be if you could get your partner to test and share the results with you. If his tests are negative, there is no realistic risk to you.  If this is not possible, I would suggest a single test for gonorrhea and chlamydial infection at some point more than 3-4 days after the event and a single HIV test at six weeks following the exposure.  In the interim, I know you have a tendency to worry about such things and, would urge you to resist that tendency.  After all, her has told you that he tests regularly and is negative (and most people do tell the truth) and the statistical risk for infection from a single exposure of this sort is much lower than your risk of being struck by lightening - in the neighborhood of less than 1 in 1-2 million.  EWH
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39 months ago
Hi Dr. Hook. Thanks for responding and being so patient. I didn’t think I’d be back so soon. In regards to testing, I got a new GYN and GP, they both have read my conversations with you and Dr. H, and I am RELIEVED to know they both 100% agree with your advice. Both said do not retest at six months as six weeks is ample time for conclusive results, so thank you both for that!
As for this episode, I will once again take comfort in your advice and note the need to relax and not panic. Statistics always help, so knowing that while I had a risk, it wasn’t as significant as I’m making it out to be helps. That and my new care team who happen to be on the up and up. THANK YOU!
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
I'm pleased I could help.  Sounds like your GP and GYN are doing you well.  Take care.  EWH
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39 months ago
I just found out the man in question has been sleeping with someone who is Known HIV positive. I’m completely freaking out and I just learned of this moments ago. I don’t know what to do and am now feeling suicidal as the thought of having caught HIV is terrifying. I will pay to continue this conversation in a new thread. If her viral load is undetectable, need I be worried? She has had this for many years. I don’t know what to do and now it’s too late to take PEP. Can I catch HIV from pre-ejaculate? He finished on my stomach but I’m not sure in the brief moment we were in contact if he had pre-ejaculate. Im truly terrified im a single mother and now I may be sick. 
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
I'm sure that your partner has had sex with a person with known HIV is upsetting but your risk for having acquired HIV remains very low.  You do not know that he has HIV and, in fact, it is unlikely that he is.  Even if he had HIV, your risk for infection would be likely be lower than that the one and 1-2000 likelihood of getting infected which is the estimated risk for infection following sex with an infected partner.  Given the brevity of your exposure and that he ejaculated outside of you makes the risk lower still. 

If his other partner is on HIV therapy and her viral load is undetectable his risk for infection is low, as is yours. 

You are correct, it is too late for PEP to be helpful;.  The next step in determining your risk is to test.  The fastest and most direct way to find out if you were even exposed is to see if you can get an HIV test.  If his test is negative, you are not at any risk for HIV from this exposure. If this cannot be done, you should seek testing.  An HIV RNA test could provide you with proof that you were not infected as soon as 10-14 days following exposure.

Your risk for infection remains very low.  As upsetting as this is, please try not to worry- the odds are very much in your favor.  EWH
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39 months ago
Thank you. I am leery of relying on his test results bc he could be in a window period and have a false negative. The only thing I feel would be 100% certain is my own result. I feel like I’m in a nightmare. As for the RNA test
You speak of, is it 100% conclusive after 14 days, or would I need to go back for additional testing? I know you’ve responded 3 times but if you could respond to this I’d feel much better. I am still unsteady and not sure what my  next step other than testing is.  
Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
If his test results are negative at this time the results should be very comforting.  The likelyhood that he is in a window period and therefore his test is falsely negative are vanishingly low. 

In general, we do not recommend the RNA test, in part because they occasionally give falsely positive results and in part because they cost considerably more than the other, recommended HIV antigen/antibody tests which take a bit longer to provide definitive results.  At he same time, it is the RNA tests that are used by the Red Cross to keep the blood supply safe- if you have a negative RNA test at 14 days (and, given the event as you reported it, I am confident it will be) you should have complete confidence in the result.

I understand that you are shaken by the event you have described.  That said, your risk for infection, for all the reasons outlined above, remains quite low.  I hope my comments have been helpful but this will be the final comment as part of this thread.  Please try not to worry.  EWH
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