[Question #365] Risk and testing ?

35 months ago
Hello Doc,
     I recently had vaginal intercourse with a 43 year old Caucasian lady during a business trip.  It was a one nighter where we met at the hotel bar enjoyed great conversation and all that led to an eventual broken condom.  I have no idea how long I was unprotected but let's just assume it was the entire time.  She was a very smart, well kept professional and mother.  She was divorced a couple of years prior.  I am a healthy circumcised man with no  Sti's.  She wasn't overly concerned as she has had a hysterectomy and had been tested for hiv etc. 3 months prior and was all clear.   I am in a relationship and when I arrived home I had unprotected intercourse with my partner (female) approximatley 24 hrs after this exposure.  I have read many of your old and new posts but would like your estimation on the risk of sti with this exposure especially hiv.  Also if I did contract hiv from this exposure what is the risk that I gave it to my partner 24 hrs later?  Lastly how accurate is the 4th gen duo test at 15 days vs 28 which I know is conclusive or is a RNA test the way to go at the 15 day mark?  I am considering taking one but my PCP still believes in the 3 month rule..... Small town USA.  He wasn't really sure about the tests accuracy which is what lead me to your site.  I am just looking for a little piece of mind as I wasn't overly concerned until I heard some statistic and my brain took over from there.  I am currently 12 days post exposure and feel fine other than anxious.  Your thoughts are greatly appreciated!

 
Edward W. Hook M.D.
Edward W. Hook M.D.
35 months ago

Welcome to the Forum.  I'll try to help.  The risk of the exposure that you describe is low, based on your description of your partner, that she told you she had been previously evaluated and was negative and, implicitly, by the fact that you were using a condom (suggesting that you both were committed to safer sex practices).  Unfortunately, the condom broke and so testing is appropriate, just to be sure.  so, IF she was infected (unlikely), how high is your risk?  Low.   Remember that most STIs are not transmitted with a single exposure and that for HIV the risk for infection is, on average, 1 infection in 1000 exposures, IF your partner was infected.  For other STIs the risk of transmission would be higher but still relatively unlikely, being in the range of a 20% chance of infection if your partner had gonorrhea or chlamydial infection.  Thus, on the basis of these figures, your risk for infection is low overall.  Nonetheless, testing is reasonable.  For HIV, the 4th generation tests give accurate/reliable results at 4 weeks/28 days and at 15 days would detect most but not all recent infections but precisely what that proportion might be is debated.  Certainly most however.  The RNA PCR tests are not much better than the 4th generation tests and really do not add assurance sooner, despite what those who sell them will tell you. 

In summary then, this was a low risk exposure.  The likelihood that you were infected in tiny (probably less than 1 in 100,000) and the risk that you infected your wife lower still.  My recommendation however would be to wait until 4 weeks for testing for the complete assurance you desire.  I hope this comment is helpful to you.  EWH

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34 months ago
Thanks Doc.  A quick follow up, due to some travel issues I can test at 27 days or 33 days.  I am really ready to put this behind me so will the 27th day be a major issue or am I better waiting for the later date?  Thanks for your advice and patience.  My nerves get a little tighter by the day.....
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Given your situation and circumstances, I'm confident that testing using a 4th generation test at 27 days will provide you with reliable test results.  EWH
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34 months ago
Thanks for all the info Doc, you and your partners provide a wonderful service to those of us looking for real, scientific data here on the WWW!  Especially those of us in places that don't have experts readily available!  I got my results back from my 28 day duo( I was able to get it on the 28fh day after all).  The results were "HIV Screen 4th Genereation wRfx  result: non reactive, reference rang: non reactive.  I just want to double check and make sure this means I can move on with life without further concern.  I can tell you one mishap is not worth 28 days of concern!  Thanks again for all that you and your group provide to those of us that find ourselves in these most aweful situations!
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Correct, this is a conclusive result which indicates that you did not acquire HIV at your encounter 28 days earlier.  Time for you to move on without concern.  EWH
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