[Question #3946] Scared of possible HIV Exposure

34 months ago
Hi Dr's,

About 10 days ago, I engaged in protected oral and protected receptive anal with a transgender person. This is my first and last experience with this. Moving on to details, the condoms did not rupture in either act and there was never any unprotected contact but I am kicking myself for not verifying that it was a latex condom. I know I was STD free from testing 3 months prior. My partner informed me that he/she was tested for all STD's, including HIV, 3 weeks prior to this event and was negative and in-fact has never been diagnosed with any STD ever; I've confirmed this twice with him to make sure he stuck with his story. He/she also said that he always uses condoms for sex but I know he has many partners and things can go array. 

Down to my issue, I had stomach problems and diarrhea starting 2 days after this even which lasted for 2 days. Then at day 8, I started getting a mild sore throat with stiff neck and now at day 10 the diarrhea has returned. No fever as of yet but some fatigue. I am highly concerned, actually freaking out, that this is not coincidental and somehow got infected when my partner was in the detection window and I've read that this is the most contagious time period. I know condoms are not 100% effective. 

Questions:
1. I was planning on doing a HIV RNA NAAT test to get advanced warning if I need treatment. When is an appropriate time period for this test? If this is negative I will wait for the 6 week window for conclusive test. 

2. Should I get tested for other STD's like syphilis, gonorrhea or chlamydia based upon my symptoms? Would the latter two be a swab test?

Thank you for your help. 



  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Welcome to the forum. Thanks for your question.

You had an entirely safe sexual exposure. It does not matter if the condom was not latex or polyurethane. Although natural skin condoms have gotten a bad rap because of the theoretical possibility of transmission of bacteria and viruses through pores, in fact there has never been a reported case of HIV acquired through an intact natural condom. Further, it is unlikely your partner had any transmissible STDs:  self-belief and statements about recent testing, not being infected, etc generally are reliable. People don't often lie when asked directly.

You also shouldn't be worried about your symptoms. Although conceivably they could occur with a new HIV infection, they are not typical (especially without fever, obvious lymph node enlargements, or skin rash); but they ARE typical for a hundred minor day to day viral infections. To your specific questions:

1) Considering the low chance your partner had HIV, the protected exposure, and lack of symptoms that suggest HIV, I would put the chance you were infected at under 1 in a million. In other words, zero for all practical purposes. If I were advising my own patient, a family member, or even myself if somehow I were in this situation, I would recommend against testing for HIV. But if you decide to go ahead with testing for additional reassurance, you really shouldn't spend the extra money on an RNA NAAT, but would just wait until you can have an antigen-antibody test at 6 weeks. You could even do it at 4 weeks, when that test is virtually (but not quite) 100% conclusive.

If you DO go ahead with an RNA test, do it 2-3 weeks after the event, followed by an AgAb test at 4 weeks. That combination will be truly 100% conclusive.

2) I see no need for any other STD testing either. But here too, if you want to have testing for its reassurance value, urine gonorrhea/chlamydia test is valid any time more than 4-5 d after exposure (just as good as a swab test, without the discomfort), and you could have a syphilis blood test at 6 weeks.

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

HHH, MD
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34 months ago
Hi Dr HHH,

Thank you for the very quick reply. I guess you think I am being too paranoid. I at first thought my odds were too low to care but once I got some weird sickness symptoms just after this event (and I am normally very healthy), it just seemed too coincidental. I will test but probably wait till just after the 4 weeks for the a normal AgAb test for a high confidence factor (not 100% as you said but good enough).

One clarification, the diarrhea bothers me a bit. Do I need a different test for rectum infections versus urine for gonorrhea/chlamydia?

Thanks again. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Typical STDs (gonorrhea, chlamydia, herpes, syphilis, etc) do not cause diarrhea. They can infect the rectum by direct inoculation, but they don't travel through the body to affect the intestines or bowel function. Sex between men (which your partner was, anatomically) often carries risk of gastrointestinal viruses and other infections due to potential oral exposure to partners' feces or rectal secretions. In that sense, diarrhea can be sexually acquired and it is conceivable your diarrhea indeed is related to the sexual exposure. But diarrhea alone is almost never result from acute HIV infection. 

If your diarrhea is severe, or lasts more than a week or so, or if associated with cramping or blood, see a doctor. Otherwise, I wouldn't worry much about it.
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33 months ago
Hi Dr,

My stiff neck and sore throat resolved but I am stiff having significant diarrhea (no enlarged lymph nodes are hat I can feel or fever). Antacids and Imodium help for the diarrhea for about a 12 hour period but it seems to always return. I am on a trip but will be visiting a Dr as soon as I get back because I am frankly very scared and will tell him/her about my circumstances. 

I even reconfirmed again with my partner that he was tested, negative, and that the condom never came off or broke. He annoyingly confirmed. I just don’t know what is going on with my system here. 

I know this is my last possible post, but do you have any advice? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
I have already given my best advice. Your symptoms definitely are not due to HIV or any recognized STD, although you could have acquired a viral gastrointestinal infection from your partner. Or this illness is a coincidence, not from the sexual contact described. See your doctor when you can, if the symptoms are continuing when your travels are done. In the meantime, it sounds like your symptoms are fairly well controlled -- anything dangerous probably would not respond to Immodium as well as it has so far. But trust me:  for sure this isn't HIV or any other standard STD from the exposure described.

As you understand, that would normally conclude this thread. But I'll leave it open for one final comment, preferably after your symptoms clear up and/or you have seen your doctor. But I won't have anything more to say until then.
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33 months ago
Hi Dr HHH,

So I am back in town today and my diahrea resolved about two days ago and I am feeling pretty much 100% now. On my trip, two other people started to complain about stomach problems 5 days after my issues started and one had vomiting. I am guessing I may have been patient 0 and given it to them and it could only be a typical bug in that respect. I am in a much better place health wise as well as mentally.

I will probably stick to my plan of testing for HIV between 4 and 6 weeks for my own reassurance but have really low fear now. 

I think I will skip syphillis testing (and all other  STD tests becauae I have no symptoms). A sore would be pretty obvious right? 

Some places now have HCV in their STD test panel. Is this recommended these days or any easier to transmit than HIV? Only reason I ask is because I hear it can be symptomless. 

Thank you for your time, patience, and guidance through a stressful time (even if it may have been unwarranted). If my future test shows anything other than negative, I will message for professional reasons, otherwise just assume I am negative. 



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Glad you're getting better. Sounds like you and others were sharing a garden variety infection, probably norovirus.

Indeed lots of online services are offering HCV testing as part of STD panels, but it makes no sense. HCV is almost never sexually transmitted except among men having traumatic (potentially bloody) rectal sex (e.g. fisting) with other men. A recent calcluation re heterosexual transmission is once for ever 190,000 unprotected vaginal sex exposures with a single partner. If sex occurs an average of 3x weekly, this means it would take several hundred years of regular sex with an infected partner before transmissioin might be likely. In other words, its nonsense in an STD panel. (OTOH, all people should be tested at least once -- so on that basis, not a bad idea, I guess.)

Thanks for the thanks. I'm glad the discusion has been helpful.

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