[Question #5680] Unprotected vaginal hiv risk with gonorrhea

21 months ago
Dear Dr, I’m male 31yr, straight, Brazilian. 11 days ago I performed unprotected vaginal sex with a girl that had very recently divorced from her ex. Few weeks before this event she did her annual checkup with her ginecologist and all results negative for STDs, including HIV. Turns out 2 to 3 days after sex I started having discharge in penis and the Dr diagnosed Chlamydia and treated with azitromicin 1g+levofloxacin 750mg. He Asked blood tests for HIV, syphilis, hepatitis and chlamydia, all came back negative including chlamydia Igm antibodies (didn’t test gonorrhea). 1 week after taking antibiotics the discharge continued and became more yellow/yellowish. I went to a more STD specialized doctor and as soon as he looked the discharge He diagnosed gonorrhea (unfortunately didn’t think testing was necessary) and treated with ceftriaxone 500mg. I understood from 2nd doctor that it was to soon for chlamydia, if indeed was chlamydia it would have came from a few weeks older episode.
As gonorrhea symptoms appears very soon, it implies that it came from this event and as she had her annual checkup with ginecologist few weeks ago all clear, it suggest that she was very recently infected.
Bottom line, 5 days after the sex we both tested hiv 4th generation (antibodies+p24) both came back negative.I know the risk for HIV for one vaginal act is around 1/1000, I wouldn’t be very concerned if the gonorrhea didn’t appear, so:
1) as I contracted gonorrhea does this risk (1/1000) increase a lot?
2) Even though she tested negative I’m worried as the gonorrhea infection was recent, what if she also contracted hiv and didn’t show yet in the exam? Ive heard early stage of hiv are more contagious due to high viral load, but shouldn’t p24 appears positive if she was indeed in that high contagious viral load of early stage?
3) I’m very worried and anxious waiting 4wks to repeat exam. Would you recommend PCR test due it’s smaller window?
4) Please advise how much at risk am I.
Thanks
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Welcome to our Forum and thanks for your question.  You and your partner were clearly unlucky.  I'll be pleased to provide information in response to your questions.
1) as I contracted gonorrhea does this risk (1/1000) increase a lot?
If your partner had HIV (which I think is unlikely, the presence of gonorrhea and the associated inflammation would slightly increase your risk for infection but the odds would still be very stong that you would not get HIV.  I would estimate that your risk for acquiring HIV IF EXPOSED (which I doubt was the case) would be about 1 in  700, still just a small fraction of 1%.

2) Even though she tested negative I’m worried as the gonorrhea infection was recent, what if she also contracted hiv and didn’t show yet in the exam? Ive heard early stage of hiv are more contagious due to high viral load, but shouldn’t p24 appears positive if she was indeed in that high contagious viral load of early stage?
You are correct that if persons are in the very early stages of HIV they have a high viral load and are more infectious for sex partners.  However, persons with high viral loads also have positive p24 antigen tests. That your partner had a negative 4th generation 5 days after your encounter test pretty much guarantees that you were not exposed to HIV. I would not be the least bit worried if I were in your situation.

3) I’m very worried and anxious waiting 4wks to repeat exam. Would you recommend PCR test due it’s smaller window?
As I said above, I would not be worried in the least.  If my assurances are not sufficient, an HIV PCR test at this time (11 days after exposure) would confirm that you had not acquired HIV and should be believed.  Personally, I do not think further testing is needed.

4) Please advise how much at risk am I
See my comments above.  most women, even most women with gonorrhea do not have HIV.  Your partner tested negative 5 days after the encounter. there is no medical of scientific reason for concern.  

I hope these comments are helpful.  EWH

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21 months ago
Dear Dr. Edward Hook,
Your words came as music to my ears and certainly I feel like I’m off the Hook -no pun intended ;-) - with the situation! Nevertheless, I’ll test 4th generation after 4wk from exposure just to follow  protocol and consider final close.
I just want to thank you and highlight what a great service you’ve been providing, answering our questions in details and  with all the patience.  It’s a great opportunity we have to access such a specialist in the subject.
Your answer covered all my concerns and you may close this thread!
Many thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
 Thank you for your kind words. I am pleased that the information I provided was helpful to you. Take care. EWH ---