[Question #5838] HIV risk heterossexual anal sex

18 months ago
Hi Dr.
Im male, heterosexual, white, 37 yrs. live in Florida.
9 years ago (2010) I had anal sex with a girl that I met in a club in Florida.
It started protected but the condom broke at some point and we didnt realize that. I think the sex lasted 5 minutes.
I dont know if the girl had hiv or not, the only thing that I know about her is that she was arround 25 yrs, lived in NY and she was white.
I never got tested after that, Im planing to test on end of the month and this sotry scares me.
So, Id like to make a few questions to easy my mind until the test:

1- what are the odds that I got infected by this encounter?

2 - Since that day (9 years ago) Ive never had any big health problem, just minor colds, flu, stomach bug etc.
Every year I do a complete blood count test (CBC) for screening (I have done like 20 of them), the tests, including the last one I did last month, always comes normal (WBC arround 7500, lymphs arround 2500 (35%) etc.) 
I know that CBC cant diagnose HIV, but I know that it can disrupt it over the time.
So my question is: after 9 years, is it possible that if I had hiv, would I be experiencing some big health issue and/or abnormalities on the cbc? if so, what to expect? (I know that there are people who go to aids stage much later or sooner, this question is meant by what you see in practice in general).

Thanks a lot!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
Welcome to the forum. Thanks for you question.

There is nothing in your story that justifies being scared of HIV. There is almost no chance you have it. Two statistics are behind my confidence in it:  1) It is very unlikely your partner had HIV. The chance any particular sexually active woman has HIV, even among the most unsafe with the most partners, is around 1 in a thousand. 2) The risk from a single episode of unprotected anal sex, if she had HIV, is also around 1 in a thousand. Thus, the chance you caught HIV was on the order of 1 in a million.

In addition, as you imply yourself, the fact that you are outwardly healthy is good evidence against HIV of 9 years duration.  If you had it, probably you would have had obvious symptoms and likely would have suffered one or more illnesses due to a suppressed immune system. It is also likely your CBC would have some nonspecific abnormallities, like anemia or low lymphocyte count -- although it is possible to have an entirely normal CBC until late AIDS.

Those comments pretty well cover both your questions. Nevertheless, you should be tested for HIV, as planned. Even if not at risk, CDC and other experts recommend that all adults in the US be tested for HIV at least once, regardless of risk.  Most important, obviously you'll continue to worry about it until you have the negative test result in hand. So stay mellow while you wait to be tested, and for the results to come back. You can count on a negative result. (And why wait until the end of the month anyway? Just do it now so you can stop worrying!)

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

18 months ago
Thank you a lot Dr. Handsfield, excellent answer!

I thought anal intecourse was riskier than 1/1000.
Just for educational purpose, when you said: "you would have had obvious symptoms and likely would have suffered one or more illnesses due to a suppressed immune system." can you exemplify some of that?

Im not going to test now because Im traveling abroad, but the plan is get over with it as soon as I arrive back home.

Thanks again and congratulations for awesome job here!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
18 months ago
The best estimate for insertive anal sex -- i.e. for the penile partner if the anal partner has HIV -- is actually 1 chance in 910, which I round up to 1 in a thousand (the data really aren't all that precise). Indeed it's riskier than insertive vaginal sex, 1 in 2,500 (https://www.ncbi.nlm.nih.gov/pubmed/24809629). 

The symptoms and health problems people with HIV can have are so varied that it isn't easy to summarize briefly. I'll just stand on the point that most people with HIV for so many years would not feel and look well. Details are readily available online. Try googling such terms as "HIV/AIDS symptoms", "AIDS indicator illnesses", or "opportunistic infections in HIV/AIDS".

Thanks for the thanks. I'm glad to have helped. Each question comes with two follow-up comments and replies (or 28 days, whichever comes first). So you have one coming. You might consider holding off on more discussion, if you think you'd like to keep this thread open to let me know your HIV test result, assuming it's within 4 weeks.