[Question #6030] Four days past exposure

18 months ago

Dear Dr. Hunter Hansfield:

I am a   Caucasian male 59 she is a Caucasian female age 47 - unprotected vaginal and oral - area is Houston - Galveston Texas - duration of unprotected sex was for an extended period - I have read a few of your responses - I see that from some of your post this type of sex(vaginal) there is a 1 in 2500 chance if she did have HIV that it could have occurred. I also have seen you mention that there is a 1 in 100 or 1% chance that she is infected so .01x.0004=.000004=is this where you come up with a 1 in 250,000 chance that I would have contracted HIV from this episode - I do not believe she is a drug user or has sex with men who have sex with other men and I did ask her if she had any std's - she indicated she did not and if she did she would not have had sex with me - she could have had unprotected sex with others I assume - which she could that of me as well - but that would not be true cause this has only happened this one time for me - so I am concerned - I do not have any discharge or bumps on my penis and have not had any symptoms - I have tested(last was2017) - and this is only episode of unprotected sex I have had - what is your advice to me as a patient

Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago
Welcome to our Forum.  thanks for your question.  I'll be answering your questions today.  FYI, Dr. Handsfield and I have worked together for over 35 years and shared forums for more than a decade.  During that period while our verbal styles vary, we have never disagreed in our assessments or advice.  By chance, I happened to pick up this question.

While your math is correct, your calculated risk for acquisition of HIV is even lower than you have arrived at.  The reasons for this include that HIV is far less common among women than men and thus, while about 1% of Americans have HIV, over 70% of those are males.  Further, risk for HIV declines with increasing age- thus your partner's risk for HIV is lower than average based on her age as well.  Finally HIV is less common in the Houston-Galveston area than in the Southeastern U.S., the Northeast or California.  For all of these reasons, I estimate your risk for infection being more than 10-fold lower than the 1 in 250,000 risk you calculate.  In other words, the paragraph above is a long winded way of saying your risk for having acquired HIV is very, very low and substantially lower than your calculations predict.  

I would also point out that there are other STIs which are far, far more common than HIV (gonorrhea, chlamydia, trichomoniasis) and thus, as we discuss your (very low) risk for acquiring any STI, including HIV, we should consider other STIs as well.   

Having said that, your overall risk for acquiring any STI is very low.  I see no immediate need for testing unless you develop symptoms.  OTOH, if you anticipate that you will have other partners in the future, then we would suggest that you consider periodic STI testing as a matter of good sexual health, in much the same manner that we recommend checking your blood pressure periodically.  It will help keep you healthy.  If you decide to test, now or later, we would recommend testing for gonorrhea, chlamydia and trichomonas.  All of these tests can be done on a urine specimen and would be accurate now, four days after your exposure.  As for even less common STIs such as syphilis and HIV, I would recommend waiting to test until 4-6 weeks after your exposure.  At that time blood tests for HIV and syphilis will be accurate and, in your case, I expect that they will show that you did not acquire an STI.  Finally, we specifically do NOT recommend testing for herpes as part of any screen in an otherwise asymptomatic person.  The tests are just not good enough for this purpose and are often misleading.

I hope that this information is helpful.  EWH
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18 months ago

Dear Dr. Hook

I certainly appreciate your response - so the chances that I would have acquired HIV from this incident is greater than 1 in 250,000? How long after having unprotected vaginal sex would it take for (gonorreah, chalymidia,trich) to present itself and what would be the symptoms? I assume a burning sensation when you urinate? How long would it take for the symptoms associated with HIV to present itself ? (10 - 20)? or sooner ? Last night was my first night I actually got a decent nights sleep thanks to your response - I want to say thank you for what you and Dr Handsfield do as your chosen careers - regardless of any sexual preference my hope is one day they find a cure for HIV - it truly seems to take the pleasure away from a natural need. Finally how effective has it been to manage HIV - can one still lead a normal life if it is acquired ?

18 months ago

Dr Hook :

I sent a follow up question back to you and have not gotten a response - perhaps you are on vacation? So when you can please respond to it as well as this - so you would advise me not to be concerned about a potential Hiv exposure given this incident and the chances of having been exposed are much greater than one in 250,000 from this incident - I have also read responses that both you and Dr Hansfield have written that because the risk of this incident is so low that if you are concerned about having unprotected sex wife your wife that both you and him see the risk as small enough that both you would - but of course you are not me so - of course its my decision to make - and finally when you say you see no need to test unless you have symptoms this relates more to the other STI?STD - than HIv I assume - Is this correct - going on day 11 now and I have had know symptoms - would the other sti's have shown up by now other than syphills?

Again thanks once again!

Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago
I apologize for the delay response to your question and thank you for the reminder.  Replies below:
1.  Your chances of having gotten HIV are not greater but LOWER than the 1 in 250,000 you calculate.  Even less to worry about than you thought.
2.  Symptoms of the most common STIs, gonorrhea, chlamydia, NGU would be expected to occur within the first week-10 days after exposure.  Symptoms of the HIV/ARS (acute retroviral syndrome) would occur within the first three weeks
3.  Yes, were I you, if no symptoms by now, given the nature of the exposure you report, I would not be worried about having acquired an STI.  

Hope this helps. Again, sorry for the delayed response.  EWH
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17 months ago

Dear Dr. Hunter :

It is now 38 days past exposure - in my original post I asked for your advice - you indicated that you see no reason to test given my sexual exposure unless I had any symptom related to the other STI's - (other than HIV)- and you felt that my exposure to HIV would have been extremely low given my exposure - well I have had no symptoms - Would there be another advice you would give me perhaps other than - use a condom and do not be concerned with this past incident as it relates to HIV and the other STI's? Also thanks for your expert advice

 

Patrick

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

Thanks for the follow-up.  Your summary is correct.

Just a few additional somewhat generic suggestions which you may find helpful going forward.

1.  If the relationship that you are involved in is ongoing and monogamous, it may be worthwhile for you both to get tested for the common STIs- i.e. chlamydia, gonorrhea, perhaps trichomonas and blood tests for syphilis.  The reason for this is not one of mistrust (I anticipate that the tests will be negative) but to establish trust going forward so that there will be no concerns about possible STIs going forward.  It is a good way to establish a level of trust. (Parenthetically, we would specifically recommend AGAINST blood tests for herpes which are troubled with limitations to their accuracy and relatively frequent falsely positive results)

2.  If you, your partner, or both are going to have sex with others, since STIs can be asymptomatic, it is a good sexual health practice for you to periodically (every six-12 months, depending on the frequency of partner change) to have a sexual health check-up with the tests mentioned above. 

3.  As you already mention condoms and perhaps a discussion or question to partners about past STIs and when the persons was last tested).

I hope this information is helpful.  As per Forum guidelines, this thread will now be closed.  I hope that my comments have been helpful to you .EWH

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