[Question #6561] HIV risk
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66 months ago
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Hello doctor
Ok so the story happened 4 weeks ago where I had sex with this lady that I've been talking to for a while. I used condom and everything was perfect but in the middle of the action she was laying down and I was on top I pulled out my penis to change positions but the condom slipped off and got stuck inside her vagaina, so she got up to the bathroom to remove it and I was gonna use another condom but then I realized that I didn't have any extra condoms, so she pulled out the old condom and I managed to put it back on and I used it again until we finished. My questions are:
1) How risky was what I did by putting back the same condom that slipped off and use it again? Does it increase the chances of contracting stds and especially HIV?
2) I have taken the oraquick mouth swab HIV test at 26 days and it was negative, I know I took it too early but can that be a good sign that I'm negative? I’m going to take it again at 6 weeks
3) I have to mention that I'm a married person and I have been feeling so guilty of what I did, I'm too afraid to pass anything on to my wife and my 1 year old son, my wife is breastfeeding and I read that HIV could be transmitted to a child through breast milk
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H. Hunter Handsfield, MD
66 months ago
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Welcome back to the forum. There's a common theme in this and your four previous threads, which I have scanned. The answers to your current questions are partly covered there. You might re-read those discussions about the low chance most sex workers have HIV or an active transmissible STD; and the low chance of HIV transmission even if she were infected. To your questions:
1) Re-using the same condom in this situation isn't ideal, but it still would provide substantial protection, assuming you or she didn't turn it inside out, which would have resulted in greater exposure to her vaginal fluids. All things considered, any chance of HIV or other STDs was very low.
2) The oral swab HIV test probably detects around 90% of HIV infections at 4 weeks (and no significant difference for 26 days), so the negative result should be highly reassuring. In fact, I really don't think you need any more HIV testing. If we assume 1 chance in a million youcaught HIV, then add a negative test that is 90% reliable, the likelihood you have HIV is now one chance in 10 million. I hope you would agree that's zero for all practial purposes. However, if you feel you need a 100% conclusive lab test, you should have an antigen-antibody (AgAb, "4th generation") HIV blood test 6 weeks or more after the event. There's little point in another oral swab HIV test. That test misses 2-3% of HIV infections even after several months.
The chances of gonorrhea, chlamydia, or syphilis are low but not zero after such an event. You might also consider having a urine gonorrhea/chlamydia test (at any time) and a syphilis blood test (best delayed until 6 weeks after the event).
3) There is no realistic risk to your wife or baby. If I were you, I would be continuing unprotected sex at home without worry. But if you remain nervous, wait until the additional tests are negative and then resume sex with your wife.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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66 months ago
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Thank you doctor for your response, everything you said was clear and helpful to me but I just have few concerns if that’s ok
1) I always thought that the oraquick mouth swab was 99.9 accurate at 3 months but you mentioned that it could miss 2-3 % I always liked using those because of the quick result, so are they not so reliable like I thought?
2) Is there a 4th generation hiv test where they can give me the results in the same day? Because what I hate about the hiv tests is that we have to wait almost a week for the results and the waiting makes me so nervous
3) how realistic could HIV be transferred to a baby through breastfeeding? Doesn’t the saliva inside the mouth have enzymes that supposed to kill the virus and it doesn’t survive inside the mouth? So how can a baby get infected from breast milk?
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H. Hunter Handsfield, MD
66 months ago
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1) The oral swab test is the only HIV test that does not achieve virtually 100% sensitivity. The basic problems is that the amount of antibody in crevicular fluid (i.e. secretions between tooth and gum) is much lower than in blood, and a few patients just don't produce enough antibody. My 2-3% statement is correct. In most cases it doesn't matter much. If someone's chance of having HIV is say 1 in a million -- which is pretty typical for nervous persons at fairly low risk, as you seem to be -- then detecting "only" 97% of infections reduces the chance that person is infected to around 1 in 30 million. Obviously low enough to be considered zero. But persons at real risk should never rely on the oral fludis test. In addition, even for the nervous/anxious sort, why wait 3 months when you can have 100% conclusive testing by 6 weeks?
2) Yes, point of care AgAb (4th generation) tests are available. Most experts don't have quite as much confidence as for lab based tests, but they are extremely good and miss few if any infections.
3) The risk by nursing is real but low. However, hard to estimate in the situation you're worried about.When chonically infected moms (often with low viral load) nurse their babies, only 15% of the kids acquire HIV and only after 6 months (despite swallowing a few ounces of mild daily). I'm not aware of any data on risk when a currently nursing mom becomes infected, because early in her infection she may have a sky high viral load.
Putting all this together, here is simply no chance you have HIV. Believe it and do your best to move on without worry.
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66 months ago
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Thank you so much for answering my questions doctor. You always make things so clear and useful. I have to admit that I’m a very nervous person. In the beginning after what happened I wasn’t really worried about it until like two weeks ago when I felt sick and I had a mild fever. And then 2 days ago my son had some fever too. And that’s when I started to get so worried and nervous and questioning myself. And that’s why I went and did the oraquick HIV test at home. I hope it’s nothing bad and maybe it was just the weather or allergy
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H. Hunter Handsfield, MD
66 months ago
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We all get minor infections (especially our young kids), and it's human nature to put two and two together. Iin this case, however, you came up with 2+2 = 3 or 5, but not 4! The frequency of thoss various minor infections is infinitely higher than HIV, even in people at much higher risk than you. Looked at another way, even among injection drug users or gay men having known unprotected exposures to shared needles or unprotected sex, colds and allergies are far more common than new HIV infection.
Thanks for the thanks. I'm glad the discussion has been helpful. Take care and stay safe.
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