[Question #7511] HIV Concern

3 months ago
I started to get involved with a guy that I have only slept with twice, he is a firefighter. I first slept with him on June 14th and we used condoms. I was tested and cleared of everything including HIV on September 17th. By the way I have not had any sex with anyone  else in between. I stop seeing him but later met up within again recently on December 20th.  I also slept with him and used condoms but he at one point he rubbed his penis on my virgina with out a condom. However when he entered me he had a condom. We only had vaginal and oral sex.  I will schedule full std testing in February. The reason I am concern is that 24hrs after I had sex with him, I had a cold sore outbreak on my lip. I have had these cold sores appear in the past so it’s not new but I haven’t had an outbreak in years so it is worrisome. Also I have experience chest pressure  and back pain, I don’t know if this is my anxiety acting up but I felt really guilty. I have had no fevers or sore throat but I am still concern about HIV.  The guy is a very attractive and I am sure very sexually active and I am scared that I might have put myself in danger. Also should I look out for anything else as far as STDs go 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Welcome back to the forum. I'm glad to see you're not asking this time about HIV test reliability. Given those past concerns, I'll start by reassuring you (again) that if you decide to be HIV tested, an AgAb test (4th generation or "duo" test) 6+ weeks after the last possible exposure will be conclusive, no matter what symptoms you may have now or later.

Assuming you're in the US or other industrialzied country, the chance a partner such as your has HIV is nearly zero. HIV is less common than you might assume men without special risk factors (sex with other men, injection drug use, etc) -- no matter how sexually active they are with female partners. In addition, it seems you had only safe sex, i.e. consistent condom use for vaginal sex. GEnital contact without penetration ("at one point he rubbed his penis on my vagina without a condom") is little or no risk. Same for unprotected oral sex. The risk for other STDs is higher, but still low. As for your symptoms, they do not suggest a new HIV infection or any other STD.

The sympoms you describe do not suggest HIV or any STD. I'm sure they are unrelated to the sexual events described, unlessrelated to anxiety about the situation (as you suggest yourself).

I can't tell from all this whether you have an ongoing relationship with this partner or might consider it promising for the long term. If so, my main advice is that you discuss mutual testing. If both of you have negative results for HIV, syphilis, gonorrhea and chlamydia, you'll both know you could not have infected one another. (Maybe you would find he is just as concerned about STD/HIV risks as you areand would appreciate the opportunity for simultaneous testing.) If not, you could consider having vaginal swab or urine testing for gonorrhea and chlamydia, and perhaps a throat swab if you performed unprotected oral on him. These are reliable and conclusive any time more than 3-4 days after exposure. And have blood tests for HIV and syphilis 6 weeks after the last event. But in the meantime, stay relaxed and don't worry:  this was a very low risk situation and it is unllikely you caught anything.

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

HHH, MD
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3 months ago
I want to thank you for taking time to answer my question. 

By the way I am in NYC.  In regards to oral sex, I have never been tested or was concern before but I will test soon. I will test at 6+ weeks from the event just to be safe and peace of mind.  I have also asked him to get tested to be safe, he has told me that in the past he has been tested and claims to be clean and that he always practices safe sex. 

Question 
1) Are there any symptoms that I should look out for that would indicate if I caught something orally ? 

2) How soon do symptoms appear ? 

3) How likely are people to get STDs orally ? 

4) What kinda STDs can you get commonly through oral sex ? 

5) How safe are condoms, if let’s say the person you had sex with had an STD (HIV) ? 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Thanks for the additional information. It tends to confirm my belief that your partner is unlikely to have HIV.

1,2) Oral STDs are almost always asymptomatic. A sore throat or oral sores could occur, but both of these have many causes -- not usually STDs. If symptoms do occur, they could show up anywhere from 2 days to several weeks.

3) Uncommonly. In general, oral sex is safe sex:  the risk of STDs isn't zero, but a lot lower than for vaginal or anal sex.

4) Gonorrhea of the throat is the most common that is potentially serious.

5) Condoms are highly effective in preventing STDs transmitted by genital fluids (gonorrhea, chlamydia, HIV); less effective, but still quite good, against those transmitted by skin-to-skin contact (herpes, HPV, syphilis).
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3 months ago

Thank you again for answering my questions. 


Just for peace of mind. 

  1. For example if I slept with an infected partner (HIV positive) and they were not aware of their status, with a condom. What would be the likelihood of me catching this disease ? And what would it be if I had no condom both scenarios with vaginal sex. 
  2. If a person caught HIV from another person what symptoms could they expect and how soon would they appear ? 
  3. I mentioned before 24hrs after having sex with this man I developed a cold sore on my lip, which I mentioned before not very common to appear, could this be a strong indication that I could have caught an oral STD ? Or that I should be concerned about HIV. 
  4. In your opinion, if I were your patient would you be concern about this Encounter, in regards to recommending HIV or STD testing ? 
  5. What is the likelihood that a man such as the person I slept with could have HIV, Heterosexual- Male, 27yrs   Old, Ethnicity- caucasian, Professional (NYC Firefighter) have something like HIV ? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
1. As calculated by CDC, the average transmission risk to a female partner from unprotected vaginal sex with an HIV infected male partner (not on treatment for HIV) is around 1 in 1,000. (That's equivalent to daily sex for 3 years before transmission is highly likely.) With a properly used condom, probably a hundred-times lower, i.e. 1 in 100,000. If the male knows he has HIV and is on adequate treatment anti-HIV drugs, zero transmission risk. 

2. Read up on "acute retroviral syndrome", or ARS. The most common symptoms are sore throat, fever, enlarged lymph nodes, and skin rash, with typical onset 7-14 days after infection. The symptoms usually persist 2-4 weeks. However, half of all newly infected persons notice no symptoms at all.

3. A fresh outbreak of oral herpes is important for your partner, not you. You must tell him about it:  if he has not had HSV1 himself, he is at high risk for new herpes, either oral from kissing or genital if you performed oral sex on him. However, active oral herpes has no effect on your risk -- no increased risk of HIV or any other STD, as far as known.

4. From a medical or risk perspective, I would not advise my patients (or persons close to me, e.g. a family member) that testin is necessary for HIV or anything else. In general, testing usually isn't necessary after any single encounter unless the risk is a lot higher. A smarter approach is for persons who are sexually active with occasional new partners to have routine testing once a year or so (for gonorrhea, chlamydia, HIV and syphilis), rather than worrying about any particular event. However, some people can't handle the stress of not knowing and are more reassured by negative testing than by professional opinion based on probability and statistics -- no matter how expert. If that applies to you, get tested. Your choice.

5. Such a person has no more than 1 chance in a thousand of having HIV -- probably a lot less than that. The chance he has other STDs is higher. Half of such persons have HPV (and so do you, probably -- it's normal in all sexually active persons). There is maybe a 1% chance he has gonorrhea, maybe 2-5% chance of chlamydia, and a is few percent likelihood of genital herpes (although most with herpes aren't tranmissible at any point in time). The chance of syphilis very low, on the same order as HIV risk.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Happy new year and stay safe (as you have been).
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