[Question #8501] HIV Prevention

43 months ago

Hi Doctors,

Happy New Year! I had vaginal sex multiple times with a woman of unknown status on 12/12/21 and 12/14/21. I used a condom every time. However, after I had pulled out after sex I noticed that some fluids had entered the base of the condom that were not my semen. It looked as if there was a potential air bubble in the condom too. This was all while the condom was still on my semi erect penis. Nevertheless, the condom did not appear to have been broken. I say this because when I removed the condom my semen stayed at the base of the condom and did not leak out. All 3 times the woman and I had sex when I checked the condom I noticed the same thing that I described.

On 12/22/21 I came down with a sore throat, fever (103 F), body aches and slight congestion that lasted approximately 10 days (my fever only lasted 2 of those 10 days.) Although all of my symptoms have gone away, I still have a bit of fatigue that is lingering til this day (1/7/22).

In addition to this, the girl that I had sex with just informed me that she came down with a sore throat, fever, body aches and cough yesterday (1/6/22). She claims that she feels incredibly sick. She has informed me that she has been sleeping with other men. Therefore, I was wondering a few different things:

1. Is it possible that her vaginal fluid had entered via the base of the condom and somehow entered my system? I’ve always put on condoms the way that websites have shown they should be put on but perhaps I’ve been using the wrong size.

m I2. Am I experiencing HIV ARS? And is she possibly experiencing HIV ARS and was therefore highly infectious when her and I had sex?

3. Should I refrain from having sex with others (even with a condom) until I have been screened with an HIV Duo Test 6 weeks after possible infection? I just want to make sure I'm not putting anyone else at risk.

Thank you so much for your assistance! I can’t tell you how much I appreciate it.

H. Hunter Handsfield, MD

43 months ago

Welcome back to the forum. Thanks for your continued confidence in our services.

First, condom protection is considered complete as long as the head of the penis and meatus (urethral opening) are covered. It is entirely normal for genital fluids to contact the skin above the penis, and for fluids to work their way under the upper part of the condom. During sex, it's common for the penis to slide to some degree inside the condom. These are among the reasons condoms offer less complete protection against STIs transmitted by skin-to-skin contact, like HPV, herpes and syphilis; while remaining nearly 100% protective against those transmitted by genital fluids, like chlamydia, gonorrhea and HIV. So you can consider your exposure to have been well protected against HIV. And even among the most sexually active women in the US, HIV remains quite rare, and it is statistically unlikely your partner has HIV.

As for your symptoms, they aren't entirely typical for ARS, which generally does not cause nasal congestion or cough. It sounds more like you both had a respiratory virus (possibly COVID-19) than ARS.

To your specific questions:

1) Discussed above. It indeed is possible vaginal secretions worked their way under the rim of the condom, but that doesn't imply risk for HIV.

2) Also discussed above. I can't give you 100 assurance against ARS, but it is very unlikely. You and your should be tested for HIV, however -- better safe than sorry, and the anticipated negative results probably will be more reassuring than anything I can say.

3) You don't need to wait until 6 weeks after exposure to be tested for HIV. If your symptoms were ARS, an antigen-antibody (AgAb, 4th generation) HIV blood test would be positive now. The symptoms of ARS are not due to HIV itself, but are caused by the immune response to the virus. A negative result now will not prove 100% you didn't catch HIV (for that, you do need to wait until the 6 week mark). But it would show that your illness was not ARS. Same for your partner: I recommend you speak with her and recommend that she also be tested for HIV. You can expect negative results. It makes sense to hold off on sex until you have the result, just common sense -- but that doesn't mean I think it is likely you have HIV. (In the 16 years of this and our preceding forum, with thousands of questions from persons concerned about new HIV infection, nobody has ever turned out to have it. I'm confident you won't be the first!)

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

HHH, MD

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H. Hunter Handsfield, MD

43 months ago

Addendum: I forgot to mention another option to immediately resolve your concerns about HIV and ARS. Since you're in touch with your partner, why not discuss both getting tested? If both negative for HIV, you'll both know you could not have been exposed and that something else explains both your symptoms and hers. (You could also discuss COVID testing, if not yet done.)---
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43 months ago

Hi Dr. Handsfield,

Thank you so much for the information, it is greatly appreciated! My partner actually just tested positive for COVID using an at home testing kit. I did not have access to a test when I was experiencing my symptoms but I isolated for 10 days in case I did have COVID therefore, I’m fairly certain my symptoms were indeed due to COVID. I will still get tested for HIV/STIs in the next few weeks because I make a point to be tested every 3-6 months. Given this updated information would you advise I still refrain from having sex with others until I am tested?

Unfortunately, I have immense levels of anxiety regarding HIV that has had a significant impact on my sex life. Although I use condoms consistently I am always deathly afraid of catching HIV to the point where I drive myself crazy with fear after each sexual act. I'm currently going to therapy for this. I’ve asked my doctor if I could go on PREP because I’m sure this would help alleviate my fear but she advised against it. I wanted to see what advice you would give. I am a heterosexual male who never has anal sex with women. I have multiple partners but I always use a condom. Nevertheless, I want to do anything and everything I can to avoid contracting HIV. Thank you so much again for taking your time to read this and all of your advice.

H. Hunter Handsfield, MD

43 months ago

Thanks for the follow-up comments. COVID seems the logical explanation for both your illnesses.

You describe an exceedingly low risk sexual lifestyle in regard to HIV risk. I agree with your doctor: I would not advise or agree to prescribe PrEP in this situation. The large majority of heterosexually transmitted HIV infections occur in the regular partners of infected persons, usually someone whose risk factors are unknown to the spouse/partner (think of the deeply closeted gay man or injection drug user). One-off occasional exposures like you have are very rare sources of HIV. Avoid partners with obvious high risk, such as known-infected women, those who use IV drugs, etc. With that plus condoms, you'll never catch HIV -- or a risk so low you truly can disregard it.

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43 months ago

Dr. Handsfield,

Thank you so much again for the information! I'll definitely take that advice to heart. I really appreciate all of your help and this forum is absolutely amazing. I hope you have a wonderful weekend!

H. Hunter Handsfield, MD

43 months ago

Thanks for the thanks. I'm glad to have helped. Take care and stay safe.---