[Question #8557] Chances of getting HIV from protected a male to male encounter?

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42 months ago
Hello, thank you for taking an interest in this question.

I am a male, 26 years old. Not very sexually active, sometimes even once every few months or a year. I have tested for covid few days before the encounter and was negative.

About two weeks ago I had a one night stand with a person who's HIV diagnose I don't know. I was the insertive partner (top) and used protection at all times. However at the end when I was taking the condom off, the lube that was on it and inside the person landed on my tip. It was a very little amount. 

Last time I was tested for HIV was a month ago. I was negative.

Approximately 6 days ago I started to feel like I have a minor cold. My body temperature is ranging from 37.0 to 37.7 C. My face constantly feels hot and something like pressure is concetrated in my head. Pressure might be from my constant higher than normal blood pressure that I had for years now. I checked my throat with a light and it had some white spots at the very back. I don't have sore throat but there is a very minor feeling like it is always somehow closed. I read that one of the HIV symptoms is oral thrush. I did not see any white thrush on the tounge but the very back of the throat. However I have a chronic sore throat for years now and always get sick from it. 

I don't have a skin rash, which I saw is one of the symptoms of HIV. 

Also there is a general feeling of bone/muscle ache or chills but no night sweats. However I get these frequently because of the air conditioning at work.

Very occasionally for the past few day I had minor headaches that feel like pressure. 

The major symptoms that concern me the most is the temperature, white spots on the throat a chills and muscle/bone pains.

What are the chances that it is HIV?
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H. Hunter Handsfield, MD
42 months ago
Welcome to the forum. Thanks for your confidence in our services.

Sometimes the title of a question says almost everything needed for an accurate reply. Condom protected anal or vaginal sex is very safe in regard to HIV and other STIs. So unless there's a surprise in the details, most likely you have nothing to worry about.

Now I have read the question in its entirety. Guess what?

Even with entirely unprotected anal sex (several minutes), if the anal (bottom) partner has untreated HIV, the risk of infection of the penile (top) partner has been estimated by CDC to be one chance in 900. In other words, it would take over two years of daily unprotected topping known infected partners before infection would be highly likely. Which if you think about it, makes a lot of sense:  there are an awful lot of folks at risk out there who advocate condomless sex and sometimes brag about doing it frequently and remaining HIV negative. Of course that might be after say 20, 50, or a hundred exposures -- i.e. with the odds still in their favor. What about the brief contact of your urethra with anal secretions or lubricant? HIV isn't so easily transmitted:  if the risk is only 1 in 900 from completely unprotected sex, what could it be after such a trivial contact? And I'll point out that you don't know that your partner has HIV; or if he does, whether he is on effective treatment, which is 100% effective in preventing virus transmission. These considerations don't mean your risk was zero, but certainly it was extremely low.

Your symptoms are totally nonspecific -- meaning they do not point to any particular cause. Certainly few cases of ARS would have only these symptoms. And if by "minor cold" you mean sniffles or stuffy nose, that actually argues against ARS, which generally doesn't cause such symptoms. I think you're right to mention COVID, which indicates it's on your mind. Given the current state of the pandemic, that's many times more likely the cause than HIV.

Given your concern, it would make sense to see a doctor or clinic with experience in HIV. At this time, an HIV blood test would be too soon to entirely rule out a new infection. However, a negative result on a standard antigen-antibody combo test (AgAb, i.e. "4th generation) WOULD rule out HIV as the cause of your symptoms: it isn't possible to have acute HIV symptoms without detectable p24 antigen and/or antibody. And I would definitely also recommend a COVID test as well:  two birds with one stone!

Note that I suggest HIV testing not because I believe your risk is significant, but as a means to rapid reassurance about HIV. Alternatively, speak with your partner (if you know how to reach him): if he assures you he is HIV negative, or positive and on treatment, or if he tests negative now, it would show you weren't at risk at all.

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

HHH, MD
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42 months ago
Thank you for your reply. This helped me a lot to calm down. 

At this time I'm kind of confident that I don't have covid yet because since last time I was tested I was very careful to follow all the precautions and didn't go outside much. 

But symptoms I have are a little unusual for me because I don't have runny nose or sneeze at all. The cold is mostly like vague feelings of being sick and body aches. But also one thing which is weird for me is that one lymph node on the left side of the throat is a little harder than right side but it's still small and not visible. It feels like the throat discomfort comes from this lymph node, and I can actually feel it.

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H. Hunter Handsfield, MD
42 months ago
Thanks for the follow-up comments. I'm glad to have been of help in regard to your HIV concerns.

Although COVID is off topic for this forum, as an infectious diseases and public health expert, I strongly recommend you follow through on the COVID possibility and get retested. It is good you're being careful to avoid exposure (and I hope you've been vaccinated!). But regardless of your past experience and the care you have taken to prevent exposure, it remains a good possibility for your symptoms. From both a personal health perspective you should know, and in a pandemic situation you have a strong ethical obligation to know if you have it in order to prevent transmission to others. 
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42 months ago
Thank you, 

Yes, sorry I didn't specify in my reply. I meant to ask if there is a chance that the symptoms were coming from HIV early stages.

I will of crourse get tested for covid as soon as possible.
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H. Hunter Handsfield, MD
42 months ago
Is there "a chance" your symptoms are due to ARS? Possibly -- if you consider under one in several million as "a chance". From a personal perspective, if somehow I were in this situation, I would not feel a need to be tested and would be continuing unprotected sex with my wife with no worry. But I'm not you and cannot make that decision for you. Should you decide to pursue the possibility, you do not need to wait:  HIV antigen and/or antibody always are present in people with HIV symptoms, so a negative result now would prove something other than HIV is the cause. Perhaps you would also like to know that in the 15 years of this and our preceding forum, with thousands of questions from people concerned they may have HIV, not one has reported a confirmed infection. You will not be the first. If and when that happens someday, I'm confident it will be from a legitimately high risk exposure, not a trivially risky event of the sort you have described.

Glad to hear you're on top of the COVID issue:  good show.

That completes the two follow-up exchanges included with each initial question and so concludes this thread. I hope the discussion has been useful.
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