[Question #9146] HIV Anxiety

35 months ago

Hello there, I am a male person and am currently losing sleep and dealing with anxiety. Back in late June say (28 or 29) I hooked up with a woman via a social media platform. We had protected sex with a condom until the end when she removed the condom and performed unprotected oral which escalated to unprotected sex for a minute or two. I did not project semen into her and we stopped right after. I thought nothing of it at that time, but here I am freaking out if I caught something from that hookup. Today I took a fourth-generation HIV test and I am scared of the results. I have been dealing with anxiety and losing sleep because of this. Am I overreacting to this? What are the chances of contracting STI or HIV from this encounter? Also, is there any risk of contracting STI via unprotected oral such as a handjob or a blowjob? Thank you guys in advance

H. Hunter Handsfield, MD

35 months ago

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

This event was lower risk for STIs and HIV than you might be thinking. Statistically, it is very unlikely a partner like your has HIV. And when a woman has untreated HIV, the average transmission risk for a single episode of unprotected vaginal sex is around once for every 2,500 exposures. (Many spouses of HIV infected persons never catch it themselves.) You definitely can expect a negative result on your HIV test. The antigen-antibody, i.e "4th generation" HIV blood tests always become positive within 6 weeks, so your negative result will be conclusive and you can stop worrying about HIV.

Oral sex is safe sex -- not completely free of STI risk, but far lower chance of infection than unprotected vaginal or anal sex. The portion of your condomless vaginal sex was much higher risk of infection than the oral sex part was. Oral sex is zero risk for HIV, for all practical purposes.

The risk of other STIs was higher, but still on the low side both for the vaginal and oral sex exposures. Even among the most sexually active persons, at any point in time most have no active, transmissible STIs (with the exception of HPV, more about which below). And with no symptoms after 2 months, you can be confident you didn't catch gonorrhea or syphilis, and probably not chlamydia. However, for complete reassurance on these infections, you could have a urine gonorrhea/chlamydia test and a syphilis blood test. With those negative results, plus your anticipated negative HIV test, you can move on without giving these events another thought.

I mentioned HPV because you can safely assume your partner has it -- at any point in time, over half of all sexually active people age 20-50 have HPV. But this doesn't elevate your own risk: assuming you have had at least a few other sexual relationships, you undoubtedly have already been infected with HPV, perhaps more than once. Therefore, this particular event does not significantly make your chance of having HPV any higher than it already was. Fortunately, the large majority of HPV infections are harmless and remain asymptomatic, never causing serious health problems.

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

HHH, MD

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35 months ago

Thank you doctor, just received my 4th generation HIV test and it was negative. I am in relief. Thank you for the answers, i am still looking for ways to be better protected and aware of sex. I know I’m asking too much but protected condom sex has no risk with HIV? I hooked up with two other woman in August and all of them were with condoms, so no HIV testing should be done on that? Just want to make sure. Thank you again doctor

H. Hunter Handsfield, MD

35 months ago

I'm glad to hear of the negative test result, but of course I am not surprised!

Condoms are highly protective but not perfect. The main problem is improper use, such as penetration, withdrawal, and reapplication for ejaculation, which is is quite common especially when people use condoms primarily for contraception. Clumsy use when intoxicated is an issue. And even when used perfectly, condoms can break. So there is no 100% protection from condoms. However, it is quite easy to assure sex only with uninfected partners (people rarely lie about their HIV status), which of course is important. And if you do have sex with an infected partner and the condom fails, even then the average transmission risk is only around once for every 2,500 exposures. So even with condom imperfections, if you always use a condom with care, you can be confident t you will never catch HIV.

If your sexual practices follow this advice, I would suggest an HIV test maybe once a year -- and no test after any particular exposure (unless you learn your partner has HIV, the condom breaks, etc). Does this make sense to you?

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