[Question #93] HIV "risk" for insertive heterosexual male

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105 months ago
Dr. Handsfeld,

I am writing to you today to enquirer about an experience I had. 

My question revolves around the following events:

Nearly 2 years ago, I, a heterosexual male, had unprotected vaginal sex with a commercial sex worker in Chicago. It was spur of the moment and lasted for 5-7 minutes.  If it matters, she was on top and I was on bottom.  She didn't appear to have any sores, rashes, or abrasions on her vaginal area. She was a younger female. She was 19-21 half Puerto Rican American and half Italian American.  She advertised her services on the internet.  Her time was moderately to expensively priced. She emphatically insisted she didn't have HIV or any STDs. She said she had gave birth a few months prior (I could tell by her stomach this was true) and had tested negative then and as well as a month before our encounter. If it's of any help, she said she too was "overcome" by the moment and only had sex with me because I was younger and good looking.  Most of the time, her clients just wanted hand stimulation etc.

I read your website 2 years ago and my initial concerns were allayed by both your and Dr. Hook's indications that straight men rarely, as an insertive partner rarely contact HIV from a single encounter. This, I was an unlikely candidate for PEP and most likely didn't need to rest regarding this specific instance. And, I generally didn't worry. 

I didn't have sex after that as I wanted to wait for a genuine relationship. Now, that time has come. And, today I went to go get an HIV test from my local municipal clinic. Due to budget cuts, I have to wait two weeks as the center is open sporadically at best. And, because I'm confronted with a potentially positive result based upon that experience alone, I wanted to reach out to you. 

My questions, if you could help me answer them are:

Do I have a 1 in a million chance of contracting HIV? (Based upon the likelihood of get having it at 1/1000 and the transmission of a single time if she is positive of 1/1000)

I have had no symptoms in 2 years. No: fevers, no nightsweats, no rashes, no flu like symptoms, no pneumonia like symptoms etc. Is the lack of symptoms a good sign?

Have you seen someone contact hiv from a one time exposure since medhelp closed?

Can I expect a negative result? (I know you can't diagnose me over the computer, but I want to see if my situation lines up with a "low/er" risk activity.

And, finally, if I can't stand to wait for the free test can I buy the oraquick test? (in the sense of do they generate a lot of false positives)

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H. Hunter Handsfield, MD
105 months ago
Greetings and welcome to Ask the Expert. Nice to hear from you again, after a past interaction at MedHelp (which obvioulsy I don't recall).

It seems to me the important thing here is that HIV testing overrules all other indicators of possible infection, i.e. symptoms or exposure history. You could have told me you had the highest possible risk for HIV (e.g. receiving infected blood by transfusion) and I would still say that if you HIV test is negative more than a few weeks later, you don't have HIV. You're planning to do that, so you'll know for sure in 2 weeks whether or not you have HIV. Almost certainly you do not, however. But as you suggest, you can use the Oraquick test at home. The rate of false positives is higher than with lab based tests, but still rare -- the vast majority of results are completely reliable. At this time, the anticipated negative result will be 100% reliable. Or you could arrange for a blood test through an online testing service.

As those comments imply, the chance you have HIV is zero or close to it -- probably lower than your 1 in a million estimate. Although your calculation based on exposure at the time makes sense, as you already suspect, the lack of symptoms in two years further reduces the chance. And no, since the MedHelp days my experience remains the same, no patients of mine acquired HIV from a one time exposure like yours. But really, that's entirely irrelevant anyway. I've never taken care of someone struck by lightning, but that fact doesn't change the odds it will happen to you. Rare things happen, whether or not the doctor you ask has had that experience.

I think that covers all your questions, but feel free to comment or ask anything that remains unclear. Best wishes and stay safe--   HHH, MD