[Question #9620] HIV condom broke menstruation
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30 months ago
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Hello,
I am a male 35 years old from Europe. Before 15 days I had vaginal sex with a woman early 30s who I met recently. She was menstruating and the condom broke leaving me without protection for 1-3 minutes before I realized it. As you can suspect blood was also on my penis. We decided to do testing for HIV, Hep C+B. I have to mention that after sex and a lot of anxiety and frustration, confessed me she had Hepatitis A before many years. Next day because I was very frustrated and panicked, I went to an emergency hospital and gave me PEP which I took for 2 days. Tests after 3 days came negative for her and me (HIV test antib+antigen duo) and so a hospital specialist told me to stop PEP. The girl seems a bit promiscuous and not so trustworthy as she is dating another man for months (who’s status is unknown) but always using condom for sex as she stated.
After 10 days of the encounter I had an enlarged lymph node in my left armpit, painful to touch and while moving arm. 3 days after the node was gone but another one seems to appear now(can not trace clearly) lower on same armpit as I have same kind of pain near pectoral muscle and armpit. Also have a stiff neck and muscle pain while turning my head left, and a weird dull pain on the left shoulder top while abduct arm. Have a slight sore throat and some form of headache. NO fever of rash.The woman had a serious illness with high fever (39o C), excessive cough, headache, chills and fatigue a week before we had sex. She said she was positive initially for Covid and later on tested positive for H1N1 influenza rapid test.
1.How do you evaluate this incident for HIV infection possibility?
2.Could I have contracted HIV but the PEP had lower the intensity or duration of my symptoms?
3.Is it possible the woman was ill from possible previous infection of HIV ARS symptoms and the rapid test for COVID/ H1N1 cross reacted as false positive?
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Edward W. Hook M.D.
30 months ago
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Welcome to our Forum and thanks for your questions. I'll be glad to comment. This was a low risk event and, based on the information you have provided, you can be confident that you were not exposed to HIV. Let me provide some comments:
2.Could I have contracted HIV but the PEP had lower the intensity or duration of my symptoms?
3.Is it possible the woman was ill from possible previous infection of HIV ARS symptoms and the rapid test for COVID/ H1N1 cross reacted as false positive?
1. The exposure to your partner's menstrual blood was no more risky than exposure to vaginal secretions during unprotected intercourse. The amount of virus in blood and genital secretions is about the same.
2. The fact that your partner tested negative for HIV following your encounter is strong evidence that you were not exposed to HIV. I agree with the recommendation to stop PEP.
3. Her past hepatitis A in no way increases or decreases the likelihood that she had HIV. Hepatitis A is a foodborne illness and is not transmitted in the same way that HIV or other forms or hepatitis is.
4. The lymph node in your armpit does not sound like the lymph node swelling associated with recently acquired HIV which is generalized and occurs in many location. It sounds as though there was some sort of inflammation on the left side of your body, perhaps in the hand or arm.
5. Her symptoms a week before you had sex is explained well by her positive tests for COVID-19 and influenza.
Thus, in response to your specific questions:
1.How do you evaluate this incident for HIV infection possibility?
See my comments above. There is good evidence that you were not exposed to HIV.
2.Could I have contracted HIV but the PEP had lower the intensity or duration of my symptoms?
No. See my reasoning above.
3.Is it possible the woman was ill from possible previous infection of HIV ARS symptoms and the rapid test for COVID/ H1N1 cross reacted as false positive?
No, there are no data to suggest that the ARS causes falsely positive tests for COVID or influenza.
I would not worry that you were exposed to HIV. I encourage you to continue to use condoms going forward. Although they break about 1% of the time they are used they remain excellent protection against both HIV and other STIs. EWH
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30 months ago
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Thank you for the fast reply.
My concern is HIV and sadly i am overthinking that she had viral symptoms (explained as tested positive for covid and H1N1) maybe due to ARS hence why I had mine right know at an exact right timeframe of a contraction.
Since the duo test has a window period of 4 weeks, I am frustrated if she had contracted the virus between this period and eventually expressed it the week before we met.
Combined though my enlarged lymph nodes, are neck muscle stiffness and sore throat worrisome for acute seroconversion of HIV?
Furthermore what do you suggest to do now? I am thinking of testing again but when do you think is the right time to show true results unaffected from PEP? I am really worried that I might contracted HIV so its difficult to have patience.
Also i was just wondering, do you find the nature of the incident worthy for prescribing PEP at first place?
Thank you again
Furthermore what do you suggest to do now? I am thinking of testing again but when do you think is the right time to show true results unaffected from PEP? I am really worried that I might contracted HIV so its difficult to have patience.
Also i was just wondering, do you find the nature of the incident worthy for prescribing PEP at first place?
Thank you again
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Edward W. Hook M.D.
30 months ago
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Your questions have, in large part, an answered above. Repeating the questions using slightly different words, will not change the answers. The fact that she had a negative test for HIV following you were encounter is evidence that she could not have transmitted HIV to you. Persons with negative tests do not transmit infection. Persons who are experiencing the ARS always have positive tests. If her viral symptoms which occurred the week before your encounter were due to HIV, her HIV test would have been positive following your encounter.
Testing is always a personal choice. If your swollen lymph nodes were due to HIV ( I am sure they were not) an HIV test would be positive at this time. I am confident that if you choose to test at this time, your HIV will be negative proving that you’re a muscle, stiffness and swollen lymph nodes are not due to HIV.
Similarly, taking pet is a personal choice as well. My recommendation would have been not to take PEP as your encounter as described was quite low risk to start with.
EWH
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30 months ago
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Hello Doctor,
I did a test for HIV (4th gen DUO) at 32 days after the incident with the girl. It is negative and so i feel a bit relaxed. Although i wanted to ask you if i can rely on it as concusive results? I know by the latest standarts of the HIV 4th gen test is considered 100% after 6 weeks. Should i do it again though to be sure?
Also, since i took PEP for two days after the incident, could this be a reason to delay the expression of antibodies in my test and therefore should i repeat testing after a longer period of the testing timeframe?
Thank you for your responses and reassurance so far.
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Edward W. Hook M.D.
30 months ago
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You were 32 day test results rule out HIV with a more than 99% probability. Considering all of the other factors that you have already mentioned, I would have no further concerns and would see no need for further testing.
The two days of PEP that you took, should not in anyway influence the accuracy of your test results.
I hope that with this information, you will be able to move forward without continuing concern.
This third response includes this thread, which will be closed shortly without further responses. Take care. EWH
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