Are the chips stacked against me?

[julgirl123]

In the past month I've had sexual encounters with 3 diff men (I am female).  With two of them it was only kissing and unprotected oral sex and I did not allow either of them to ejaculate in my mouth.  Both of these guys were white, hetero, circumcised, and said they were clean.  Neither of them had any lesions, warts, bumps, or cuts on their penis.  The third guy is a bit different.  I had 3 rounds of intercourse with him inthe course of a few hours.  The first two rounds I insisted on using condoms for both the vaginal and anal sex we had.  I did perform unprotected oral.  For 3rd round...in the heat of everything...I foolishly
went and had uprotected vaginal and then unprotected anal sex.  I did not allow him to ejaculate in me not that it means anything.  This guy was white and hetero but since he was born in europe was uncircumcised.  I noticed no lesions, warts, bumps or cuts on his penis.  I also asked him before and after our session if he had any stds and he stated he didnt and that I didn't need to worry.  But since I broke my rule and went condomless of course I'm worried.  Ok now my questions:

1) since unprotected anal is the highest risk for hiv transmission and unprotected vaginal a close second, where does this place me in terms of my risk?
2)since he was uncircumcised does this make my risk even higher?
3)I have to take avonex for ms but hadn't taken it for a month before my encounter...because this drug messes with your immune system could this make things riskier?
4)I know that a test at 3 months is considered conclusive so I will take one then but can I be reassured by a negative result at 6 wks or so?  
5)will I need to test beyond 3 months if results come back neg. Based on my situation?
6)is it ok for me to have protectected sex/unprotected oral while I'm waiting for results or will this mess up any results I get and ill have to start counting out days/weeks again?  

Thank you for your time and assistance

[Edward W Hook, MD]

Great.  Glad I could help.  EWH

[julgirl123]

Dr. Hook,

Thank you very much for your time and responses.  I will do my tests and I have resolved to only practice safe sex from now on.  Sex is just not fun without being smart about it.

[Edward W Hook, MD]

Yes, an OraQuick Rapid HIV test will provide a reliable answer at 8 weeks.  I anticipate that your test will be negative.  EWH

[julgirl123]

I will definitely test for other stds.  In terms of the 8 weeks, does this include using the OraQuick rapid hiv test?  

[Edward W Hook, MD]

Welcome to the Forum.  I'll provide some information which I hope you will find helpful.  By way of background, HIV is pretty uncommon among heterosexual men with fewer than 1 in 1000 being infected.  Further, even with higher risk exposures such as anal sex, most exposures do not lead to infection.  Thus the odds of you having been infected in the exposures you mention are low.  Let's work through your questions:

1) since unprotected anal is the highest risk for hiv transmission and unprotected vaginal a close second, where does this place me in terms of my risk?
You are correct that different sorts of exposures have different risks and that rectal sex has about the highest associated risk.  If your partner has HIV, here is no meaningful risk of infection from giving or receiving oral sex.  The risk with unprotected vaginal sex is about 1 infection per 1000 exposures to an infected partner which for receiving rectal sex the risk goes up to about 1 in 100.  Infection can occur without ejaculation although risk is probably somewhat higher (hard to say how much) with ejaculation.  As you know, properly use condoms make the risk essentially zero.

2)since he was uncircumcised does this make my risk even higher?
The lack of circumcision makes him more likely to acquire infection if exposed and thus makes him slightly more likely to have been infected in the past.  If he was infected, there would be little meaningful increase in risk of transmission to you over the average figure I mentioned above.  

3)I have to take avonex for ms but hadn't taken it for a month before my encounter...because this drug messes with your immune system could this make things riskier?
Obviously this has not been formally studied but there is no reason that the avonex, or your MS, make you more likely to acquire infection.

4)I know that a test at 3 months is considered conclusive so I will take one then but can I be reassured by a negative result at 6 wks or so?  
Actually, at this time we consider an 8 week test conclusive. We are not aware of any instances in which it has taken more than 8 weeks for a test to become positive in at least 3-4 years.  The 3 and even 6 month recommendations are based on older tests and are too conservative.  

5)will I need to test beyond 3 months if results come back neg. Based on my situation?
No.

6)is it ok for me to have protectected sex/unprotected oral while I'm waiting for results or will this mess up any results I get and ill have to start counting out days/weeks again?  
Having sex between now and the 8 week result will not mess up your test results.  If you do however, please you condoms.

Finally, you are at higher risk for other, far more common STDs, like chlamydia and gonorrhea than HIV.  I suggest you get yourself tested at all recent sites of exposure.

I hope these comments help.  EWH