HIV - Prevention Expert Forum
Exposure and Confusion about Risk
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Exposure and Confusion about Risk

Dear Doctors,

I have recently begun a relationship with a man who is HIV +. He is on meds and has been for a little less than a year. We recently had sex where I was the insertive partner (I am also a man, so it was anal sex), and he performed oral sex on me for a brief amount of time. We used a condom for the anal sex and afterward he showed the condom to me and all of the semen was still inside and there were no noticeable tears or rips. He did not use a condom when performing oral sex on me.

This was about 3 weeks ago tonight. Yesterday, I noticed under one of my armpits a bit of a rash. It is not itchy, but I am unsure of its origins. It is more patchy and red, about 2 - 3 inches in diameter or so. It's not painful, and this is the only symptom I have. I have had a dry, not sore, throat for a while now, but it is just annoying and not painful or sore.

My partner is very adamant about having safe sex, and we used a good condom that was not even close to expiration, and quite a bit of lubricant.

Can you provide me with some insight into my level of risk and whether I should be concerned?

Thanks so much.
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Welcome back to the forum.

It seems you are carefully following safe sex practices with your infected partner.  Oral sex is essentially no risk, especially for the insertive (penile) partner; and as long as the condom doesn't rupture, anal sex is also safe.  Equally important, with your partner on antiretroviral drug therapy, his viral load and potential for transmission are likely to be low -- even with unprotected anal sex or blood exposure.  However, I would suggest you speak with him about his viral load, if you haven't done so.  If it is low or undetectable, you would be at little or no risk even in the event of condom failure or if a condom were not used during anal sex.  (I'm not suggesting unprotected anal sex -- just attempting to reassure you about how low the transmission risk probably is.)

As for your rash, your description is not at all suggestive of an HIV infection.  The rash of ARS does not occur alone; there would always be fever and other symptoms.  And it is a body-wide rash, not localized as your is. The minor throat irritation also is not typical for ARS.  If your symptoms continue or you remain concerned, see a doctor for in-person evaluation and reassurance.

If your partner's viral load is low, he remains on treatment, and if your sexual practices do not change, you can ignore any and all minor symptoms that might occur.  You should have an HIV test about once a year -- but if these factors don't change, it need not be any more often than that.

Best wishes--   HHH, MD
8 Comments
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Thank you kindly for the prompt and thorough response, Doctor. I will avoid follow-up questions unless absolutely necessary for this response. You have taken an immense burden off of my shoulders over this ordeal, even though the rational part of my thought process told me I have nothing to worry about. Nonetheless, you have put many of my worries to rest, and I can't thank you enough for that.

Take care, and best wishes to you.
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239123_tn?1267651214
Thanks for the thanks.  I'm glad to have helped.  My only final advice is that you talk with your partner about accompanying him to his next appointment with his HIV doctor.  The two of you can have a conversation with the doctor about avoiding transmission, testing frequency, etc.

Best wishes for a successful, romantic, rewarding relationship.
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Avatar_f_tn
Thanks again for the responses, Doctor Handsfield. It is greatly appreciated. I am concerned about a small bump on my penis shaft (possible syphilis?). I will be going to be examined today.

My question is, if my HIV + partner did have syphilis when he gave me oral sex for the minute or two he did (maybe less), would this still be relatively no risk? I guess I am slightly confused about the risk of HIV transmission being increased with syphilis, and thought it would only apply if I had an active syphilitic chancre and were to say have unprotected anal sex.

Sorry for the followup, I know I said I would keep them limited. And I won't post again after this.
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Avatar_f_tn
Quick note about the chancre - It is the size of the tip of a pencil and hasn't grown or spread for more than two weeks. It's painless, and hasn't ruptured or opened into an actual sore or lesion. Looks like a tiny pimple, but I've never had one that doesn't go away with time.
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239123_tn?1267651214
For sure your penile bump is not a chancre, and I'm inclined to doubt it has anything to do with your current sex partner.  However, I would recommend you be examined professionally to determine the cause.
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Avatar_f_tn
Dr. Handsfield,

I just was curious about something regarding the window period. Am I correct in my understanding that a test 3 months after an actual exposure rules out HIV infection before the 3 months and all possible exposures? If I had unprotected sex with someone at the 2-month mark into my 3 month window, but that person has continuously tested negative, then I am good to go, right?

My understanding is that it will take no longer than 3 months to develop detectable antibodies if you were exposed and infected. Not that the 3 month window is continuously restarted with each possible exposure, specifically because it's not an exposure if the person doesn't have HIV.

P.S. Sorry for the followup. If you'd like, I'll gladly pay the posting fee again for your time.
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I'm a little confused.  This question started out with you being in a new relationship with an HIV infected person, but apparently you are concerned about other sexual exposures as well.

If you had a partner who was "continuously tested" with negative results, then of course you could not catch HIV and the window period doesn't matter.  Window periods for HIV testing apply only to sex with partners who have HIV or whose status is unknown.

Even if there is exposure to an infected partner or one whose HIV status is uknown, the real window is 4-8 weeks, depending on the specific test (or combination of tests) done.  It is rarely necessary to wait 3 months.  See the thread linked below:

http://www.medhelp.org/posts/show/1704700
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H. Hunter Handsfield, M.D.Blank
University of Washington
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