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HIV risk after condom break - I'm uncircumcised
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HIV risk after condom break - I'm uncircumcised

Hi, I think I know the answer to this question, but could use the reassurance.

I had a condom break after a one night stand with a girl in London.  I'm worried about my risk of HIV.

Background:

-I am straight white male
-She was a straight white female, and she said she was clean because she "just had a checkup".
-I am uncircumcised, but after the condom broke, only my head appeared to be exposed
-I'm not sure how long the condom was broken for, but it was a relatively, err, vigorous session
-In the morning I noticed there was some dried fluid on the bed sheets with a slight dark tint, like there was some trace of blood

It has been 5 weeks since this happened, and I've been paranoid that every weird itch or sneeze is the start of acute symptoms.  Fortunately, aside from a lingering cold, I haven't had any ARS symptoms, which I assume significantly increases the odds that I'm fine.  

What are the odds I have HIV?  I will go get a test soon, but I'm still deathly afraid of what I might find out.

Also, if I caught another STD, would I likely have symptoms by now?
239123_tn?1267651214
Welcome to the forum.  Thanks for your confidence in our service.

I'm happy to provide the reassurance you seek.  You are indeed at little or no risk for HIV from this event.  First, HIV is rare in women in London.  Last I heard, date from the UK Health Protection Agency (HPA) estimated an overall rate in sexually active women at under 1 in 1,000.  So unless your partner is at special risk (e.g., immigrant from southern Africa, injection drug user, etc), it's unlikely she is infected.  Second, if she had HIV, the average transmission risk for a single episode of unprotected sex is around 1 in 2,000.  Being uncirumcised roughly doubles the risk, i.e. 1 chance in 1,000.  In your case, maybe even lower, given the brief exposure after the condom broke.  So in a worst case scenario, we can roughly estimate the chance you caught HIV at 1 in a million (0.001 x 0.001 = 0.000001) -- and probably lower than that.

ARS symptoms are very poor predictors of new HIV.  The most typical usually are due to other causes.  Likewise, lack of ARS symptoms also don't make much difference.

As for other STDs, lack of symptoms is only slightly reassuring.  Chlamydia is the single most common, potentialy serious STD in this situation and often is asymptomatic.

Don't hestiate to be tested for HIV and common STDs (chlamydia, gonorrhea, syphilis).  Your local NHS GUM clinic would be an excellent choice for expert, lifestyle-sensitive care.  Routine HIV testing in the UK and at GUM clinics is the duo test, which is virtually 100% accurate at 4 weeks and beyond, so you needn't delay.  For the reasons above, you can count on a negative result.  And enough time has passed for accurate testing for the others as well.

Feel free to return to let me know your test results.  But stay mellow in the meantime.  Certainly the HIV test will be negative, and probably the others as well.

Best wishes and happy holidays--  HHH, MD
7 Comments
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Avatar_m_tn
Thanks for the quick reply.  I was actually on a trip and live in the US.  Do clinics here also have tests that would be accurate at 5 weeks in?
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Avatar_m_tn
And one more thing to add: does the possible presence of blood in the vaginal fluid significantly change the risk?
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239123_tn?1267651214
The duo test (for both HIV antibody and p24 antigen) is not as frequently used in the US as in most industrialized countries.  You can phone your local health department to see what test(s) they offer.  Or just wait a week; the standard blood tests for HIV antibody in standard use are fully accurate at 6 weeks or more after exposure.  (You'll see a lot of outdated information on the web and elsewhere about 3 months for reliable results.  It isn't necessary to wait that long.)
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Avatar_m_tn
I have a couple quick follow up questions that I'm hoping you can help me with.

1) I noticed that there was some dark color to the left over fluids on the bed.  I think this means there was some blood.  Does this increase the risk by much?

2) I'm curious why a lack of symptoms is not a good indicator that someone did not catch HIV. I realize that the presence of symptoms is not good way to diagnose a positive result because there are so many other potential causes so the specificity is very low.  Going on the inverse, most people who do have the virus do get symptoms with ARS.  So, wouldn't the fact that I had no flu like symptoms be like taking a test and seeing a negative result with say an 80% sensitivity?

I realize that testing is the only gold standard so I more ask this out of curiosity.
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Avatar_m_tn
I have a couple quick follow up questions that I'm hoping you can help me with.

1) I noticed that there was some dark color to the left over fluids on the bed.  I think this means there was some blood.  Does this increase the risk by much?

2) I'm curious why a lack of symptoms is not a good indicator that someone did not catch HIV. I realize that the presence of symptoms is not good way to diagnose a positive result because there are so many other potential causes so the specificity is very low.  Going on the inverse, most people who do have the virus do get symptoms with ARS.  So, wouldn't the fact that I had no flu like symptoms be like taking a test and seeing a negative result with say an 80% sensitivity?

I realize that testing is the only gold standard so I more ask this out of curiosity.
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239123_tn?1267651214
1) Vaginal sex during menstruation does not significantly increase the risk of HIV compared with sex at other times.

2) The symptoms of ARS are very nonspecific -- meaning the identical symptoms occur in many other conditions, mostly minor.  Even after high risk exposures, and even when ARS symptoms are typical, usually they are caused by something other than ARS.  It is true that up to 80% of people with new HIV have symptoms, but many such cases are very mild.  Symptoms, whether present or absent, always are far less reliable than the blood tests in judging whether or not someone is infected.
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