Hiv risk after anal sex with transsexual and Combo test

[giulian]

Dear Doctor, I live in Israel. I am married. I got drunk and I went to visit a woman and paid for her service. She was a transsexual. She looked very clean, apartment very clean and she was very gentle and not drunk. We had oral sex and anal. I was active. At a certain point I wanted to go to the toilette and I didn't see the condom. I asked and she said "I put u the condom and I take it out now, you are too drunk”. I came back from the toilette she invited me to look into the garbage close to the bed to see the condom. The condom was there but I can't be sure it was mine. When I went to the toilette my penis was not with liquid or dirty. I called her. Again I asked and she said that she used the condom, I was too drunk and that anyway she does frequent tests and she is ok. If I am really stressed she would show me the last test result. She said she is only 21 years old, have a boyfriend, all life in front of her and she protect herself and her body first then the body of the others for her health. I went to the hospital. Did a blood test for HIV and for hepatitis, a doctor sent me to a specialist. I met with the responsible of the immunology department: he said in my case the chance is very low and it's not necessary to take the medicine of the 72 hours. He said that the "girl" doesn't have reasons to lie, so probably she used the condom. In case she didn't again the risk I got the HIV, in case she would be sick, is very low. He gave me vaccine against sexual diseases + antibiotic.  Blood checks for both HIV/hepatitis prior that night was negative. The specialist said to do a Combo test 3 weeks later to be sure. Do you think the chance that I got HIV is real low in my case? If are low, how much low? Is it ok 3 weeks COMBO test? Difference to do the Combo test 3 or 4 weeks later? How do I need to behave with my wife? I am not doing sex with her.If the woman is HIV positive, what's the chance I could get the HIV with anal where I was active? Thanks a lot. Max

[Edward W Hook, MD]

As I have already told you, the exposure you describe was very low risk for getting HIV.  Now, 4 weeks later, you have a negative antigen/antibody test which would be expected to detect about 95% of infections if they had occurred.  My sense, based on what you have told me, is that you have no reason for concern about HIV.  The decision about sex with your wife, given these facts is up to you.  EWH

[Edward W Hook, MD]

Welcome to our Forum.  I will confirm what your doctor has already told you.  there is very, very little risk that you got HIV from the exposure you describe.  Here are the reasons why:

1.  Your partner told you she did not have HIV and gave you details which make it very likely she was telling the truth.  That she offered to show you her test results further supports that she was telling the truth.
2.  She said a condom was used and you saw a used condom.  Again, this is good evidence that she was telling the truth to you and that a condom was use.
3.  Even if she had HIV and if a condom was not used, both of which are unlikely, your risk of getting HIV from a single act of anal intercourse is less than 1 infection per 100 sex acts.  The odds are very much in your favor.

Your risk for HIV from the exposure you describe in close to zero and not something to worry about.  At 3 weeks a combination antibody/antigen test will detect well over 90% of infections acquired 3 weeks earlier.  At 4 weeks the proportion of infections detected is even higher.  At whichever time you get tested I predict the result will be negative, proving that you did not get HIV.  

It is most unlikely that your wife is at any risk because of the behavior you describe. Take care.  EWH

[giulian]

Dear Doctor,

After 4 weeks from the "event" I did HIV 1,2 Ab's + P24 Ag and the result is negative.The Doctor there said its not definitive and I need to do HIV test in 30 days from now to have 2 months and to be sure 100%.Looking at my case what do you think?I am married and I don't know what to do or say anymore to my wife.1 month I don't have sex with her because I am afraid for her and she is asking questions.Following the Doctor advise I shouldn't have sex with my wife for another month,then test again and only if negative come back in life.
Please,tell me what you think looking at my first email.
Thanks a lot!
Max

[Edward W Hook, MD]

The combo test will detect more HIV infections soon after infection than the standard test which detects only antibodies.  After 8 week the two different types of test (standard and combo tests) are equal.  
EWH

[giulian]

Thanks for your answer.Sorry for my English but I didn't understand the last part of your answer,also I am not an expert in terminology.
"The answer is yes but how much of an improvement of that would be over a standard combination antigen/antibody test is unknown. Probably not an awful lot."
I just know exist this combo test and the regular hiv test..
In my previous posts I understood that in my case the combo test after 3 weeks give me 90% result and after 4 weeks much more.
Can you explain me better please?
I got confused and don't know what's best to do at this point.
Thanks a lot.
Max

[Edward W Hook, MD]

In the period between 2 and 4 weeks antibody production, on average, is increasing most quickly.  Waiting until 4 weeks will give you the best result.

The unstated implication of your question is that you are wondering if a negative PCR test at the time you get tested would give you a higher degree of assurance that you are not infected.  The answer is yes but how much of an improvement of that would be over a standard combination antigen/antibody test is unknown.  Probably not an awful lot.  EWH

[giulian]

Dear Doctor,

Next Monday will be 22 days from the "event" and I would like to do the Combo test.I have the possibility to wait another week since my wife is abroad but I am struggling to wait.Looking at my case, 22 days or 28 days from the "event" doing a Combo test what's the difference in terms of testing 3 weeks or 4 weeks after the "event".What do you suggest me to do and is there anything other test I should do beside the Combo one?
Thanks a lot
Max

[Edward W Hook, MD]

This 1% risk is operative IF your partner was infected.

Hepatitis C is very rarely sexually transmitted and should not be a concern.  As for hepatitis B, this risk is a bit higher as hepatitis B is more easily transmitted than HIV.  If you have not been vaccinated, you should be and sooner is better.  Protection if you are just starting the vaccine now, post exposure, is not perfect but there is protection to be derived.  You might have your doctor test to make sure that you have not already unknowingly had hepatitis B - many people who have had it do not know it and get over it.

Yes, with the antibiotics you need not worry about other STDs, particularly if your tests were negative (and if you were not tested, you should have been but there is nothing to do about that now).

read comments about testing above.  If you have access to a combined antigen/antibody test it has slightly increased sensitivity, particularly over the first 4-6 weeks following exposure.  How much more is hard to say.   the antibody tests by themselves are very good.  EWH

[giulian]

Dear Doctor,

thanks for your answer. I leave apart the stress and how bad and stupid I feel for what happened, especially because it was my first time in life and I am not used to this behaviour.
1 infection per 100 sex acts means I have 1% risk if I am not mistaken? It seem to me very risky..
What's the risks to get Hepatitis B/C in my case? Because if the HIV is a low risk as you said, the Hepatitis where it stands in the scale? The doctor said to do vaccine for B and 8 days are over. How this protect after exposure if I do it now or in a couple of days? What the risk for the C?
Also, I did vaccines against sexual diseases and got a one time antibiotic (1000 mg), can I be relaxed about other diseases?
Combo test, exist a way to do the test and get an immediate or almost answer?
Anything else you would suggest me to do?
Thanks a lot!
Max