I screwed up badly

[aksteve2012]

I went on a trip for work got a little drunk and ended up with a transexual. She is 40 and probably has done this her whole life I would guess, I did see something she had that said she was tested hiv free not too long ago, don't remember the date. In the four nights I was down there and did each other anally with condoms twice but without ejaculation and two times without ejaculation each i guess.. A little oral but no ejaculation as well. I asked her at the time and she said we were safe without cum.  I took her work for it like the fool I was acting.  I will cost me my marriage to tell my wife everything and don't want to do that but don't want to get her sick either.  I would love to get tested but have read it takes six months to see hiv?  I never did this before in 25 years of marriage and would like to just shoot myself rather than tell her what I have done.

[Edward W Hook, MD]

Welcome to the Forum.  You have been misinformed in several ways about HIV and how it is transmitted.  

First, there is no risk of HIV if your exposures were condom protected, no matter what sort of contact was involved.  

Second, there are no data on how ejaculation effects risk for HIV transmission.  We do know, without a doubt, that HIV can be spread during genital and anal sex without ejaculation.  It also makes common sense that ejaculation may increase risk for HIV transmission since there is more virus transferred from person to person, if the partner who is ejaculating is infected.  

Third, it does not take 6 months to get a reliable test result from HIV testing.  At 4 weeks following exposure a 4th generation test (i.e. a test that tests for both HIV p24 antigen and HIV antibody) provides definitive results.  Although not recommended because PCR tests have more falsely positive results, the combination of a negative PCR test and a negative test for HIV antibodies at 4 weeks also provides definitive evidence that HIV has not been transmitted.  

Your question is a bit unclear and it is not clear to me whether condoms were not used for all exposures.  Finally, your partner said she did not have HIV.  Indeed most people, including most transsexuals do not have HIV.

I hope these comments are helpful.  EWH

[Edward W Hook, MD]

Glad I could help. EWH

[aksteve2012]

Thank you so much.  You have helped me greatly and I appreciate your help greatly.  Impressed with your promptness and sense of calm that you've injected into a very crazy time in my life.


One reason for my desire to be tested is that it was her desire to go w/o protection and could only assume she did with everyone she met.  Doing the math in my head I assumed I slept with half of California.   On top of hurting my wife by cheating on her I didn't want to give her some disease.  Perhaps as a help to someone reading my saga she has forgiven me and we are all good, believe it or not.  If questioning whether to test or lie and hope you don't give someone you love a disease I know i made the right choice.  

[Edward W Hook, MD]

Regarding the timing of testing and when results are “definitive”, many conservative, often government, agencies recommend far longer periods for what they call definitive results than is needed.  The reason for this is that their recommendations are based on older data published on tests which were not as good as those presently in use and these agencies take the position that they cannot "afford" to be wrong if someone were to develop a positive test at a time point longer than their recommendation.  On this Forum we tell clients that results at 8 weeks are definitive based on a more current reading of the medical literature and that we can find no specialist who has found someone who took more than 8 weeks to develop a positive test after a known exposure.  

In your case I used the 4 week figure because at 4 weeks the evidence will be very strong but not quite definitive as to whether you did  or did not (this is the most likely outcome of testing) get HIV and my sense that your state of mind would benefit from getting an answer sooner.  At 4 weeks well over 90% of tests that are going to be positive will be.  When that figure is combined with the low statistical  probability of getting HIV from the exposures you describe, a 4 week result will provide an answer that is almost certain to be verified if you repeat testing at 8 weeks.

I hope this clarifies things.  EWH

[aksteve2012]

The testing agency suggested coming back at the end of the week to test for other std's and to establish a baseline and then to come back after four weeks to test for hiv and I am doing as much.    Thanks again, truly appreciated.  

Side note is that after reading your original reply I told the tester that you had said four weeks is adequate she suggested six months for a conclusive result?    

[Edward W Hook, MD]

Thanks for the clarification. Testing is a reasonable thing to do as your partner may have had an STD.  At this time testing at all sites of exposure  (i.e. penis/rectum) is appropriate.  HIV testing will need to wait until at least 4 weeks follwoing exposure. EWH

[aksteve2012]

I'm sorry for the poorly written question. I was very upset and sick with remorse. I am very uninformed of the whole std thing as a happily married man for 25 years I had no need to know. Two times at least were done without a condom to me and two times to here without a condom.  Perhaps three times to her with a condom and perhaps two times to me.  Ejaculations were all done outside as she believed that the risk .  No condoms were used for oral for either of us and we did it alot just not to ejaculation.  She did however have alot of precome.   I did tell my wife and I am planning to go to a testing facility today to at least schedule and appointment. I suppose they will know what test to do for other possible std's as well.  Thanks for your time.