Risk Assessment Needed

[billl36]

Hello Doctor,
I am a white male, mid-30s, married, circumcised. I'm overcome with anxiety. Yesterday I had unprotected sex with a stripper. During a heated lap dance, she gave me very brief oral sex and my penis intermitently slipped inside her for a few thrusts three seperate times (I pulled out repeatedly, didn't stay inside too long), the last of which I ejaculated inside of her. I immediately pulled out and all told, if you put the total time together I'd say I was inside her or touching her open vagina with the head of my penis for less than two minutes.

It was absolutely stupid and I am sick over it. She assured me that she is clean, hadn't had sex in three months, gets tested regularly, doesn't really sleep around and offered to go with me to a clinic so I could observe her getting tested and see the results. I hope she was being honest, but frankly I don't know the woman so who knows? I decided to take her up on her offer to go together and get tested as I simply can't wait and have to deal with this anxiety for several more months to get a conclusive HIV test. I need to see her results to help calm me down. I will definitely get tested at the appropriate time, but what are the chances that I'm infected? And how long, if at all, should one wait to get STD tests? Can those be taken immediately? Thank you.

[Edward W Hook, MD]

He is probably correct.  The negative PCR adds to the fact that your exposure was very low risk. I will paste in a comment made to a prior client about PCR tests- "In general we do not recommend HIV PCR tests for HIV diagnosis.  The problems with these tests are: that they have a higher false positive rate than antibody tests, that the time course by which they become positive in infected persons, while certainly sooner than the antibody tests, is not well characterized; and that they tend to be expensive.  They are becoming more widely used but at the present time are not sufficient for a definitive diagnosis of HIV and while a negative test is somewhat helpful information in many situations, it is not sufficiently well characterized to be definitive. "


Hope this helps. If I were you I certainly would not be worried that I had HIV at this time. EWH

[billl36]

So, eight days after exposure I took the PCR RNA test and it came back negative. The Lab told me that it is 100% conclusive, I do not have HIV. Of course, they are a company selling a product. My anxiety lessened but I decided to go to my regular doctor and talk through the issue. In researching him a bit more on the Web, I found that he is actually certified in HIV care, worked with the gay community at high risk clinics for more than 20 years and is himself HIV positive.

He assured me that the PCR test at 8 days is totally conclusive. Given his expertise, i want to take his word for it and move on with my life. What are your thoughts on his comments that I have nothing to worry about? I'm afraid to get too comfortable with the thought that I'm in the clear only to find out later I'm not. (And the girl I was with reneged on her offer for testing and told me to leave her alone, which only heightened my anxiety)

I have also been seeing a counselor to help me deal with all of this insanity. This has been the worst month of my life. I'm trying to stay away from the Internet as much as I can, but it's hard.

[Edward W Hook, MD]

In general we do not recommend HIV PCR testing for diagnosis is HIV infection for several reasons.  While the PCR is likely to become positive more quickly than other antibody detection tests (i.e. usual blood tests), at the present time the blood tests are becoming more and more sensitive and detecting infection earlier and earlier so that the time difference in detection between PCR test and antibody detection tests is becoming smaller and smaller and at present is, in general only a week or two.  In addition the time course over which the PCR tests become positive is less well described than for the blood tests and, as a result, it is difficult to make a definitive statement on what a negative PCR test means at any time within a few weeks of exposure to a HIV infected or possibly infected partner.  PCR tests are also more expensive than regular antibody tests.  Finally and most importantly, the false positive rate for PCR tests (i.e. a positive result in persons who do not have HIV) is higher than for blood tests.  Each of this on this Forum have seen a number of people who were worried needlessly because of false positive tests. For all of these reasons, we rarely recommend testing for HIV diagnosis using PCR.  EWH

[billl36]

As a follow up, one week after possible exposure I just had blood drawn for an HIV RNA test. Can you give me some insights on its reliability? It was expensive, but I simply can not deal with this level of anxiety for months on end and do not want to put any of my loved ones at risk.

[Edward W Hook, MD]

Welcome to our Forum.  I see that you have posted on the HIV community site as well and I second what they have already told you.  Penetration is penetration and therefore puts you at risk, IF (and this is a big IF) your partner is infected.  Fortunately most women, even exotic dancers do not have HIV or other STDs and even if your partner did, most exposures do not lead to transmission of infection.  In your specific situation, that your partner offered to go get tested is a further good sign.  The most direct way to address your concerns is to take her up on her offer to go get tested.  If she is not infected, she cannot transmit infection to you.

You may wish to go get tested as well but as I already said, her test results will be more valuable to you than your own test results.  FYI. should you want to get tested, when you can be tested depends on which STD, including HIV you are being tested for.  As far as gonorrhea and chlamydia, testing at any time 2-3 days following exposure will give reliable tests. For HIV on the other hand, it takes longer and there is no reliable test which can absolutely rule out HIV until 4 weeks following exposure and for the most common HIV blood tests, results are not completely reliable until 8 weeks.  

Hope these comments are helpful.  EWH