Risk assessment pls

[r99732]

Hi Doc,

I am a white heterosexual male from the US - no STDs at time of risk. Circumcised.

On vacation I recently met a woman from a developed country that has a very low HIV prevalence (.01%). We had unprotected vaginal sex twice. My concern is enhanced because for the past year this woman has worked in a sub-Saharan African country that has a very high HIV prevalence (around 10% 15-49). She is not a CSW or anything. She is Asian. I don't know her sexual behaviors where she works. We both said we didn't have anything prior to the act - but who knows, especially given the window period. Plus I don't know last time she was tested.

What is your assessment of this risk? How worried should I be? Are we talking lightning strike numbers or are we in the realm of something more likely?

[Edward W Hook, MD]

Welcome to the Forum.  I'll be pleased to comment.  This was a low risk encounter.  Just because a person has worked in a country with higher HIV rates does not make them a risky sex partner. Rather in countries with both high and low HIV rates there are higher and lower risk groups- it is the behaviors that put people into these groups that are the primary determinants of risk.  Most women do not hive HIV and most unprotected exposures to infected partners still do not lead to infection.  My advice is as follows:

1.  You should get checked for the far more common bacterial STIs such as chlamydia and gonorrhea.  This can be done as a urine test and is something we advise for all persons who have new or multiple sex partners as a matter of routine sexual health maintenance.
2.  I would not worry about HIV ("lightning strike risks") but would again as part of routine sexual health maintenance ge checked at some point in the future. This too should be a routine activity of you have new unprotected partners, just as you should periodically get your blood pressure checked.
3.  In the future, I'd advice both asking partners about their sexual health and using condoms.

Bottom line- I see nothing particularly risky about this encounter.  The advice above is routine sexual health messaging that I believe should be practiced by all who have new or casual partners.  EWH

[r99732]

Hi Doc,

I apologize for not asking the follow up questions in one go. This will be my last. And I do thank you for your time.

I'm wondering whether I should worry about HSV-2. I'm guessing no since you didn't mention it but just wanted to make sure.

Thanks again.

[r99732]

Okay thank you

[Edward W Hook, MD]

No it does not.  Pther STIs are far, far more common than HIV.  EWH

[r99732]

If it turns out I acquired one of the more common STDs, would that change your assessment on the HIV risk?

[r99732]

Hi Dr. Hook,

Thanks so much for your counsel. I'll do as you advise.