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need individual risk assessment
Dear Doctors,
I understand that individual assessments are important, so I would like your advice.
On NYE, I went on a 2nd date with a guy. Unfortunately, we got drunk and had sex. I never intended to go this far, but he sat on my uncircumcised penis. By the time I realized, it was too late, and I climaxed in him. Right after the short incident, I freaked out, took a shower, and asked him about the last time he was tested. He said 2 months ago. The Mon. after, I went and got tested and told him the results. That Wed., he said he went and got tested negative. 2 weeks later and worried about his window, I asked him about his sexual history. At that point he got defensive and said that he got both the rapid antibody test and the RNA test and offered to take another test.
Now comes my list of tests. I'm aware of over testing, but the info is important for my questions. All of the tests below came back negative.
3 days - rapid blood test at Dr.'s
2 weeks - PCR RNA Viral Load Test and rapid blood test at Dr.'s
3 weeks - rapid mouth swab test at SF Magnet clinic
5 weeks - rapid blood test at Dr.'s office (Dr. said to stop worrying, and get 3 month test as formality)
6 weeks - rapid mouth swab test at SF Magnet (counselor said stop testing, even my 2 week RNA was enough)
7.5 weeks - rapid blood test at clinic
Based on the info above, most people would stop worrying, but I can't help my obsession with the 3 month conclusive window period.
1. What would your assessment be, and do you recommend testing at 3 months or can I be assured enough to stop testing?
2. It's now 9.5 weeks. If I test now, can I stop testing?
3. In metro areas like SF what are the hiv rates among white msm pop? I've heard as high as 1/4?
4. Is the risk as an uncircumcised top per exposure 1/1000?
5. Can I calculate my own risk as (1/4) * (1/1000) * (1/100 [8 week negative]) = 1/400,000? Is that too optimistic or pessimistic?
6. SF Magnet says RNA test at 2 weeks is enough. Do you agree?
Thank you!
I understand that individual assessments are important, so I would like your advice.
On NYE, I went on a 2nd date with a guy. Unfortunately, we got drunk and had sex. I never intended to go this far, but he sat on my uncircumcised penis. By the time I realized, it was too late, and I climaxed in him. Right after the short incident, I freaked out, took a shower, and asked him about the last time he was tested. He said 2 months ago. The Mon. after, I went and got tested and told him the results. That Wed., he said he went and got tested negative. 2 weeks later and worried about his window, I asked him about his sexual history. At that point he got defensive and said that he got both the rapid antibody test and the RNA test and offered to take another test.
Now comes my list of tests. I'm aware of over testing, but the info is important for my questions. All of the tests below came back negative.
3 days - rapid blood test at Dr.'s
2 weeks - PCR RNA Viral Load Test and rapid blood test at Dr.'s
3 weeks - rapid mouth swab test at SF Magnet clinic
5 weeks - rapid blood test at Dr.'s office (Dr. said to stop worrying, and get 3 month test as formality)
6 weeks - rapid mouth swab test at SF Magnet (counselor said stop testing, even my 2 week RNA was enough)
7.5 weeks - rapid blood test at clinic
Based on the info above, most people would stop worrying, but I can't help my obsession with the 3 month conclusive window period.
1. What would your assessment be, and do you recommend testing at 3 months or can I be assured enough to stop testing?
2. It's now 9.5 weeks. If I test now, can I stop testing?
3. In metro areas like SF what are the hiv rates among white msm pop? I've heard as high as 1/4?
4. Is the risk as an uncircumcised top per exposure 1/1000?
5. Can I calculate my own risk as (1/4) * (1/1000) * (1/100 [8 week negative]) = 1/400,000? Is that too optimistic or pessimistic?
6. SF Magnet says RNA test at 2 weeks is enough. Do you agree?
Thank you!
MEDICAL PROFESSIONAL
Welcome to the HIV forum.
I find your story a little hard to swallow -- your penis got inside your partner's rectum without you realizing it was happening, and was there long enough to climax? Hmm...
People rarely lie when asked directly about HIV status, so it is very unlikely your partner has HIV. Given the circumstances you have been rather seriously overtested, but the results are reassuring. With the standard tests in current use, including rapid tests, almost 100% of newly infected people have positive results by 6 weeks. So your results are reliable and show you weren't infected.
1,2) Personally, I see no need for testing at either 9.5 weeks, 3 months, or any other time. But since so many agencies still stick with the now outmoded 3 month advice, perhaps you'll want to do it. If so, you can expect it to remain negative.
3) Probably closer to 1 in 10, not 1 in 4 -- but I'm not certain. The SF Magnet clinic, or the local health department, can give you a better estimate than I can.
4) The level of risk doesn't matter in assessing your situation. Even if the risk were 1 in 10, your test results prove it didn't happen. But 1 in 500 to 1 in 1000 probably is about right.
5) You risk is far lower than that. Even if 1 in 4 is correct, it obviously is not applicable to your partner, who had a negative HIV test. I would start with 1 in 1,000 chance he had HIV, then take it from there.
6) The RNA tests are usually not considered the last word. That result was reassuring, but the negative antibody tests at 5, 6, and 7 weeks are more important.
Now comes the lecture: You let yourself get into an unsafe exposure (unprotected anal sex) with a man whose HIV status you did not discuss before the exposure took place. Better get in the habit of NEVER having sex, even safe sex, with another man without first discussing HIV status and not proceeding with those who are positive, don't know, or give evasive answers. Your experience is an excellent example why this is important even when safe sex is intended. Follow these rules and you can expect to go a lifetime without HIV. Fail to do so and HIV probably is in your future. You didn't catch HIV this time, but it is time to stop trusting to luck.
Best wishes-- HHH, MD
I find your story a little hard to swallow -- your penis got inside your partner's rectum without you realizing it was happening, and was there long enough to climax? Hmm...
People rarely lie when asked directly about HIV status, so it is very unlikely your partner has HIV. Given the circumstances you have been rather seriously overtested, but the results are reassuring. With the standard tests in current use, including rapid tests, almost 100% of newly infected people have positive results by 6 weeks. So your results are reliable and show you weren't infected.
1,2) Personally, I see no need for testing at either 9.5 weeks, 3 months, or any other time. But since so many agencies still stick with the now outmoded 3 month advice, perhaps you'll want to do it. If so, you can expect it to remain negative.
3) Probably closer to 1 in 10, not 1 in 4 -- but I'm not certain. The SF Magnet clinic, or the local health department, can give you a better estimate than I can.
4) The level of risk doesn't matter in assessing your situation. Even if the risk were 1 in 10, your test results prove it didn't happen. But 1 in 500 to 1 in 1000 probably is about right.
5) You risk is far lower than that. Even if 1 in 4 is correct, it obviously is not applicable to your partner, who had a negative HIV test. I would start with 1 in 1,000 chance he had HIV, then take it from there.
6) The RNA tests are usually not considered the last word. That result was reassuring, but the negative antibody tests at 5, 6, and 7 weeks are more important.
Now comes the lecture: You let yourself get into an unsafe exposure (unprotected anal sex) with a man whose HIV status you did not discuss before the exposure took place. Better get in the habit of NEVER having sex, even safe sex, with another man without first discussing HIV status and not proceeding with those who are positive, don't know, or give evasive answers. Your experience is an excellent example why this is important even when safe sex is intended. Follow these rules and you can expect to go a lifetime without HIV. Fail to do so and HIV probably is in your future. You didn't catch HIV this time, but it is time to stop trusting to luck.
Best wishes-- HHH, MD
Thank you Dr. Handsfield for your response. It's reassuring to hear that my test results are reliable, and that I'm over tested. I will probably go at 3 months anyway as a formality like my doctor suggests, but it's nice to have your response to get me through the stress.
I can see how my story seems implausible, but up until NYE, I had never been a top in a relationship, and had always asked my boyfriends about their status before sex (even asking them to get tested with me) on top of always using condoms. Now that I look back on it, I probably could have guessed that he was trying to sit on me, but I think the effects of alcohol plus my lack of experience in the matter contributed to my slow reaction. Since we were doing other stuff prior to it, by the time it happened, I was already close to climax so the whole episode probably lasted under a minute.
Clarification aside, the lecture is deserved, and the past two months have been a living hell of stress thinking that the one mistake I made in life could have ruined it forever. This was a hard lesson to learn, but I will never let alcohol impair my judgment with sex again. Thanks again for the service you and Dr. Hook provide. It helps immensely!
I can see how my story seems implausible, but up until NYE, I had never been a top in a relationship, and had always asked my boyfriends about their status before sex (even asking them to get tested with me) on top of always using condoms. Now that I look back on it, I probably could have guessed that he was trying to sit on me, but I think the effects of alcohol plus my lack of experience in the matter contributed to my slow reaction. Since we were doing other stuff prior to it, by the time it happened, I was already close to climax so the whole episode probably lasted under a minute.
Clarification aside, the lecture is deserved, and the past two months have been a living hell of stress thinking that the one mistake I made in life could have ruined it forever. This was a hard lesson to learn, but I will never let alcohol impair my judgment with sex again. Thanks again for the service you and Dr. Hook provide. It helps immensely!
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