Do I Need Testing?

Based on this encounter, can you tell me if I need testing...

I was dating a man I've known for a few weeks and decided to have sex one night. I insisted we use a condom and things were fine until he said he could feel it slipping off. I can't remember exactly what happened, either I moved away quickly or he withdrew and the condom was still inside me for about a minute or maybe less. We switched to a new condom, same thing happened where it started to slip, but this time he withdrew and it was still in tact on the lower part of the penis.

As for his history, he said he has not been tested but seemed to think I was crazy to suggest he might have HIV. He has been with 8-9 women in the past, but that's really all I know. And he's a U.S. citizen.

The whole thing has made me so anxious, just really need to know whether or not I'm at risk here and need testing.

Thank you.

[H. Hunter Handsfield, M.D.]

I see no significant risk of HIV here.  In general, testing after single exposures doesn't make a lot of sense, unless there is reason to believe the risk was particularly high, such as sex with a known-infected partner or someone at particularly high risk, such as a man known to be bisexual, an injection drug user, etc.  A better strategy is for sexually active persons to just be tested routinely from time to time, like once a year.

Presumably you have no evidence to suggest an especially high chance your partner had HIV.  Among exclusively heterosexual men in the US, fewer than 1 in 1,000 have HIV, and the average transmission risk for a single episode of unprotected vaginal sex is once in every 1,000 exposures.  Thus, even if no condom was used at all, I would put your risk of having caught HIV somewhere around 1 in a million.  And from your description, it sounds like the sex in fact was condom protected most of the time.

Having said all that, the fact that you are nervous enough to have come to the forum to ask the question at all suggests to me that you might need testing for psychological reassurance -- i.e. this event might play on your mind until you prove to yourself you weren't infected.  If so, go ahead and be tested in about 6 weeks for peace of mind.  (This is not "code" to suggest I really believe there was some risk here.  I do not.)  Also, as suggested above, all persons sexually active outside mutually monogamous relationships should be tested from time to time.  If you haven't had an HIV test in the past year, this seems a good time, since it is on your mind.  While you are at it, get tested for the common STDs (gonorrhea, chlamydia, syphilis).

In other words, from a risk assessment perspective you don't need testing on account of the exposure you describe.  But the decision is up to you.

I hope this helps.  Best wishes--  HHH, MD