Exposure Risk

Background:  I had sex (receptive anal) 24 days ago with a HIV-positive man.  He also gave me oral sex, and we kissed and had sex for 40 minutes.  We used 3 different condoms, and none of them broke.  Before we had sex, the guy said he was negative when I asked him if he had HIV or any STDs, to which he said "no".  The following day on his MySpace profile, it said he was HIV positive and that he was an ex-meth addict, but no longer.  I've also have had a sore throat for the last 8 days with fatigue those days too and do not know what to think.

Question: (1) How likely is it to get HIV from someone with such poor mouth hygiene, as meth deteriorates your gums (2) I took a rapid finger ***** test today (24 days out) which came back negative, any suggestions as to when to retest or how good these results are?  (3) i'm seeing a doctor tomorrow, should i have any other tests run (for strep, mono, etc....or chlamydia, gonorrhea, or syphillis (syphilis)?).

[Edward W Hook, MD]

I'm sorry to hear that your partner was not truthful.  I hope my answers will be helpful to you.

Regarding the exposures you describe, there really is no risk to you from your receipt of oral sex or kissing.  Kissing is no risk, even deep kissing and even with gum or dental disease. As for receipt of oral sec, the quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.

So, what about receptive anal sex.  Without a condom your risk of infection was somewhere in the neighborhood of 1 infection per 100 exposures.   With a condom, your risk is further reduced somewhere in the neighborhood of 1000-fold.  Thus the chance that you got infection form this exposure is very low.  The negative rapid HIV test at 3+ weeks further diminishes the likelihood that you got HIV since well over half of persons who acquire HIV develop positive blood tests within about 2 weeks of their exposure. Your symptoms are likewise unlikely to be due to HIV. The so-called acute retroviral syndrome is quite uncommon.

In answer to your specific questions:

1.  See above.  Even with poor oral hygiene, his mouth is really not a concern related to risk for acquisition of HIV.
2.  Your first test is good news and greatly reduces even the small chance that you had HIV.  The further out you test, the less likely infection is.  A repeat test at 6 weeks will detect over 95% of HIV infections and at 12 weeks you can be 100% sure that you did not become infected.  
3.  STD screening is always a good idea.  Given that your exposures were condom protected, your risk is quite low. Thus, there is nothing in your history or description to cause me to recommend testing to further sort things out.  You probably qualify for periodic STD "screening (testing in the absence of symptoms) if you have had multiple partners over a period of less than a year.  As a matter of personal protection, we recommend annual testing for anyone who has had either a new or two or more sex partners in the past year (we consider this to be health maintenance- we also recommend you get your blood pressure and cholesterol checked regularly).

Hope this helps.  EWH