Extremely Worried About Risk After Breakup

Hello,

I am a heterosexual white female living in the U.S. I recently broke up with my boyfriend of a year. He was not a drug user nor has he had sex with other men. Since our relationship ended, and I learned of some of his infidelities, I have become extremely worried about HIV. We had three recent incidents of unprotected vaginal sex - a little more than a month and three weeks ago. He did not ejaculate any of those times.

I was tested twice for all STDs, including HIV, during our relationship as part of regular checkups - both times everything came back negative. Because I was terrified, I went ahead and got tested yesterday for all STDs. Negative again, which was some comfort I suppose, but I realize I need to test again in two months to be totally out of the window period.

For the last two weeks, I have felt horrible. Headaches, nausea, vomiting, sore throat, etc. Logically, I understand that the flu has been going around (several of my coworkers and friends have all come down with horrible flu over the past few weeks) and I realize that the stress of worrying about this could be having a seriously negative impact on my body, but I'm still stressed out and unbelievably angry at myself that I let this happen. I should have known better.

My question to you is about the risk after several unprotected heterosexual exposures. Do I need to wait another 9 weeks (which would be the exact three months after our last encounter) or would a test any earlier than that be considered accurate?

I realize you answer so many of these questions, and I'm sorry to add another one to your plate, it's just the anxiety of the breakup coupled with the anxiety of a possible infection is really starting to interfere with my day-to-day life.

Thanks so much for your help, and thank you for all of the work you do for this forum.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I'll try to help.  The bottom line is that most likely you are not at risk at all for HIV.

You don't say much about your partner.  Let's first look at his risks for HIV.  Is he bisexual and, if so, were his infidelities with men?  Is he an injection drug user?  Is he African American with multiple partners?  Has he been incarcerated?  Is he from a country where heterosexually transmitted HIV is especially common, like parts of Africa?  If none of these things, then the chance he has HIV is zero or close to it.  (Despite what you might assume from the media, heterosexually transmitted HIV remains rare in most populations in the US and other industrialzied countries.)

When a man has HIV, the transmission risk to female partners averages once for each 1,000 episodes of unprotected vaginal sex.  And your negative test results so far are reassuring; probably about 70-80% of newly infected persons have positive results by 3 weeks.

Your symptoms don't mean anything one way or the other.  The symptoms of HIV are identical to other minor garden variety viruses, and yours don't sound much like HIV anyway.

You describe your anxiety as one of the main issues here, and I am inclined to agree.  All things considered, if your partner doesn't have the risk factors I listed above, you really didn't need HIV testing at all -- that's how low your risk was (except of course for the reassurance you will feel after the negative results).  The other STD tests -- now THOSE were good ideas and I'm glad all was negative.  You were at much higher risk of chlamydia, gonorrhea, syphilis etc than for HIV.

So have another test about 8 weeks after your last sex with your former partner.  You need not go later than that, although some experts recommend going as long as 3 months -- so it would be OK to wait until then.  Whenever you get tested, you can definitely expect negative results.

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