Please Assess My risk

7/2/10- ended a brief relationship with another white male, 24 y/o. He was only a top. We had sex ONCE, whereby he entered me briefly without a condom (7/2/10). He did not ejaculate...and he stated he was negative. I believe he was.
7/4/10: lapse of judgment- met another guy. I always ask their HIV status ( He did NOT lie about his name nor age, he was 44. I tracked his email and phone via a friend I did find out later that he is a teacher in a public school. When I emailed him again, he stated that he is negative.  He "dipped" for a brief moment..whereby he then put on a condom and ejaculated in the condom. We did use lube and he the condom did not break. Since he found out I knew what he did, I had asked him to get retested. He said he did on July15th. He stated he was negative.
7/28/10- I met another white male, 35 y/o. He too stated he was HIV- and only was a top.  We used a condom during anal sex with lubrication. He withdrew after completion...and clearly everything was ok with the condom.
He, still erect,.had the condom on...full of semen.. I masturbated him for like 5 minutes or so (with the condom still on)...Without thinking clearly, We tried sex again...him again as the penetrative partner. As he was about to enter me again...the tip of the condom tore at the top..releasing some of the semen.He quickly withdrew...saying that he thought the condom had broken.  It did.Noticing my anxiety, he calmed some fear saying that he was negative...of course he may not know since the year had past since he tested. I immediately showered and cleaned the best in and around the anal area with soap.
I do know that I should not have reused the same condom again..NOW I HAVE LEARNED WHY! Stupid of me.

[Edward W Hook, MD]

Welcome to the Forum.  You had 3 or 4 sexual encounters in the pat month in which at least some of your exposure was unprotected.  Trying to protect yourself most of the time will only get you "a little bit infected" (which is like being a little bit pregnant) if you keep it up.  I make no judgment in your choices but I would be acting irresponsibly if I suggested to you that you were practicing safe sex.  If you are going to practice safe sex, do so all the time, not most of the time. If you are not, then do it with the knowledge that you are not and o not allow yourself to think that only allowing a "little dipping" will protect you.  The majority of STDs, including HIV are spread by persons who do not know that they are infected.

Now, having come down rather hard on you about your exposures and condom use, I must admit that all your partners sound as though they have been tested although, in at least one case, as long as a year ago and were negative when they did. I would believe them about their status. Most people do tell the truth. Thus I suspect your risk of infection is low but low is not zero.   That said, my advice is for you to get tested for STDs (i.e. gonorrhea, chlamydia) now at site of exposure and then to get HIV testing at a later date.  HIV tests with standard antibody tests obtained at 8 weeks following your last exposure of concern will give completely reliable tests.  If you are tested with the recently approved, combination antibody/p24 antigen tests, results at 4 weeks following your exposure will be completely reliable.  

I hope these comments help.  Please take care of yourself.,  EWH

[upstateny123]

I know there was a limit on what I could type...sorry.

7/30/10:met a guy, who was in the Navy (35 y/o) visiting his parents. We used a condom, the condom did NOT break. He was top.I tested 4 weeks from the 2nd risk on July 4th- with the Home Access test. It was negative. I am trying to assess my risk in regards to HIV.  I have not had any ARS symptoms.  I know always to be using condoms and having them with me.

[upstateny123]

I did want to add as a follow up:
Situation 1 and 4 do not concern me...as the first guy I know rather well and do BELIEVE he is HIV-. In Situation #4, we used a condom that did not break. and I do believe that men in the military are tested regulary.

I am mostly concerned with Situation 2 and 3.

And is a Home Access test kit just as reliable as those finger prick tests you take at the Health Dept.?

by the way...this is not my normal sexual activity...I have no idea what I was thinking last month. THis was the only sex that I had this year.

THANKS AGAIN!!  

[upstateny123]

Thank you Dr. H.

If you would be kind enough to answer the following ..as simple yes/no.

1. Would a Home Access test at 4 weeks negative give an idea?
2. Does the Home Access test = the test @ the HD at 8 weeks?
3. I have already been prescribed 2g of Zythromax as a precaution.
   would that do justice to any bacterial std's if there were any that I should have been tested for?

thank you.

[Edward W Hook, MD]

1.  Yes it would detect over 90% of infections acquired 4 weeks earlier.
2.  At 8 weeks the health department test would have detected virtually all infections.  At any point in time the Home Access test result should be considered equivalent to the results you would get from the health department for a specimen taken at the same time.
3.  this would cure gonorrhea, chlamydia and NGU. Those are the major concerns.  EWH

[upstateny123]

As a last follow up I contacted the ID Unit at a local hospital. Upon talking with one of the the ID Doctors, she stated that Quest Diagnostics DOES offer the p24 antigen as a test ...along with the HIV AB test.
In order for me to take the test with Quest she stated that I would need a doctor's referral, which she is willing to do.

LAST QUESTION (I promise  ;)    )

If I take this p24 antigen test with the HIV AB screening @ 4 weeks from the last possible exposure...would that result in a definitive screening?

I do appreciate your help!

[Edward W Hook, MD]

As I said before, a combination test at 4 weeks will provide you with definitive information.  I am confident that the result will be negative.  EWH