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HIV Prevention (Expert Forum)
Pre seminal fluid
by Mr.Bob, Jul 04, 2006 12:00AM
Hello Doctor H,
Two days ago I had an encounter with a transexual sex worker (unknown hiv status). We had some foreplay and there was some pre seminal fluid for both of us. I was the anal receptive individual. I always check to make sure that not only are condoms used, but used correctly. It was dark in the room when the sex worker placed the condom (I did not see it being done). My fear is that is was not placed correctly the first time (placed in reverse initially...this is common) and that some pre seminal fluid was on the outside tip of the condom (a 50/50 chance). A lubricant was used. To make matter worse, I had some rectal bleeding from the episode due to the roughness of the encounter. At no time did the condom break.
I've been tested recently and it has been negative. As you can see, I'm rather anxious to be tested again. How would you rate my level of exposure? Is a PCR justified? If a DNA-PCR is justified, it seems to have a high false positive result. Is a P24 justified? Like most people, I just hate waiting the six weeks to get tested with an antibody test.
One last question, what is the statistic on the number of people who develop antibodies at 26 days?
Two days ago I had an encounter with a transexual sex worker (unknown hiv status). We had some foreplay and there was some pre seminal fluid for both of us. I was the anal receptive individual. I always check to make sure that not only are condoms used, but used correctly. It was dark in the room when the sex worker placed the condom (I did not see it being done). My fear is that is was not placed correctly the first time (placed in reverse initially...this is common) and that some pre seminal fluid was on the outside tip of the condom (a 50/50 chance). A lubricant was used. To make matter worse, I had some rectal bleeding from the episode due to the roughness of the encounter. At no time did the condom break.
I've been tested recently and it has been negative. As you can see, I'm rather anxious to be tested again. How would you rate my level of exposure? Is a PCR justified? If a DNA-PCR is justified, it seems to have a high false positive result. Is a P24 justified? Like most people, I just hate waiting the six weeks to get tested with an antibody test.
One last question, what is the statistic on the number of people who develop antibodies at 26 days?
Doctor's Answer
by H. Hunter Handsfield, M.D., Jul 04, 2006 12:00AM
, Jul 04, 2006 12:00AM
Of course you underrstand that I cannot begin to know whether your partner placed his condom correctly; you will have to use your judgment. But from your description I see no reason to worry about it. If a condom in fact was correctly used and didn't break, your risk from this event was zero or close to it.
I generally do not recommend anybody get tested for HIV as the result of any particular exposure, except in special circumstances--such as unprotected sex with a known-infected perrson. It is much smarter to just have regular testing, say once a year (if you are consistently safe with condoms), to as often as every 3 months if your sexual choices are not always so safe. So if you haven't been tested recently, this would be a good time--but not because of this particular exposure. If/when you are tested, a standard antibody test is all you need; PCR would be inappropriate in this setting. P24 iss borderline; the P24/ELISA combo is pretty commonly used these days, so you could have that; but in this case the P24 part really isn't necessary. Somewhere around 90% of infected people develop positive antibody tests by 4 weeks.
Finally, I referred to you making apparently safe sex choices. That's really only partly true: using condoms for anal sex is good. But the missing part is that you apparently didn't ask your partner his HIV status before having anal sex. That was really dumb. Nobody should ever have sex with a person at high risk for HIV, even condoms or other safe sex methods are planned, without asking about HIV status and sharing one's own HIV status. No exceptions.
Good luck-- HHH, MD
I generally do not recommend anybody get tested for HIV as the result of any particular exposure, except in special circumstances--such as unprotected sex with a known-infected perrson. It is much smarter to just have regular testing, say once a year (if you are consistently safe with condoms), to as often as every 3 months if your sexual choices are not always so safe. So if you haven't been tested recently, this would be a good time--but not because of this particular exposure. If/when you are tested, a standard antibody test is all you need; PCR would be inappropriate in this setting. P24 iss borderline; the P24/ELISA combo is pretty commonly used these days, so you could have that; but in this case the P24 part really isn't necessary. Somewhere around 90% of infected people develop positive antibody tests by 4 weeks.
Finally, I referred to you making apparently safe sex choices. That's really only partly true: using condoms for anal sex is good. But the missing part is that you apparently didn't ask your partner his HIV status before having anal sex. That was really dumb. Nobody should ever have sex with a person at high risk for HIV, even condoms or other safe sex methods are planned, without asking about HIV status and sharing one's own HIV status. No exceptions.
Good luck-- HHH, MD
I hope the Doc's comment didn't sting too badly. We all make mistakes. I always ask my male partners if they have HIV before we do anything (including oral or even kissing), but in my experience, so many guys lie or purposefully avoid getting tested so they can say "no, I haven't tested positive" and feel like it isn't a lie, that it's a wash.
I'm rooting for you and hope the test is negative. I don't think you were dumb, but do ask a few more questions next time. And learn some alternatives to anal sex that will give you the same pleasure.
J
Dr. H's comments did not sting at all, at this point I'm open to being chastised for being stupid. You are correct about asking a partner about their status, all you can hope for is that they answer honestly. The big lesson is not to engage in any activity with someone who is for the most part a stranger.
As we all know, the waiting game is the worst part. I'm very tempted to get a p24 test in the next two weeks so I can have some positive news to go on, although I know that it is not confirmatory. I'm in the process of getting more info on this test.
Thanks for your kind words!