Question about exposure

Hi Doctor,

About two months ago I was date raped one night. Although I cannot remember details of the entire night, I do remember that no protection was used, and he did not ejaculate in me. Immediately after this incident, I have been obsessing over possible exposure to HIV because this man was a complete stranger. What makes it worse is that earlier in that week, before it happened, I believe I had BV, which I understand can increase the risk of catching HIV. This is my only unprotected exposure with sex ever.

At this point, I am terrified of getting tested, even though I know it is absolutely necessary. I think what I really need right now is just any type of assurance you can give me that I did not catch this.

Thanks a lot

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I'm sorry to hear about your unpleasant and undoubtedly traumatic situation.

However, the health implications probably are nil with respect to HIV.  The likelihood any particular male in North America has HIV is very low -- and there are no data to suggest the risk is any higher in rapists and jerks than in the general population.  Even if he were an injection drug user or bisexual, the odds are strong he wasn't infected.  And even if he was, the average transmission risk for a single episode of unprotected vaginal sex, if the male partner is infected, is around 1 in 1,000.  So if we assume 1 chance in 1,000 your partner had HIV, the odds you caught it from this event are around 1 in a million.

It is true that BV may increase the risk, but only by about double.  Doubling the chance from 1 in a mllion makes it one chance in 500,000 -- still overwhelmingly in your favor.

So just go ahead and be tested.  Enough time has passed for accurate results.  Three months after exposure is often recommended, but the modern antibody tests almost always are positive within 6 weeks of catching HIV; and if you find a doctor or clinic that offers the combo test (for both HIV antibody and p24 antigen), the results are definitive any time after 4 weeks.

And being afraid of the test result isn't rational, as you appear to know.  First, almost certainly it will be negative, so the result of testing will be one of profound relief.  Second, in the exceedingly unlikely event you were infected, of course you need to know it to get proper, life-saving medical care.

When you have your HIV test, also request testing for gonorrhea, chlamydia, and syphilis.  You can expect negative results on all of them, but better safe than sorry.  Please return with a follow-up comment to let me know the results of your HIV test, as well as the STD tests.  Stay relaxed in the meantime.  The odds are very strongly in your favor.

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

[elizab1000]

Thank you very much for the feedback, Doctor. I think I am particularly nervous because a few weeks after the incident, I did not physically feel well. Granted, I had the anxiety and fear of infection hanging over my head the entire time, so it's likely that my discomfort was all related to my mental state. Hope that's the case.

[H. Hunter Handsfield, M.D.]

Whenever someone suspects his or her own symptoms have an emotional/psychological origin, usually s/he is correct -- so it's probably a good bet.  I look forward to hearing your test results.

[elizab1000]

I hate to mention anything about symptoms, as I understand that they cannot be taken as the sole indicator of infection, but I am just hoping for some of your insight into explaining some of the physical symptoms that I experienced. What made me more anxious and confused during this time was the fact that I traveled out of the country for two weeks, so I was unable to recognize things that may have just been attributed to jetlag/foreign foods or symptoms of infection.

3 weeks after the incident, I went to Asia on a trip. For one whole day, I felt extremely nauseous and fatigued. During this week, I also experienced occasional bouts of diarrhea. The most alarming thing to me was the formation of itchy bug bites. As I spent a lot of time outdoors, and the weather was tropical, I was bitten by quite a few mosquitoes, yet some of the bites did not like traditional mosquito bites. Would a rash caused by recent infection resemble localized bug bites? I would have two spots on one leg, another few spots on one arm, then more spots on my other arm. All extremely itchy. I also noticed that I had a stiff neck, with the muscles on one side of my neck appearing swollen despite the fact that I couldn't feel any nodes or lumps upon inspection. All this time, I was preoccupied with thoughts and anxiety of infection, so I was definitely hyper aware of any little thing that happened to my body. Also during these two weeks, I had a complete lack of appetite. I understand that anxiety and stress in general can cause dips in appetite, but could it really last two weeks? For days I would hardly be consuming any amounts of food.

When I returned home from this trip two weeks later, everything seemed to go back to normal. Despite the fact that my anxiety remained at a high level, I felt fine and my appetite was restored. I am worried about this because I know that the symptoms of acute infection dissipate in around two weeks, which is what happened with my situation.

Again, I know you get asked these "symptom guessing" questions all the time, and obviously you were not there to experience the things that I felt so it would be impossible for you to tell me what exactly was wrong with me during that time. I'm just shocked by how much of a coincidence it was that at the exact times I should be feeling symptoms of infection according to statistics, is exactly I did start to notice out of the ordinary physical changes. I do plan on getting tested sooner, rather than later; however, at this point it is still hard for me to wrap my head around the worst case scenario.

[elizab1000]

Sorry, I forgot to ask in my previous post whether or not the acute rash would leave scarring behind? In some of the places where the bumps appeared, there are scars from where I scratched because they were itching.

[H. Hunter Handsfield, M.D.]

You're right about one thing:  it is pointless to speculate about symptoms when a definitive answer (testing) is immediately at hand.  I'll just say that your rash and other symptoms do not raise concerns about HIV and do not change my opinion or advice, and I won't play the "what if" game  Please don't post anything more until you report your HIV test result; suck it up and just do it.