Recent HIV question

Hi I am a 23 years old gay male.This past saturday I had a few drinks and saw some guys that went to my gym.Being stupid and NOT smart I accepted their invitation to go back to their place.This was a couple.The guys were on something,not sober thats all I can say.We started kissing and having oral sex.I performed it on both and they performed it on me.Then one tried to have anal sex with me but just slipped the head in and right back out.During the oral sex there was no semen involved,no one came.There was no anal other then that previous incident where he slipped the head in for like 3 seconds.After that it was just kissing and oral.Unprotected oral to clarify.Near the end, one of the guys told me to "take care of myself because I was young and very cute".Then he confessed he was positive.I was upset and he told me not to worry because we didnt do anything risky.MAYBE for him but too late now.Anyways its been only 3 days.I can't sleep or eat.Im worried sick although I read what I did isn't that risky.I went to my doctor today,she said she could offer me PEP but didn't think it was necessary,she said just to go back next week and she will test my viral load.If that came out good I could finally sleep.After the doctor I went to the free HIV clinic and tested negative on the Oraquick test.I know in 2 days nothing will show but I needed peace of mind.Although the guy told me the oraquick will show funny lines in the 1st 48 hours of infection since I was so young.Is that true?

The clinic guy said not to worry and just take the viral load test and retest for antibody in 12 weeks to be completely sure.My question is....Did I make the right decision as to just take the viral load test and not do PEP?Was my exposure big knowing one of the guys was positive?My doctor said she also saw no cuts in my mouth.She sounded like my risk was low but I am worried sick.

[Edward W Hook, MD]

So to summarize- oral exposure and minimal rectal exposure to a partner.  What is the risk?

Let's start by relieving you of any concern about your oral exposure.  The figure we quote regarding risk for HIV following sex with an infected partner is 1 infection per 10,000 exposures.  This is likely to be a conservative estimate.  Neither of us has ever seen or heard of a convincing case in which oral sex was clearly the route of infection.  Some experts say oral sex is no risk.

Now for the rectal exposure. This is a higher risk exposure with the quoted risk being 1 infection occurring per 100 exposures.  Of course any average statement is composed of a number of instances, some with higher risk, some with lower risk.  The brevity of your exposure, combine with the fact that you were not fully penetrated and that there was no exchange of secretions is all in your favor.  Nonetheless, testing for HIV is something you should pursue.  A PCR test is sometimes helpful but not recommended for routine use because of cost and problems with false positive tests.  In your situation, it may be warranted as suggested by your health care providers.  

Finally regarding PEP.  Your indication is borderline at best.   At this time, more than 72 hours post exposure it has no role and would not be useful.  Thus further consideration of the "what ifs" is not warranted.  

Hope these comments help.  Please kee p us posted as your results come back.  EWH

[elgeneral24]

Thanks for response.In reality the 72 hours haven't passed.This incident was exactly 38 hours ago.Althought the doctor said even if she had all the money in the world she wouldn't recommend PEP for my risk.

How bad are the false positives in the Viral Load test??

Do you consider the anal risk as something very risky since no full penetration happened and it was so fast?

Sorry to bother.thanks

[Edward W Hook, MD]

I agree with your doctor - still do not think your risk warrants PEP.  There are more false positive withthe PCR test thatn with the regular antibody tests.  How much more is tough to say.    

If I thought your risk was high, I would suggest PEP.  EWH

[elgeneral24]

Well I definately feel a little better since I also spoke to a few hiv experts where they also told me the risk was low.One even told me in San Francisco there are 2 places that give PEP for free but my case would not qualify.

[elgeneral24]

How confident can I be with a negative viral load test 9  days after exposure

[Edward W Hook, MD]

It is hard to say.  
Unfortunately not 100% but it would certainly be evidence in your favor.  EWH

[elgeneral24]

Hi doctor,

I went to get my PCR viral load on Monday which is 9 days after the exposure.Results will be back friday.My doctor says I will confirm it with a 3 month antibody test.But this viral load will give me a very good idea of what to expect.

I was also reading about nudging and dipping.With my exposure to the head of the penis(of a hiv +guy) in my rectum for a few seconds and no penetration,should I have to worry about that as a risk,or should I be more concerned with the oral sex??

I am getting headaches from the anxiety,I know theyre not symptoms of HIV but that of anxiety.Do you think I will come out of this one?

[Edward W Hook, MD]

I am confident you will be fine and that the tests you have plann will bear this out.  Just follow the plan your doctor has outlined.  Please, no further questions unitl you have test results. We look forward to hearing thathtey are negative. EWH

[elgeneral24]

Hi doctor,

My viral load test at 9 days after exposure came out negative.My doctor says thats good enough for her but I can retest at 3 months with antibody test to be 100% sure.Although she insisted that if I were to have HIV the viral load would have shown at 9 days after because that's when the virus is replicating and I would have high amounts of HIV at that point.Do you agree??

I am more calm now,this can really throw someone off, so I suggest everyone uses protection even for oral sex if you worry about things like this a lot.The guy I had the encounter with mas very muscular and looked very healthy and he ended up having HIV.Incredible but true.Thanks.

Please advise if I should pursue further testing........

[Edward W Hook, MD]

I agree with your doctor.  The negative viral load makes it most unlikely that you got HIV from this expsoure.  the right thing to do for further followup is with blood tests.  I would say you could be re-tested at 8 weeks rather than waiting till 12 however.  EWH

[elgeneral24]

Doctor just thought I'd let you know I got a negative oraquick oral swab test at 30 days post exposure.

So we're at 30 days negative oraquickoral and a PCR at 9 days post exposure.....Going for a 12 week.

[elgeneral24]

Doctor I read that the oraquick is not as good in detecting hiv during seroconversion as a standard elisa.

My 30 day oraquick oral came out negative,and most say by 4-6 weeks antibody test show pretty accurate between 85-90%.Is that the same with oraquick oral??

I will retest with oraquick at 6-7 weeks.I know if that is fine I can expect a negative 3 month result.

Please advise on oraquick oral at 30 days......I will ask no further questions,just inform you with my results.I promise.

[Edward W Hook, MD]

The oraquick is still a good test. Don't worry.  It may be slightly less sensitve but if that is the case it is not much.  EWH