Risk Assesment

Hi Dr. First of all thanks for your great service. My question is regarding risk of exposures, I have had 2 episodes of unportected vaginal sex with 2 different girls in the US (not CSW) and several (around 7) espisodes of condom protected vaginal sex with csw's mainly in Latin America. Since the 2 unprotected sex episodes a took a quick test at week 2 which came back negative. Do you think I should do another round of testing more than a year has passed since those 2 episodes? Are the protected sex exposures a reason to take another test? Thanks a lot and I look forward for your answer.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  But I need to point out the Disclaimer message, with its advice for users to search for questions like their own -- in the hope of convincing others with common questions that they can save the posting fee.  Here are the standard responses you could have found:

HIV is rare in most heterosexual men and women in the US, including CSWs; and it is not particularly common in Latin Amerca either.  Even without condoms, sex between an infected woman and her male partner carries an average transmission risk of only once for every 2,000 epsiodes of vaginal sex (equivalent to unprotected sex with infected women once a day for 5 years and maybe never getting infected).  And your Latin America exposures were condom protected (and condoms work to prevent HIV).

So on the basis of the exposures described, you didn't need HIV testing at all.  However since you started down that path, with testing at 2 weeks (which is much too soon, would detect maybe 30-40% of new infections), you probably should finish it for peace of mind.  And testing once a year makes sense anyway for non-monogamous sexually active people.  If you get retested, you definitely can expect negative results.

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