Risk Assessment-Few Questions

Dear Doctors,

I appreciate your help. Here is my situation:

I have been in a monogamous relationship with my boyfriend for 3 years now. One year into our relationship (we were already having unprotected vaginal sex for about 10 months at this point) my boyfriend got tested for all STD's including HIV and tested negative for everything.  I had gotten tested for everything except HIV (at the time I didn't think I needed to be tested for HIV) prior to meeting my boyfriend and had tested negative for everything.

Now, I recently realized that perhaps I should have been more cautious and been tested specifically for HIV, and I will tell you why. Prior to meeting my boyfriend 3 years ago, I had unprotected vaginal sex once with another partner and he pulled out prior to ejaculation. He was someone I had known for a couple of months and we had talked about our past and he said he was clean (he's white, American, mid twenties, educated, donates blood) so I am not so concerned about this exposure. What I am more concerned about is that I had 4 episodes of unprotected oral sex in which I performed fellatio with another partner who was an immigrant from Brazil (we met at a club here in the US and were only in contact for a month) with a much lower socio-economic status (I also had 3 episodes of vaginal intercourse with him but that was protected).

I have gotten the nerve to be tested but I'm waiting for the results on Tuesday, but I have been driving myself crazy in the interim.

So here are my final questions:

1) Is it any additional reassurance that my current boyfriend tested negative for HIV after we were already having unprotected sex for almost a year?  In other words, had I contracted HIV from my prior partners would I have already transmitted it to my boyfriend a year into our relationship when he got tested?

2) How much of a risk am I at with the episodes of unprotected oral sex, given that this partner from from Brazil, less educated, lower SES?  

[Edward W Hook, MD]

There are several parts to the answer that I am about to provide.  I'll get to the punch line first however- I am confident that your test results on Tuesday will be negative and that you can count on them as being accurate.  Let's now get to the details and "subplots":

Your prior boyfriend was a very, very low risk partner who, when he donated blood, was tested for HIV.  You can be confident that he did not have HIV.  

In answer to your question however, in theory, that you had been sexually active with your current BF for almost a year before he had a negative HIV test does not assure you that you do not have HIV.  Transmission does not occur every time people have sex.  In fact, transmission occurs only once in every 1000 episodes of unprotected sex, on average.

The prevalence of HIV in Brazil is higher in the U.S. but the chances that your Brazilian partner had HIV remains low.  Even more importantly however, even in the unlikely circumstance that he had HIV, the quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  Bottom line, performing oral sex on this person almost certainly did not put you at risk for HIV either.

Finally, while I am confident that you do not have HIV, I need to chastise you a little bit about your concerns about getting tested.  There is no reason not to get tested, ever.  Testing does not give a person HIV.  Thus it cannot change whether or not a person has HIV.  What it does do however is give people the information they need to validate their efforts to keep from getting HIV OR, if they are so unfortunate as to have HIV, to allow them to get therapy and to avoid giving the infection to others.  Thus, there really is no reason to worry about getting an HIV test.

Thus to summarize, you have nothing to worry about.  Your exposures to date sound as though they are VERY low risk and I am confident that your HIV test will be negative. In the future however, don't worry or hesitate about getting tested.  Hope this helps.  EWH

[wondering1234364]

Dear Dr. Hook,

Thank you very much for your prompt response, I truly appreciate it. I completely agree with you; it was ridiculous for me to think that I didn't need to be tested for HIV.  I am certainly glad that I went ahead and got tested.

Again, your medical knowledge was very informative and helpful.