Risk Assessment

Hello.  I have posted in the Community Forum also, but I do need your expert advice.  Will try to be as brief as possible.  I am a female that had sexual encounters with the same man for ten months.  Practiced safe vaginal sex, never had anal, and unprotected oral sex.  First week in Jan. condum slipped off and second week in May condom slipped off.  My last protected sexual experience was July 19 with protected vaginal and unprotected oral.  He tried anal but I pulled away immediately and condom got stuck in my .... and pulled it out.  I do not think he ejaculated at this point.  What is my risk?  Got tested for Hiv, Gonor., Clym, Herpes 2, Herpes1, and everything else.  Everything negative post 38 days, which was so called protected.  I do not think anything slipped off like in the past.  He is uncircumsiced also.  Do not know his status.  Became very sick two days after test and was tested for Lyme.  Came back positive.  Was on antibiotic for three weeks and then tested negative for Lyme.  Did I have late seroconversion?

Symptoms included extreme fatigue, no vomiting or diarrhea, weight loss, no appetite, body aching, and night sweats,.  Did not have a high fever, but had night sweats from Sept. 7th to 13th.  Was sick from Aug. 27th until October 13th.   Also had tingling in my feet, hands, and face prior to lyme treatment.  Could it be Hiv?

Do I need to get tested again?

[Edward W Hook, MD]

I will not comment on the issue of possible Lyme disease here as it is far off the topic for this forum other than to state, as was mentioned in your exchange with the members of the Lyme community, being tested for Lyme disease was a bit of a fishing expedition by your doctor whom, I presume was being thorough.  Lyme tests are two stage tests and prone to false positive results.  Irrespective of whether you had Lyme or not, you took therapy and now have a negative test.  (I will not comment further on the Lyme disease question).

I will however comment on your STD and HIV risk, starting with the bottom line - you have nothing to worry about.  First, with respect to the STDs, you have been tested and have negative tested. the tests are very reliable and can be believed.  In addition, if you took the doxycycline after your last unprotected sex, even if you had gonorrhea, chlamydia or syphilis, the doxy would have cured it.  Thus there is no reason at all to worry about STDs.

As for HIV, again there is little risk.  Here are the reasons:
1. The odds that your partner, a heterosexual male, was HIV infected are very low - less than a 1% chance unless he had other risk factors.
2.  In the unlikely circumstance that he had HIV, your risk of getting infected is no more than 1 in 1000, again very very low.
3.  Finally, you had a negative test more than four weeks after your last unprotected sex.  At that time, the test would have detected 85-90% of all infections acquired 4 or more weeks earlier.  When you put all of these factors together, it is clear that your risk for HIV from the exposures you describe is close to zero.

Lastly but not least, your symptoms are really not suggestive of recently acquired HIV.

There is really no need for further testing.  You need not be concerned that you have acquired HIV or other STD from the exposures you describe.  

Hope this helps. EWH  

[feelstupid1000]

Forgot to add I had leg trembling from August 25th until second week in October.  Also, had a fever off and on low grade around 99 to 100 degrees off and on.  My legs were the worst.  They legs hurt so bad and would tremble.  Forgot to add my headaches.  

[feelstupid1000]

THANK YOU.  

[feelstupid1000]

I have one more question.  Since I started getting sick 35 days post possible exposure.  I say possible, because a condom was used, but we did perform oral sex on each other.  Almost 100% semen did not come out of condom.  I guess I am afraid it came out of the top.  What is the usual time frame you get sick post exposure, how long does it last, and what are the most common three symptoms people get?  Since you are the expert, I hope you would answer and not get mad at me for asking.  I know I am very anxious,

[Edward W Hook, MD]

This is your anxiety speaking.  The timing is wrong and the exposure is no risk.  You can search the HIV site for comments on the ARS but the symptoms are non-specific.  Forget this exposure and move on. EWH