Unprotected sex

[hope4thebest490]

Hi Doctor,

Thank you for taking the time to answer my questions.  I had unprotected vaginal sex with a woman of unknown status less than 4 weeks ago.  Not smart I know, but the with the anxiety I have had since I have learned from it.  I am white, uncircumcised, and married (hence the extreme anxiety)  I have not had sex with my wife at all.  The woman I met at a bar  swore she was okay and had only been with 4 men, but I would say she was promiscuous.  I had what I would call a bad flu bug as soon as 4 days after sex with her.  Fever, chills, loss of appetite, some sweats at night for about 3 or 4 days.  I also had really bad watery diarrhea for about a week.  The sex happened overseas and they symptoms came on as soon as I got back.  Also right now, I have a few canker sores in my mouth.  I just saw on one of your posts that the symptoms cannot appear before 7 - 10 days, but I am confused because researching the web a bunch of sites they say it can come on within days?  I know overall my risk is probably low, but I can't help but think based on how bad the bug I had and the timing it has to be HIV....  Thanks again.

[Edward W Hook, MD]

This will be the last answer.  Yes, circumcised men are at lower risk for HIV than uncircumcised men.  This thread is now over.  EWH

[hope4thebest490]

Thanks again Doctor Hook.  I mistakenly wrote in the original post I was uncircumcised, this should have been circumcised.  From what I understand being circumcised may reduce your risk also.

[Edward W Hook, MD]

Your hypothetical question is the sort of question that fuels un-needed anxiety.  It's like asking what are the chances I'll get hit by a meteorite while have sex with a new partner.  You are correct that the 1 in 1000 figure is an average figure.  During the acute, viremic stage if infection HIV is more infectious making transmission a perhaps 1 in 100 chance.  The odds of having sex with a person who is HIV blood test negative and viremic however are tiny making the risk of this occurring far lower in general than if got infection from a person with an established test.   EWH

[hope4thebest490]

Thanks so much for your answers, much appreciated.  One last question.  I realize this is theoretical, but as I understand it many of the transmissions occur when an infected partner is in their acute or initial stage of infection as they have much more of the virus, in this case in their vaginal secretions.  I realize it is unlikely but theoretically if this girl was in this stage how does that change the chance of transmission from a single occurrence.  From 1 in 1000 to 1 in ______.

[Edward W Hook, MD]

Welcome to our Forum.  Since you have looked at other posts on our site, I'm sure you have seen some of our repeated posts stating that to worry about symptoms as an indicator is a complete waste of time.  Let's review your situation to make my point:

1.  Your partner's HIV status is unknown to you. OK, but the fact is that only a small percentage of persons, even "promiscuous" women have HIV.
2. Even if she had HIV, your risk of infection from a single exposure is less than 1 infection in 1000 sex acts.
3.  you note that you have been traveling.  What a good way to get a non-STD/non-HIV viral illness.  These sorts of illnesses are VERY common among travelers.
4.  As i said earlier, it is quite unusual for a person to get symptoms of early HIV within a few days of exposure and far more "typical' (it is hard for me to call a rare event typical) for symptoms to occur 7, 10 or even 2 weeks following sex.  I don't know where you are getting your information but to state that the symptoms of early HIV start in a few days is not correct.  


So, what to do. You should get checked for STDs (i.e. gonorrhea, and chlamydia mostly) which are far, far more common than HIV.  You probably should also get HIV testing, just to be on the safe side.  At 2 weeks after exposure a standard HIV antibody test will detect about 50% of infections, at 4 weeks this goes up to more than 90% and at 8 weeks virtually all HIV infections would be detectable.  In the meantime, I also urge you to stay off of the internet. There is a huge amount of misinformation there.  

Hope my comments help.  EWH