What is my actual risk?

[Craftygirl14]

A few doctors have told me that I'm low risk for HIV and that they wouldn't recommend testing. I'm 23 and have had two partners. I was with my first for 4 years and he only had one partner before me. I later found out he cheated on me (not intercourse) with another girl. We broke up for a bit and he slept with another girl in that time frame, but he says he used a condom and "barely penetrated her". He was not into injectable drugs and came from an educated, upperclass background. When we were dating, he hadn't been tested for HIV. I know HIV risk is low, but I've had symptoms that I read can indicate HIV. Shortly after I lost my virginity, I was diagnosed with cervical dysplasia (CIN 2). I had LEEP and all follow up paps have been neg. (7 years now). I had an HPV DNA test a few years ago and it was neg. I've never had any other STDs. I used to get recurrent vag. yeast infections, but since I left my former partner they have stopped (4+ years). A few years ago I had a mild bout of shingles that lasted for two weeks. I get mild angular cheilitis a few times year, but I tend to lick my lips. I have psoriasis, which has been a problem since I was a kid. These current and past symptoms are enough to cause me to worry about HIV infection, even though I know it's not likely. I'm still in contact with my ex and he hasn't mentioned anything about HIV to me. My current partner of 4 years was a virgin when I met him. Based on this information is it likely that I have HIV? Thanks!

[H. Hunter Handsfield, M.D.]

My first response is after your opening sentence, before I read anything else:  If 'a few doctors' have judged your risk to be low, undoubtedly it is.

Now to the rest of your question:  And again after reading the next sentence:  The chance a woman with only 2 lifetime sex partners has acquired HIV is just about zero, unless one of the partners is known high risk (bisexual, injection drug user, etc)--regardless of whether those guys had other partners, past STDs, etc.  Heterosexually transmitted HIV in women is almost entirely limited to the regular, long-term partners of HIV infected men, like the wives of injection drug users.

And reading on:  Shingles, HPV infection, and abnormal pap smears are not indications of increased HIV risk; and psoriasis is not known to be a risk.  Finally, you provide no evidence whatever that either of your life sex partners might have HIV.

Of course I cannot guarantee that any particular person isn't infected.  But if I were a gambling man, I would be happy to bet my house at the roulette table that you do not have HIV.  But the real question is why you are stewing about it instead of just getting tested.  Since you're worried, why speculate?  Have an HIV test.  You need the negative result to calm your anxieties.

Best wishes--  HHH, MD

[Craftygirl14]

I should add that I've never used condoms, and I've had a lymph node in my neck that never completely subsided after tonsillitis when I was 16. I also have accumulations of white debris along the sides of my tongue (but the doctor said it's just that - debris). Thanks again.

[H. Hunter Handsfield, M.D.]

Makes no difference in my response.

[Craftygirl14]

Hi Doctor Handsfield,

After hearing your advice and doing a lot of soul searching, I took the plunge and got an HIV test. It was negative, as you predicted. I feel like a million pound weight has been lifted off my shoulders. Thanks so much for helping people like myself out. Your advice is very much appreciated.

[Craftygirl14]

Follow up: I know my negative HIV test was conclusive for the exposure I was worried about, but since the test I keep getting recurrent angular cheilitis and continually read that it is a symptom of HIV or a compromised immune system. Should I be worried about other immune system problems of non-infectious origin, or is angular cheilitis a common enough occurrence in healthy people that I shouldn't be concerned? Thanks again!

[H. Hunter Handsfield, M.D.]

Angular cheilitis is not usually a sign of immune deficiency.  I see no reason for concern.