Risk Assesment

[JanetDoe2012]

I test annually for HIV other STIs.  My last yearly test was earlier this year and the results were negative.  I am a female who has had 3 partners since my last negative test, all of which have been protected.  The very last encounter (which was about a week ago) began protected but the condom slipped off.  I'm estimating that we went unprotected for a couple minutes at the max.  When we realized this, he put on a new condom and we began again.  My partner is an AA male, 41 years of age and not an injection drug user nor does he sleep with other men that I am aware of.  I was going to shrug this incident off and just move on without testing because I've read through this site and it seems that you usually do not recommend testing after a single brief exposure.  Is this accurate?  What is the likelihood that I did contract anything (STIs and HIV) during this exposure?  Would it be safe for me to just put this behind me and just move forward with my life? And when I do test (so long as I continue insist on condom usage) can I expect negative tests??  

Any advice would be helpful.  

[Edward W Hook, MD]

Home Access is a good test.  AT 4 weeks it will detect over 90% of recently acquired infections.  At 8 weeks it will detect all.  EWH

[JanetDoe2012]

Very Last Question, I promise!

I have ordered a Home Access Test to take at 4 weeks.  If the results are negative, can I rely on those results?

[Edward W Hook, MD]

Great question but one that is quite difficult to answer.  You are not alone in your concerns.  Here in the U.S., perhaps more than anywhere else, we place far more stigma and judgement on STDs and topics surrounding sexuality than in other places.  Thus our concerns and worries are fueled by our environment and the society we live in.  STDs are never a good thing but they are not the end of the world either and should not be feared.  I suggest you try to approach your concerns not from a fearful "could I have...) perspective but from a more healthful, sexual health perspective in which we accept that "stuff happens" and that part of your approach to staying health should involve occasional checks for STDs, depending on your circumastances and situation.  If you are concerned, why no get teted and just put the issue behind you.  that will allow you to enter into your new relationship without concerns.

I hope this makes sense.  EWH

[JanetDoe2012]

Is it normal to be very anxious over an exposure such as this?  It worries me, as I just began a relationship with an ex. (who tested negative for everything)  I have convinced myself that I'll test positive and am afraid to have sex with my bf ... Do you have any suggestions that may ease my mind?

[Edward W Hook, MD]

Correct... and the odds that all will be fine. Please don;t worry. EWB

[JanetDoe2012]

Ultimately, I should just be safe and test for everything, correct?  I don't know how I'm going to make it through the next three weeks!

Thanks doctor! Ur help is appreciated!

[Edward W Hook, MD]

I think your decision is certainly reasonable.  As for HIV testing, unfortunately while you can get the results of the common STDs just 2-3 days after an exposure, testing for HIV takes longer.  At 4 weeks an HIV antibody test will detect over 90% of recently acquired infections, at 6 weeks about 95% and at 8 weeks all infections can be detected,

Mathematically, assuming your partner is of average risk your chance of getting HIV form a single exposure is about 1 in 100,000 (assumes your partner's chance of infection is 1% and the risk of infection form a single vaginal exposure is 1 infection per 1000 acts of intercourse.  

Hope this helps. EWH

[JanetDoe2012]

You've raised some valid points Dr. Hook.  I think I will go ahead and get tested for STIs, for the sake of my own health and for the sake of any future relationships.  Having a peace of mind is definitely worth the hassel in my opinion.  As far as HIV, are you saying that it is the least of my worries? Would it be an unwise decision if I decided to wait until my next annual exam to at least test for HIV?  

[Edward W Hook, MD]

Welcome to the forum. Before I address your question, let me complement you on your doing all that you should to maintain your sexual health - regular testing and condom use are the way to go.  Great work - you could put us out of business :)

Your question is a good one and the answer, for better or worse comes down to a judgment call based on how likely you feel it is that your partner might have an STD.  He certainly does not sound particularly high risk but we see people who are not high risk with STDs all the time- they can be asymptomatic although are not usually, particularly in men.  Furthermore, even if he had an STD, the fact is that most exposure do not lead to infection (the data available suggests that if he did have gonorrhea or chlamydia, there would be a 30-40% chance of transmission.  Thus, to work with the numbers, if we were guess that there is 3% chance that your partner was infected (reasonable estimate, or perhaps a bit high) then following your single condom mishap, your risk of infection is about 1-1.2%).  This brings us to the question of how do you feel about those odds and how do they balance out with the hassle of getting tested?  this risk of HIV from this encounter is far lower than the riswk of more traditional STDs so that is what I've concentrated on.

I'm not trying to dodge your question.  These are the issues you need to weigh in deciding whether to test now or wait for your annual evaluation.   A more detailed discussion with him might be helpful as well.  EWH