Odds on possible HIV Infection after UTI

[terrified_brian]

Doctor,

It has been about 2 weeks since my exposure. Like so many others on the forum I had a condom break on me during insertive anal sex. I would guess anywhere in the area from 2 to 5 minutes I was exposed before noticing. I found out afterwards he was HIV positive.

I now have symptoms such as burning in my penis, and clear, very sticky discharge following urination. Had tests done, nothing back yet. i'm guessing chlamydia.

I have also just recently developed severe diarrhea, and a sore throat.

What are the effects of poppers (inhalants) being used by the bottom?

Please shed some light doc, my mom is a mess crying all day and night since the incident, very scared as am I. I'm a 23 yr old recent college grad who made a big mistake, and if I get another chance, never will again.

What are my odds, if any, from coming out OK? I undestand this may be one of the highest risk posts on your boards for awhile, and I'm terrified. I don't know what to tell my loving mother to comfort her.

[H. Hunter Handsfield, M.D.]

The first and most important lesson probably is that you were dumb to get involved in anal sex, even with a condom, without knowing your partner's HIV status beforehand.  Knowing, asking, and sharing HIV status is just about the most important HIV prevention strategy for sexually active gay men--plus condoms for anal sex, even if both partners believe they are negative.  If nothing else, learn and follow that lesson; otherwise it is a good bet you will catch HIV someday.

OK, lecture over.  Clearly you have urethritis; it could be chlamydia, gonorrhea, or nonchlamydial NGU.  Most providers would have already prescribed antibiotics, without waiting for the test results (but maybe not if no visible penile discharge was seen).

Most likely your diarrhea and sore throat are coincidental and not caused by HIV.  The risk of catching HIV during any single episode of unprotected insertive anal sex is low, even if another STD is acquired.  An association of HIV infection with inhaled nitrates (poppers) is suggestive but not proved; and the risk would be to the exposed person--i.e., I doubt there is increased risk for the top when the bottom guy has done the sniffing.

You are right that your story is one of the rare STD Forum questions that involve significant HIV risk; >90% of them involve trivial or no risk.  But still the odds are strongly in your favor.  But the bottom line (no pun intended) is that you need to be tested.  If not yet done, see a health care provider who knows a lot about HIV and follow his/her advice about testing.

Good luck-- HHH, MD

[Willl]

If that is the only time and since it was insertive and not receptive, the odds should definitely be in your favor.
Did you see a doctor about prescribing PEP? Are you circumsized and did you urinate and wash off directly after it happened?

[terrified_brian]

I did not know of his status until later. It was discussed, but I found it to be a lie from others around the club. He probably should go to jail. It was the biggest mistake of my life.

It was a one-time only deal, yes Will.

[H. Hunter Handsfield, M.D.]

If you asked about HIV status and he lied, I withdraw the "lecture" in my initial response; I'm sorry you didn't make that clear in your question.  Don't take it personally; it's still a valid lesson for sexually active gay men.

HHH, MD

[terrified_brian]

Doctor,

1.) I have just been prescribed doxycycline for the urethritis. 2 times a day for 10 days. How long should this take to get rid of the pain?

2.) You say the odds are strongly in my favor. If you had to estimate odds what would you say they are?

3.) I read some numbers online. Blood to mucous membrane is .09% chance for HIV transmission. How the heck is it so low for HIV infected blood?

What makes urethritis such as chlamydia easier to transmit than HIV?

It has been 2 weeks now, I plan on getting tested at 3, 6, and 13 weeks.

[Willl]

If there wasn't blood involved then that is also good for you.
I was going to suggest contacting him and finding out if he is on medication or not and what is viral load is since this could influence transmission. But if he lied once he will lie again. How confident are you in the people that told you he was lying?
..sorry I know this is horrible situation

[terrified_brian]

Will,

Can a urethritis disease be transmitted without blood?

I have no way of contacting the person. I just ask for you to hope with me as my testing period comes closer. I will try to keep you updated

[Willl]

The time I got an UTI was from having anal and there was blood. But I don't think blood is always necessary in order to transmit the bacteria. The Dr. will be better to answer this one. You might look into PCR and other sooner tests if it helps the anxiety.

[Willl]

Your risk may still be around 0.5%, but it depends on a lot of other factors.

[Willl]

I meant 0.05%.

[H. Hunter Handsfield, M.D.]

Your symptoms should start to improve in a couple of days, but might take several days to clear up entirely.  Were you given only doxy?  If you're having prominent pain, it might be gonorrhea--which requires other treatment.

It isn't possible to calculate any particular person's odds.  What works on a population level cannot take into account individual factors that you don't (probably can't) know about:  stage of your partner's infection, his viral load, whether he takes antiviral therapy, and so on.  It is unlikely that the chance you have HIV is higher than 1 in  (1%), but it could be that high.

Just being exposed to HIV does not itself result in infection.  Just putting HIV-infected blood or secretions on a mucous membrane does not usually result in infection.  Also, the amount of virus in the infected material makes a big difference.  The only exposure that approaches near certainty is direct injection of substantial amounts of infected blood into another person's bloodstream, as with transfusion or organ transplantation.  You were almost certainly exposed; that is, you can assume that HIV was deposited on the skin of your penis and perhaps in the urethra.  It doesn't mean you will be infected.

The ease of transmission of all infections varies extremely widely.  Chlamydia is just much more infectious than HIV.

HHH, MD

[terrified_brian]

Dr. Handsfield,

I only got doxy, I dont have a diagnosis yet, but im guessing chlamydia (the discharge was clear)

I know odds are low, but like you said so many times, only negative at 13 weeks will make me happy.

One Question: I recently read this on a British website, any truth to it?

"
If exposure was over 48 hours but less than 4 weeks ago, and where signs of HIV infection have been detected, it is possible to offer 3 or 4 antiretroviral drugs in combination as a means of limiting the spread of HIV in the body. Interference with virus replication at this stage of infection may permit eradication of HIV from the body after several years of treatment, or to maintain infection at an extremely low level for the rest of the patient's life. It is first necessary to confirm infection. HIV p24 antigen testing can detect HIV infection within 2 to 3 weeks of infection."
^what are your thoughts on that?

This experience has been the turning point in my life. If I am OK after 13 weeks I'll be a better person the rest of my life for it. Not only would I never do a thing like this again, It snapped me out of my depression and made me realize how lucky I am to have the people close to me.

If I get a negative at 13 weeks, pick your favorite upscale restaurant in the area Doc, and I'll fly out to Seattle from Philly and treat ya, with a personalized "Handsfield" Eagle jersey for you, just for all the help and knowledge you share with us everyday. I cannot tell you how much it means to everyone.

[H. Hunter Handsfield, M.D.]

Your British website is talking about post-exposure prophylaxis with antiviral drugs.  It is too late for PEP in your case; maximum efficacy is when PEP is started within 24 hours of exposure, and starting more than 72 hr later does not prevent HIV infection.

You don't need to wait 13 weeks to be confident about your infection status.  If you have negative tests after ~6 weeks, you can be virtually 100% confident you weren't infected.  The 12-13 week test will just be icing on the cake.

The rest of this is getting too close to practicing medicine from afar.  Thank you for your confidence, but you should be asking these questions of your own health care provider.  Follow his/her advice about what tests should be done (P24 antigen, PCR testing for HIV RNA, standard antibody tests) and when.

HHH, MD

[terrified_brian]

Ok thank you Doctor-

I guess my next step would be calling my insurance company and health care provider and being referred to a physician who knows a lot about this.

Do you agree with the British websites statement about if HIV was detected prior to 4 weeks than the level of the virus could be kept to a very low level for the rest of the patient's life?

I had never heard that before that's why it confused me

Thanks

Brian

[H. Hunter Handsfield, M.D.]

There is no evidence that early, aggressive HIV therapy can reliably keep HIV "to a very low level for...life".

HHH, MD

[terrified_brian]

Ok Thanks Doc, but one more question.

If I'm on antibiotics for chlamydia, would the antibiotics in my system prevent ARS symptoms from occuring if they were going to?

[who_is_this]

No.

[JohnnyV]

I feel for you and I'll pray that you are negative.

In the future, Brian, I'd share a strategy with you: Avoid anal sex entirely, even with condoms, until you've found your lifelong husband. Try doing "thigh sex" where you stick your penis between his pressed thighs, and if he needs stimulation in his butt, use your wet fingers or a dildo. Thigh sex isn't the same but it comes close, and you get the same body contact; it's one step above frottage. This was what the Greeks were really doing for those hundreds of years of rampant male-male sex you've read about
-- and how could Plato and Alexander the Great be wrong?

The whole business about asking people their HIV status is, in my humble opinion, not effective at all. (I think Dr. H hasn't been involved in male-male hookups, so he may not be totally hip to the scene on this issue.) Gay men lie about their status all the time, and if they got tested 5 years ago they'll say they're negative even if they've been screwing around several times a week. Also, the most infectious time is when someone's just gotten infected, and during that time he won't test positive.

J

[terrified_brian]

Thanks Johnny, I really appreciate the kind words and prayers.

I definitely will be avoiding it from here on out.

This has really been a scary experience, and the support from others on the forum has really been great. I'm praying for everyone else in similar situations also.

[terrified_brian]

I got my labs and culture results back for the urethritis and it came back negative for everything.

I did have discharge after urination, is this possible for the results to be negative?!?!

very confused

Brian

[MiamiLat]

Hello Brian,
I was exposed on 12/05/05; unprotected insertive anal sex with someone who I later found out is pos. I tested at 6 weeks via OraQuick Rapid Advance: Negative! I am waiting to retest at 12 weeks (3mos). From what I understand, the odds of aquiring HIV from this type of exposure is 6.5 in 10,000 (0.06%). I know this is a VERY difficult time, feel free to contact me for support: ***@****

[imanidiot]

I engaged in unprotected sex on tues. its now thurs and im so paraniod.The girl i didnt know, I think she had a bad drug problem a few years ago, she is 26 and has brown and black teeth.isnt that typical for people with heavy drug use?

I have had a sore throat since then, is it possible to have sypmtoms of hiv yet? What should I do now?

Im 27, a father of 2, and really scared..what are the chances of getting hiv from a girl having vaginal sex 1 time?
Thank you so much for your help, and your time,
Im an idiot