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HIV Transmission from Pre-Ejaculate

I am concerned that I may  be infected with HIV. At the beginning of May of 2011, I tested negative for HIV. This was approximately 2-3 months after I had unprotected sex with someone who didn't ejaculate inside of me. On 8/31/11, I had unprotected receptive vaginal-penile sex with someone who I had last had sex with in January of 2011 and with whom I always used condoms (he would even pull out of me before coming even though he was wearing a condom). When we had sex in August, he pulled out before ejaculating. Then a few weeks later we had unprotected sex again and he didn't ejaculate inside of me. On 10/1/11, I developed a cold that lasted a few days. A couple of weeks later I met my current boyfriend. Since we had both been tested somewhat recently, we had unprotected sex and are still having unprotected sex. About a month after I first had sex with him, he came down with a cold. After he got a cold, I got a cold twice.

I'm concerned that I may have gotten HIV because I had a cold a month after I had unprotected sex, my boyfriend also got a cold a month after we first had sex and I've gotten a cold twice since then. I seem to be fine now, except I am having trouble swallowing, my throat feels slightly swollen and my ears ache. None of my lymph nodes in my neck and head area are swollen though, but the area slightly below my underarm lymph nodes is tender. I have read many conflicting stories about the likelihood of a woman contracting HIV from being exposed to pre-ejaculate, so any insight either Dr. Hunt or Dr. Edward could provide would be very much appreciated.
13 Responses
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum.

There are no data on HIV transmission risk from exposure to pre-ejacualate fluid, and I don't know whether such fluid has been analyzed to see how much HIV is present in infected persons.  However, it is generally assumed that it carries a transmission risk.  However, almost certainly the risk is exceedingly small -- far lower than from unprotected intercourse, with infected semen deposited in the vagina, and even that carries an HIV transmission risk of only 1 in 1,000 if the male is infected.

So the title of your question misrespresents the important potential exposures here.  The important fact is that you had unprotected vaginal sex last August; and you have recently started unprotected sex with a new partner.  On the other hand, you describe no reason to be suspicious that either of those partners has HIV.  Heterosexually transmitted HIV remains very rare in the Pacific NW.  More below about your former partner's race.

There is nothing in the symptoms you mention that makes me suspicious you have HIV.  Even in people at very high risk (which you definitely are not!), a cold is almost always just that -- a cold.  And your other symptoms do not suggest HIV either, especially in the absence of fever and skin rash.

Looking at your follow-up comment below, you don't say your partner's race except "not caucasian".  It matters.  If he is of Asian ethnicity, statistically the chance he has HIV is lower than in whites.  If Hispanic or Native American, somewhat higher.  If African American, the chance he had HIV is several times higher than in whites.  However, that does not mean your partner was at high risk for having HIV, and regardless of his race, the chance of HIV in a mostly monogamous male from Ohio is very low.  Here is a thread that goes into detail about the elevated risk of HIV in some (but not all) African Americans:    http://www.medhelp.org/posts/show/717093

But here is the final deal:  Even though your risk for HIV is low, my advice is that you have another HIV test.  A negative result will prove you didn't catch HIV from your partnership last August.  I would further advise that you ask your new partner to be tested for HIV as well; and both of you could have routine STD testing (gonorrhea, chlamydia, syphilis) as well.  Assuming you both have negative results, you'll both know there are no risks for these STDs going forward.

I hope this helps--  Best regards--  HHH, MD
Avatar universal
I wanted to add that I'm Caucasian, live in the Pacific Northwest, do not use drugs and have never had an STD. The partner I'm concerned about is not Caucasian, but he grew up in an upper class area in Columbus, Ohio and has mainly dated Caucasian women and has had a couple of monogamous relationships within the past 5 years.  
239123 tn?1267647614
MEDICAL PROFESSIONAL
See above.
Avatar universal
The partner from August is black and originally from Brazil. He was adopted and moved to Ohio when he was 10. Thanks for your reply and I will get tested again for HIV. I have been tested 3 times this year for Chlamydia and Gonorrhea and was most recently tested about a month ago. I was also tested for several other STDs in April, so I'm only really concerned about HIV.
239123 tn?1267647614
MEDICAL PROFESSIONAL
Please read the discussion in the other thread about African Americans and HIV risk.  That information, combined with your August partner's lifestyle, should help determine whether he might be at increased risk. However, I stand by my comments above:  it sounds very unlikely he had HIV.  But I also stand by the advice that you be tested, if only for the reassurance value it will provide.  As for other STDs, you also have been having sex in a new relationship, and I still believe both you and he might be reassured if you were to be tested together for HIV and other STDs.  But it's up to you.

Feel free to report the result of a new HIV test, if you decide to have one.  Until then, there's nothing more I can say or advise.
Avatar universal
Doctor,

Forgive me if I need to make a new thread for this, I am new to the forum and will do so if you wish, but my question is related to this. I also had a one time hetero intercourse with exposure to only precum, partial insertion for only one fleeting second. I had a question about why precum may be lower risk? Is this because there is less of it? Or in my case the short duration? I am afraid I am under the notion that "one virus" is enough, as I have seen you state is not necessarily true. I have also seen you comment that such brief encounters may also be low to no risk, but this has always been when the insertive partner asked, not the receptive. I am female, does this also go for me? Is there any work to further study precum in the future? Thanks for all your work, sorry if I am butting in and will repost if you want.
239123 tn?1267647614
MEDICAL PROFESSIONAL
Both the low volume of pre-ejaculate fluid and the briefness of your exposure make the risk low.  In addition, semen is inherently more infectious than most body fluids, above and beyond the amount of virus it contains.  In fact, there is a brand new research report on this topic, which found that the immunochemical make-up of semen has a major influence on transmissibility of HIV.

As for "just one virus": Think of it like those photos you have seen of a human egg surrounded by hundreds of sperm.  (Here is an example: ttp://media.photobucket.com/image/sperm%20and%20egg/XXX408/12-sperm_and_egg.jpg?o=30)  Only one of them succeeds in entering the egg and fertilizing it.  The normal sperm count is 20 million or more per ml of semn, and men with "only" 1 million sperm are infertile.  The biological mechansims of fertilization and HIV transmission are entirely different, but the numbers game is similar.  Although in theory a single sperm cell could result in conception and a single HIV could result in transmission, neither of these ever happens. I doubt there will be much future risk on pre-ejaculate fluid and HIV transmission.  It's apparently not a serious concern and probably not worth the effort and expense.

My advice is that you stop worrying at all about the biological mechanisms.  The fact is that almost all people who catch HIV sexually have had hundreds of exposures to infected persons -- either because they have lots and lots of partners, or because they are the regular partners of infected spouses or partners.  The transmission chance for any single exposure almost always is very low; and as far as we know, it is zero if there is no deposit of semen into the vagina or rectum.  This applies to both insertive and receptive partners; the risk for the receptive partner is always higher, but both are very low risk for single exposures.

You should be using condoms for any and all vaginal or anal sexual encounters, even without ejaculation; and you should select your partners with care, avoiding those at obvious high risk for HIV.  If you do those things, you can be very confident you will never catch HIV -- even if there is the occasional lapse, e.g. in event of condom failure or a partner who is at high risk but you didn't know it.
Avatar universal
Hi doctor would you put spanish escorts in a high risk category? I received oral sex, fingering, and frottage and I'm experiencing wierd symptoms of headaches and dizziness 6 weeks after the exposure. Is it too late for seroconversion and are these symptoms just a common cold?
Avatar universal
Thank you for your comments above and sorry for the delay in replying. If I understand correctly, I should not be worried about the volume of precum I may have been exposed to from a half second insertion as precum is not known to transmit HIV. I have been greatly troubled by this episode for a few weeks now. I have spoken to my friend about this incident, and expressed my concern as I prepare for testing. When I asked him if I had anything to worry about, he was very open and offered that everything was fine. However, I did not point blank ask him his HIV status, but it seems he thinks he is negative. He is a white, hetero, 22 yo non drug using, male who I am friends with at college/work with. He has had a few girlfriends (college students,white) but to my knowledge he has never been tested and probably doesn't ask their STD status, as he never asked me mine. I am probably worried because I always ask, an wonder if maybe he just doesn't think about infection because it's not brought up a lot in our small town. Am I overreacting? I feel like I should expect a negative test, but wanted your opinion. Thanks, veryworried.
Avatar universal
Doctor I apologize and realize this is thread creep. Would you prefer I put a post in for my followup question if I can tonight?
239123 tn?1267647614
MEDICAL PROFESSIONAL
In my previous replies, I missed the fact that you are not the original poster.  It is our policy not to respond to thread jumps, i.e. to answer questions from new users in existing threads, even when the topic is similar.  This is partly my fault, so I'm letting your questions and my earlier replies stand.  However, I'm afraid it won't be possible to discuss it further.  If you still need our advice, you'll have to start a new thread.  (Given you've had substantial free advice already, I'm sure you'll agree this would be fair.)
Avatar universal
I completely agree and have posted a new thread with a similar name. Sorry for the inconvenience. To both the doctor and ariel99137.
Avatar universal
Hi Doctor Hunter,

I just wanted to let you know that I got in touch with the person with whom I had unprotected sex in August and he informed me that he had tested negative shortly before we had sex. Since I only had sex with people who were HIV negative after testing negative for HIV in May and before sleeping with him, and my current partner is HIV negative, I believe it's safe to assume I'm still negative. I may get tested in a few months, but I am no longer concerned that I have HIV and believe I have just been hit hard by the cold season. Thanks again for your reasonable advice.
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