I had unprotected vaginal sex with a 22 year old African American college student (female) of unknown status. I have read several of your posts regarding transmission odds, which have been reassuring, but I still wanted to post as I have been quite worried. In my state, 1/60 African American women have HIV and as you say the odds of vaginal transmission is about 1/2000 (I am also circumsized). Multiplying these numbers together suggests a very low risk. I went to the ER and received pills and shots for other STDs. Urine tests came back negative. I just can't stop worrying about this. I have also had persistent dry mouth+sore throat a couple days since the event, probably due to anxiety. The sore throat is dissipating, and now I feel a bunch of mucous back there so I am thinking it may be allergy related. Any kind words would be appreciated.
Welcome to the forum. Thanks for your question, and for reading other threads on the forum for questions similar to your own.
I disagree with the opening of the response you received on the community forum, "HIV transmission is not a game of numbers and statistics." In fact, that is exactly what it is, and I congratulate you on the analytical approach you have taken to assessing your risk.
Of course I don't congratulate you on your decision to have sex with a new partner without using a condom. Still, as you correctly calculated, the chance you caught HIV is extremely low. It is true that HIV is far more common in black Americans than in other racial or ethnic groups (and not because of greater "promiscuity" in African Americans); this is discussed in detail in the threads linked below.
However, it is still very unlikely that the rate of 1 in 60 of all AAs in your state having HIV applies to a 22 yo female college student, and the odds are strong you were not exposed. And as you already have seen elsewhere, even if she had HIV, the transmission risk for a single episode of unprotected vaginal sex, female to male, averages around once for every 2,000 encounters. Your symptoms don't concern me at all; they are not typical for HIV, and there are some common-sense, alternative explanation, of which you mention two (allergy, anxiety).
For peace of mind, I recommend you be HIV tested -- not because the risk is high, but because a negative test probably will be more reassuring than all the scientific rationale and statistical analysis I can provide. If you find a clinic or physician where the HIV duo test (for both antibody and p24 antigen) is offered, you can have a definitive test any time 4 weeks or more after the exposure; or 6-8 weeks for a standalone antibody test. (As discussed many times on this forum, it is rarely necessary to wait for the officially recommended 3 month mark for a reliable antibody test result.)
In the meantime, why not contact your partner and tell her your concerns? You may find she is just as worried as you are -- after all, in general women are more at risk for HIV from their male partners than the other way around. You both probably would be reassured to know the other is HIV negative -- and neither of you would have to go through a few weeks of uncertainty.
I hope this has been helfpul. Best wishes-- HHH, MD
Thanks for the comments. Yes I had read those previous threads. From what I know of my partner, she usually dates white men so I am assuming her exposure to other AAs is limited. She is also planning on attending med school...
I originally brought up PEP in the ER but the doctor (and the CDC) seemed to think I was too low a risk. I guess only time will tell. It has been about 3 weeks since the encounter and I cannot think of anything else. Sadly, luck was never one of my strong points.
I was hoping that you could elaborate a bit more on why heterosexual transmission is so difficult. 1/2000 sounds pretty rare.
I have been constantly considering odds under a worst case scenario (i.e. she did have HIV and was in the acute stage). I know the chances of having unprotected sex with someone in the acute stage are extremely small (as has been discussed in previous threads).
I tried talking with her afterwards, but she was not responding.Thanks again for your guidance.
I don't see any difference between my advice to you and in that other thread. As I said above, you do not need HIV testing; exactly as in the other discussion, I recommended you consider it only because the negative result will probably give you more reassurance than my advice does. You can definitely expect a negative test result. In the meantime, I suggest you stop reviewing other threads or doing any other online searching on this.
Dear Dr. Handsfield,
I just received results from a standard antibody test at 4 weeks. Negative! Assuming this is ~90% reliable, along with the odds I had HIV to begin with, I now calculate my risk at about 1/half a million or so. Based on your initial assessment and these test results, is it safe to say that I can put this exposure behind me with no need for additional testing? I greatly appreciate your guidance. I think this forum is a fantastic resource!
Nope. HIV rashes are not localized or itchy -- and in any case, the test result proves that HIV is not a possible cause.
That will end this thread. Your negative duo test at 4 weeks is 100% reliable. It doesn't matter what symptoms you have now or may develop at any time in the future; you would have to look to causes other than HIV.
OK, the test result is "only" 90% reliable. Since you had under 1 chance in many thousand of cathing HIV, the chance you have it are 1 in 10X many thousand. So this doesn't change anything significantly. And as I said, HIV doesn't rash like yours.
Apologies for one further post. The rash had me a bit spooked, but based on your advice and others a localized, itchy rash >5 weeks post exposure is pretty unlikely to be due to HIV. I probably had an allergic reaction to something I placed my elbow on.
I know that you didn't even think I needed testing to begin with and my 90% reliability at 4 weeks is reassuring. Should I try to place this event behind me now with no further testing? I will base my decision solely on your recommendation. Thanks again.
You clearly remain anxious about HIV. I think you should have a definitive test, only for reassurance. If you do not, you will continue to worry about it. Have a duo test at any time or another antibody test at 6 weeks or more.
That will end this thread. I won't have any further comments or advice.
I just wanted to write to tell you that I took a second antibody test via Labcorp at 7 weeks (50 days) which was also negative. At this point can/should I forget about HIV based on my exposure? From most of what I have seen and read I am inclined to say yes. Again, I sincerely appreciate your guidance and reassurance. You really helped me get through a very stressful period in my life.
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