Aa
Assessment of Risk and Test Results
Hello Doctors,
First of all thank you for your service and for this wonderful forum. It has been a great resource and helped me to find comfort over the past few weeks. I apologize in advance for the repetitiveness of this post. I am sure it will seem like most other posts you respond to.
1 month ago I made possibly one of the biggest mistakes of my life. On a business trip in the US and while intoxicated I thought it would be a good idea to have my first ever encounter with a female escort that I found online. I am a mid 20s male, white and uncircumcised. We had unprotected oral sex for about 1-2 minutes. Then we had protected sex. At some point, the condom broke. I noticed pretty quickly and would say that my penis was exposed to her vagina for 30 seconds to 2 minutes at most before I pulled out and applied a new condom. After the session ended (Roughly 15 minutes later) I proceed to wash my penis.
1. I understand that the odds that this female sex worker had HIV is between 5%-15% and that the odds of HIV transmission from female-male for one unprotected exposure with HIV are 1 in 1000. How much is this risk increased because I am uncircumcised? Would washing the penis 15 minutes after possible exposure reduce the risk at all?
2. At 29 days post possible exposure I had an HIV DNA by PCR test, ELISA antibody test and testing for other STDs done. The PCR, ELISA antibody test and all STD tests except for herpes were all negative. In your expert opinion is a negative PCR and ELISA antibody test conclusive at 29 days? Concerning the herpes I had this well before this incident as my girlfriend told me she had it and I had been diagnosed with this a couple of years ago. At the time of this incident I had no open sores or breakouts and I have only had one very small outbreak ever. How does this affect my potential risk to HIV infection?
3. Should I get tested again at 6 weeks or 3 months?
Thank you in advance for your help and your reply.
First of all thank you for your service and for this wonderful forum. It has been a great resource and helped me to find comfort over the past few weeks. I apologize in advance for the repetitiveness of this post. I am sure it will seem like most other posts you respond to.
1 month ago I made possibly one of the biggest mistakes of my life. On a business trip in the US and while intoxicated I thought it would be a good idea to have my first ever encounter with a female escort that I found online. I am a mid 20s male, white and uncircumcised. We had unprotected oral sex for about 1-2 minutes. Then we had protected sex. At some point, the condom broke. I noticed pretty quickly and would say that my penis was exposed to her vagina for 30 seconds to 2 minutes at most before I pulled out and applied a new condom. After the session ended (Roughly 15 minutes later) I proceed to wash my penis.
1. I understand that the odds that this female sex worker had HIV is between 5%-15% and that the odds of HIV transmission from female-male for one unprotected exposure with HIV are 1 in 1000. How much is this risk increased because I am uncircumcised? Would washing the penis 15 minutes after possible exposure reduce the risk at all?
2. At 29 days post possible exposure I had an HIV DNA by PCR test, ELISA antibody test and testing for other STDs done. The PCR, ELISA antibody test and all STD tests except for herpes were all negative. In your expert opinion is a negative PCR and ELISA antibody test conclusive at 29 days? Concerning the herpes I had this well before this incident as my girlfriend told me she had it and I had been diagnosed with this a couple of years ago. At the time of this incident I had no open sores or breakouts and I have only had one very small outbreak ever. How does this affect my potential risk to HIV infection?
3. Should I get tested again at 6 weeks or 3 months?
Thank you in advance for your help and your reply.
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help. As it is apparent that you have seen the Forum and are familiar with many of the statistics we quote with such remarkable regularity, I will go straight to your questions.
1. Uncircumcised men are about twice as likely to acquired HIV, all other things being equal, as men who have been circumcised. This fact has been proven by several studies of adult circumcision which was shown to reduce risk for HIV acquisition after the circumcision wound had healed.
2. The combination of a negative HIV ELISA and negative HIV PCR provide very strong evidence that you did not get HIV from this encounter. A repeat ELISA at 8 weeks (no need to wait for 3-6 months) will provide final, definitive evidence that you are not infected from the encounter you describe.
Persons with a history of genital herpes are about 30% more likely to acquire HIV than person who do not have GH, all other things being equal.
3. No need for testing beyond 8 weeks and, to be honest, given your test results, I think this is really just "icing on the cake". I am confident that any follow up tests related to the exposure you describe will be negative.
Hope this helps. You are almost certainly in the clear now. Please do not let your experience a month ago keep you from using condoms in the future. EWH
1. Uncircumcised men are about twice as likely to acquired HIV, all other things being equal, as men who have been circumcised. This fact has been proven by several studies of adult circumcision which was shown to reduce risk for HIV acquisition after the circumcision wound had healed.
2. The combination of a negative HIV ELISA and negative HIV PCR provide very strong evidence that you did not get HIV from this encounter. A repeat ELISA at 8 weeks (no need to wait for 3-6 months) will provide final, definitive evidence that you are not infected from the encounter you describe.
Persons with a history of genital herpes are about 30% more likely to acquire HIV than person who do not have GH, all other things being equal.
3. No need for testing beyond 8 weeks and, to be honest, given your test results, I think this is really just "icing on the cake". I am confident that any follow up tests related to the exposure you describe will be negative.
Hope this helps. You are almost certainly in the clear now. Please do not let your experience a month ago keep you from using condoms in the future. EWH
MEDICAL PROFESSIONAL
Your calculations are correct. Without considering the PCR results, your negative ELISA at 29 days reduces your risk to less than 1 in 22,000 and while the true sensitivity of the PCR is unknown (the manufacturers of the test do not claim it is for HIV diagnosis, the lab does; the PCR is not a test commercially licensed for this purpose and which has not been evaluated in large studies of the sort that give us the figures we use for considering performance of antibody detection tests). Those concerns aside, I would consider your combination of test results conclusive.
I have nothing to say about the "bumps" or your groin pain. Seeing your doctor is a good idea. I doubt that they are related to the exposure which started this exchange. EWH
I have nothing to say about the "bumps" or your groin pain. Seeing your doctor is a good idea. I doubt that they are related to the exposure which started this exchange. EWH
Thank you, Doctor for your reply and advice.
Sorry for the follow up question but I was hoping you could help me statistically assess my risk at this point (I understand it is not a alternative for testing).
I have calculated the following:
Risk of HIV infection with someone who has HIV from one unexposed vaginal sex occurrence is 1 in a 1,000. Given the fact that I am uncircumcised this would be increase to 1 in 500. I also have genital herpes so this would increase the risk by 30% or 1 in 333. On the high end of your guess of the number of U.S. escorts that have HIV is 5%-15% so let’s say 15% so:
0.003 x 0.15 = 0.00045 or 1 in 2200. Are my calculations correct? Also given the fact that I had a negative HIV DNA by PCR and negative ELISA test at 29 days how does this factor in to lower my odds of having HIV? Is a a negative HIV DNA by PCR and negative ELISA test at 29 days not conclusive? If so why not? The manufacturers of the test say it is?
Lastly, I have also had two small bumps, white/skin color at the top of my foreskin on the outside of the foreskin as well as some mild but consistent pain in my left groin only. I am under extreme stress is this most likely the cause? I plan to see my doctor about these things.
Thank you for your help,
Sorry for the follow up question but I was hoping you could help me statistically assess my risk at this point (I understand it is not a alternative for testing).
I have calculated the following:
Risk of HIV infection with someone who has HIV from one unexposed vaginal sex occurrence is 1 in a 1,000. Given the fact that I am uncircumcised this would be increase to 1 in 500. I also have genital herpes so this would increase the risk by 30% or 1 in 333. On the high end of your guess of the number of U.S. escorts that have HIV is 5%-15% so let’s say 15% so:
0.003 x 0.15 = 0.00045 or 1 in 2200. Are my calculations correct? Also given the fact that I had a negative HIV DNA by PCR and negative ELISA test at 29 days how does this factor in to lower my odds of having HIV? Is a a negative HIV DNA by PCR and negative ELISA test at 29 days not conclusive? If so why not? The manufacturers of the test say it is?
Lastly, I have also had two small bumps, white/skin color at the top of my foreskin on the outside of the foreskin as well as some mild but consistent pain in my left groin only. I am under extreme stress is this most likely the cause? I plan to see my doctor about these things.
Thank you for your help,
You are reading content posted in the HIV - Prevention Forum
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
Can I get HIV from surfaces, like toilet seats?
Can you get HIV from casual contact, like hugging?
Frequency of HIV testing depends on your risk.
Post-exposure prophylaxis (PEP) may help prevent HIV infection.
