High Risk?

[manatee231985]

I am a 24yo/F currently studying in Germany, got drunk one night, and had sex with a student who is originally from Cameroon (feb. 7). I was so drunk that I do not remember him using a condom, but I found two in the trash the next day. The next day I was very sore and had chaffing around my vagina.

On February 9, I had a panic attack and went to the hospital.  I was so hysterical that the doctor prescribed me the HIV prophylaxis.  She gave me the first two doses to be taken over 12 hours and told me to come back in the morning to see the HIV specialist.  She also did a pelvic exam, and I ended up with bacterial vaginosis (treated with Metronidazol).  When I came back, the doctor informed me that a course of HIV prophylaxis will cost 1200 euro, which I did not have, so I stopped treatment after those first two doses.  He told me to come back in one month, and at 30 days, I just tested and am currently waiting on the results.

My anxiety has taken control of my life.  I wrote my partner from Cameroon, who has since returned to his home university in Italy.  He told me, verbatim: "Be sure I am safe, no sicknesses, no HIV.  I have all my tests done before coming in Germany."  I find this somewhat reassuring but my thoughts run away with paranoid scenarios.  In his country, the official estimate for seroprevalance is 6%, but I imagine it is higher (given the stigma and limited access to healthcare).  

Pursuant to my description, I have some questions:
1.  Are immigrants from sub-Saharan Africa considered "high-risk," like IV drug users?
2.  Does getting bacterial vaginosis from someone increase your risk of getting HIV?  Is it an STD?
3.  Will my tests be less reliable at 30 days given the fact that I took 2 doses of prophylaxis?

I have not had any strange symptoms, although on day 32, I came down with a minor head cold but all of my roommates are sick. I am in a foreign country and I don't know where to turn.  I thank you and applaud your work here on this forum.

[Edward W Hook, MD]

You are correct.  Your further tests will also be negative.  eWH

[Edward W Hook, MD]

Let's review your situation.  While you don't remember the events, you did find condoms in the trash.  This is strongly suggestive that condoms were used unless your trash cans normally contain used condoms.  In addition, you partner has indicated that he has been checked and does not have HIV.  This too is reassuring - most people do tell the truth.  On the other hand, the prevalence of HIV in the Cameroon is higher than in North America or Western Europe so some concern is probably appropriate.  

Statistics are also on your side.  If your partner had HIV and if he did not use condoms, your risk of getting HIV from each exposure is about 1 in 1000.  

Now for your specific questions:
1.  See above.  Rates of HIV are somewhat higher in the Cameroon than the U.S. or Western Europe.  Much of the problems from that part of the world  however arise because people do not get tested.  Your partner was.
2.  You may not have "gotten" BV from this episode.  About 10-15% of all women have BV at any time.  This is not an STD per se but a disruption and overgrowth of bacteria normally in the vagina. It is associated with a slight increase in risk for HIV if present when exposed however.
3.  Your 30 day tests will be a help.  At this time we would expect somewhere in the neighborhood of 75-80% of persons who got HIV from an exposure 4 weeks earlier to have positive tests by now.  A day or two of prophylaxis may make this a little less reliable but not much.

Bottom line.  Your risk is low and when you get your negative test as I am confident you will you should be even more confident you do not have HIV.  At the same time, because of the questions which have come up, I'd also suggest repeat testing at 8 and 12 weeks.  With each successive negative test the currently very small likelihood that you gotten HIV will become far, far lower.  After a 12 week test you will absolutely KNOW that you did not get HIV from this encounter.

Hope this helps.  EWH

[manatee231985]

A related discussion, Last follow up i promise was started.

[manatee231985]

This forum has been a complete lifesaver.  I really don't know what I would have done without it, as an HIV scare is really not something easy to talk about.

I knew that my 30 day test was negative, but I did not know that they had tested for HIV RNA, p24 Antigen, and Antibodies. A  Knowing this makes me feel even better. Apparently socialized medicine here in Germany really covers everything, and it did not cost me even one euro.  I assume that between all three there is basically a 99.89% chance that I am in the clear.  I took another test today, but I am much less worried than I was before.  Thank you again for all of your amazing work.

[manatee231985]

I just got back my results after 30 days: negative!  My next test is scheduled for May 4, which is 3 months after the possible exposure.  I assume that I can be fairly confident that my last results will also be negative?  Thanks so much for your reassurance.

[Edward W Hook, MD]

1.  See my comment no. 3 above.  A day or two of therapy might slightly delay development of HIV antibodies but not much.  I would still estimate the accuracy of your 4 week result at 85-90%
2.  The symptoms you describe are not highly suggestive of the ARS which is developed by only a minority of persons who get infected.  As you already know, we think that ANY focus on symptoms is a waste of time.
3.  I answered this question above as well.  I really think that your risk of having gotten HIV from the exposure you describe is very, very low.  I (once again) urge you not to worry.

Take care EWH

[manatee231985]

Thank you for your guidance.  I have a few follow up questions:

1.  On some of the other posts, you have estimated that 85-90% will test positive at 4 weeks.  Did you estimate lower in my case because of the prophylaxis?
2.  I know that symptoms are not really helpful in determining HIV status (only a blood test will be meaningful), but I have questions about symptoms.  I developed a minor head cold on Day 32 (cough, runny nose).  Could this indicate HIV?  I have not noticed anything else (fever, rash, swollen glands) and I have been hyper-vigilant since the incident.  I have been very tired and have had a few bouts of diarrhea but I think both stem from the anxiety.  I have been exhausting myself with worry.  How many people develop symptoms from primary infection?   At 35 days now, is it reassuring that I have not had any of the classic symptoms?
3.  In your best estimation, would you be worried if you were me?  Have you seen cases similar to mine which have resulted in HIV transmission?

I am sorry to be a bother, but I have no where to turn here in Germany.  The doctors at the hospital would not refer me to a psychiatrist.  The anxiety has really strangled all the joy out of my life and I have never been so depressed.  Going through this waiting period for the next two months is going to be so incredibly hard.  I am aware of the follow-up question rule and will abide by it.  Thank you for your time.