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Avatar universal

Really concerned

Hello,

I am beside myself at the moment.  I am a white female, on vacation in Honduras (Roatan) from the United States.  In a drunken stupor, I had unprotected vaginal and oral sex with a native Honduran (from Roatan) last night.  He is a black man, 26 years old.  He did not ejaculate, and the encounter did not last all that long.  He says that he was HIV tested three months ago as part of a requirement for renewing his drivers license (he says his status is negative).  I don't know this person, and I have no idea if he is telling the truth.  He says he has never used IV drugs, and I have no idea if he has ever had sex with a man. I feel like my risk is through the roof on this one.  I am just looking for a professional medical opinion on what my risk realistically is.  I know I need to get tested at 6 weeks, 3 months, and 6 months to be sure.

Thank you.
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Sorry you didn't tell me about your partner's new test result at the start!  You can be certain your partner doesn't have HIV; the statistical likelihood he is in the window period and actually has a new HIV infection is too low to worry about.  You definitely do not need PEP and I agree it would be difficult to find a physician willing to prescribe it.  If I were in your situation (or if you were a member of my family), I would not even have HIV testing.  Assuming you remain nervous and would feel better with a negative test result, I recommend a single antibody test 6 weeks after the exposure; or if you can find a doctor or clinic that offers the "4th generation" ("duo" or "combo") test for both antibody and p24 antigen, that test give 100% final results at 4 weeks.  In the meantime, stay mellow about HIV.  (However, it would make sense to be tested for garden variety STDs -- chlamydia, gonorrhea, syphilis -- after you return to the US.)
Helpful - 1
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum.  I'll try to help.

Most people don't lie about HIV status when asked directly, so probably your one-time partner isn't infected.  That said, I'm skeptical that Honduras (or any country) requires HIV testing as a condition for driver license renewal, so that part of his story sounds suspicious.  Unfortunately, I have no information about HIV frequency in Honduras, and certainly not in population subgroups there, e.g. whether your partner's race might predict a higher likelihood he is infected -- so I cannot estimate the exposure risk from that perspective.

However, even if he had HIV, the risk you were infected is low.  The average transmission risk to a woman for a single episode of vaginal sex, if the male is infected, has been calculated at 1 in 1,000.  And probably lower in this case, with no ejaculation.

Still, this is a sufficiently high risk situation that you should not be relying entirely on this or any other online source.  I strongly encourage you to find a doctor or clinic who understands HIV and its prevention and knows the local epidemiology of HIV.  If such an expert considers your risk sufficiently high, s/he might recommend post-exposure prophylaxis (PEP) with HIV drugs, and/or early HIV testing by PCR or other methods.

In the meantime, you are mistaken about recommended testing intervals.  Six month testing for sure isn't necessary; it never takes longer than 3 months and rarely that long; a negative antibody test at 6 weeks is virtually 100% proof against a new infection.  Even a 4 week test is 90% reliable, and as implied above there also are direct tests for the virus that are useful as early as 10 days after exposure.

Another approach, if you remain in contact with your partner, is to ask him to be retested immediately for HIV; perhaps he would be willing to accompany you to a local clinic.  If his HIV test is currently negative, you would know with nearly complete certainty that you weren't exposed.

So try to find a local clinic or doctor to advise you.  But whether or not you are successful in that, keep a level head and don't panic.  The odds are very strongly in your favor.  Please return with a follow-up comment to tell me how it all shakes out.  

Best wishes--   HHH, MD
Helpful - 1
239123 tn?1267647614
MEDICAL PROFESSIONAL
Let's take them one at a time.  Gonorrhea and chlamydia (urine or vaginal swab test):  any time after 5 days or so.

Syphilis:  Symptoms usually show up in 2-4 weeks; the blood test is accruate after 6 weeks.

HPV:  No test exists to tell whether or not you were infected.  If you were to develop an HPV problem (abnormal pap, genital warts), they probably would show up 6 to 24 months later.

HSV:  Probably best not to test on account of a single exposure.  But if you want to do it, the blood test needs to wait until 3-4 months after exposure.

That's going to have to end this thread.  I hope it's been helpful.  Take care.
Helpful - 0
Avatar universal
Doc, I just have one final question, if I may.  In regards to testing of other STD's, what is the incubation period for the other ones like HSV, HPV, chlamydia, gonorrhea, syphilis, etc.?  Just wondering how long I'm going to have to wait to be tested.

Thanks again for your help.
Helpful - 0
Avatar universal
I actually didn't know his status when I wrote my original message - we went to the hospital a while afterward.  :-)  Thanks again for your reassurance Dr. Handsfield, I truly appreciate it!!  Will definitely be getting tested for everything when I get back.


Helpful - 0
Avatar universal
Thank you Dr. Handsfield.  Actually, we went to the local hospital today and he was tested on the spot, and the results were negative (the results were ready in an hour).  I was with him the entire time and have the written confirmation of a negative result.  My partner told me that he has not had any other unprotected sex in the past couple of months.  He also told me that the hospital we went to is the best one on the island, but it IS a third world country so I am not sure how reliable their tests are - do you think that is something I should be concerned about?  

Also, I am leaving the country tomorrow -- would PEP's be effective if they are not administered right away (in other words, if I received them 24-48 hours after potential exposure)?  I could try going back to the hospital here, but I am not sure they would even have those medications.  Plus, the doctor might not give them to me because he knows that my partner tested negative.  
Helpful - 0

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