Risk?

[Rob2014]

I had unprotected vaginal intercourse with a bar pick up close to 2 and a half years ago.  Never had any significant symptoms of anything since then other than a mild cold lasting several days a month ago.  Am I ok?  Should I do anything?

[H. Hunter Handsfield, M.D.]

There's actually a good epidemiologic reason that one-time exposures are more risky at the early stage of an epidemic, i.e. the time frame of Dallas Buyers Club.  When HIV is first introduced into a population (more properly, into a network of sex partners -- i.e. the partners of partners etc), several people may be infected at more or less the same time, so that a high proportion of infected persons caught it recently and have with high viral loads, i.e. exactly the type of infected person most likely to infect others.  Now 30 years later, with relatively few newly infected networks, even when someone has HIV, s/he is statistically unlikely to be highly infectious and individual random exposures are less likely to result in infection.  This is also why, despite the usual low infectiousness of HIV in heterosexuals, we sometimes see localized outbreaks of new HIV in several persons at once -- for example, a couple of times in the past 10 years in the So. California porn film industry.

[Rob2014]

Thank you- The Dallas buyers club has caused some stress.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

Single heterosexual exposure rarely transmit HIV.  The large majority of those who acquire the virus heterosexually are the ongoing sex partners of people who unknowingly have HIV, with transmission often not occurring until several months or years of unprotected sex.  And if you're in the US, the odds any particular sexually active woman has HIV is under 1 in a thousand, including those at high risk as suggested by "bar pick up".

So is it possible you picked up HIV from that one exposure?  Sure.  But we're talking about odds not unlike those of a powerball lottery win.  That you get a cold from time to time obviously makes no difference.

Since you're concerned, have an HIV test, as well as a urine test for gonorrhea and chlamydia and a syphilis blood test.  Everyone who is sexually active outside mutually monogamous relationships should have these tests routine from time to time, like once a year.  This would seem to be a good time, since it's on your mind.  If this exposure is your only potentially risky one, you definitely can expect negative results.

Best wishes--  HHH, MD