Sex during window period?

[glovemaker]

Hello doctor. I was wondering if you could help me with an exposure.

I am a 20-year old, white heterosexual male. Uncircumcized, no other STD's that I know about. I had unprotected sex at a party with another 20-year old woman (a co-worker). I know very little about her, aside from the fact that she's from the richest county in Maryland (we both are), is white, and heterosexual.

My biggest concern is that before our encounter, according to rumor, she was having regular intercourse with an African-American man - also a coworker - aged 25. He is, however, also from a wealthy area of the state. My worry is that she may have been in the "window period" when we had sex, which I think increases the risk, correct?

I'm really freaking out about this encounter. It was my first sexual experience, and I'm really hoping it doesn't end up ruining my life. I'm kicking myself every day, can't eat, can't sleep, and so on. Please tell me what you think because I'm worried all my variables significantly bump up the odds of transmission.

[H. Hunter Handsfield, M.D.]

That numerical analysis is about right.  Being in the window period would elevate the chance of transmission -- but the odds are zilch that she was in a window period, which neutralizes any elevated risk on that account.

You really shouldn't be at all worried about HIV from these events.  In any case, I'll have no further replies until and unless you report your test results.

[glovemaker]

Thanks for the reassurance doctor. If you had to put a numerical risk on things, would you go with your typical 1/1000*1/1000 = one in a million analysis? Or would my risks be higher?

Also, how much does the window period influence the odds? For some reason that's really worrying me.

The incident happened only a couple of days ago, but I will be sure to test at 4 weeks.

Thanks again.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

Heterosexually transmitted HIV remains rare in the US.  It is true that HIV rates are higher in African Americans, but as you apparently understand, it doesn't apply to all AAs, and the chance your partner's former partner has HIV undoubtedly is low.  Here is a thread that explains this aspect in some detail:  http://www.medhelp.org/posts/show/1261996

You're obviously reacting emotionally to your first sexual experience.  That's not entirely surprising or unsual, but the health risks really are trivial.  The risk is much higher for chlamydia and other STDs aside from HIV -- although those risks also are low.  You are wrong that "all my variables significantly bump up the odds of transmission":  they do not.  

But since you're so nervous, have an HIV test.  You don't say how long it has been, but you can have a valid test 6-8 weeks after exposure; or find a lab that offeres the newly FDA-approved "combo" or "duo" test, which measures both HIV antibody and antigen; that test give virtually 100% reliable results at 4 weeks.  You also might speak with your partner about your concerns; perhaps she will agree to be tested at the same time.  The window period is brief, so probably her HIV test would be positive if she were in the window period when you had sex with her.  But don't lean on her hard; if she is confident she doesn't have HIV, you can also be confident about it.

Feel free to return with a comment to tell me your HIV test results.  While you're at it, have a urine test for chlamydia and gonorrhea.  You can expect negative results on all of them.  But I won't have any further advice until test results are available.  Go into the testing with a light heart; it is exceedingly unlikely you caught HIV.

Regards--  HHH, MD