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Exposed
May 4, 2011

Hi Doc,

I am a woman currently living in South Africa. I recently had unprotected penile/vaginal intercourse with a male partner. Immediately after the intercourse I expelled the semen in the toilet (naturally) and took a bath and then took the morning after pill to prevent pregnancy (I know I am still at risk, but just wanted to provide an accurate depiction of events). Also it should be noted that i later discovered that I had a slight bacterial infection (BV). Prior to this encounter my male partner and I also had sexual intercourse but only protected (condoms).

Unfortunately for me, we discussed testing earlier, but went in only a few days after this unprotected encounter. My initial test after a few days from the encounter (ELISA) came back negative, but his came back positive... Since then after speaking w/some friends I went for a P24 Antigen test at about the two week mark (apparently this is widely used in South Africa) and it came back negative. Since then I have not done anything and have been waiting to go back in three months to get an ELISA and possibly Western Blot test.

My questions for you while trying to cope with this uncertainty are: do any of the mitigating circumstances (i.e. I am a woman, had an infection, and took the morning after pill) have any additional bearing on the liklihood that I was infected? I know the statistics are in my favor for a one time encounter, but also know that having an infection can also decrease my odds for resistance. Also, does the P24 result mean anything at all? Or is it really just offering false hope that my final test will be negative? Should I be doing anything else at this point?

Thanks for your feedback.

Response from Dr. Frascino

Hello,

Your story should serve as a cautionary tale for all those considering unsafe sex. It just isn't worth the potentially catastrophic consequences.

The worrisome components of your story include not only that you had unprotected receptive vaginal sex with a partner who was HIV infected, but also that since he did not test until several days after your tryst we can assume he was not on antiretroviral therapy. Consequently his HIV plasma vial load may have been quite high, which would increase potential HIV-transmission risk. Your "slight bacterial infection (BV)" might increase risk if the vaginal canal mucous membranes were inflamed.

You are correct to point out that not every HIV exposure leads to HIV transmission. The CDC's estimated per-act risk for acquiring HIV from receptive penile-vaginal sex with a positively charged partner is 1 per 1,000 exposures.

Regarding the p24 antigen test, p24 antigen is one of HIV's core proteins. It surrounds the viral RNA. When HIV is madly replicating, as in early HIV infection before the immune response against HIV kicks in, p24 antigen (a protein) is produced in massive quantities. It can then be detected in the blood. It is a reasonably good marker of acute infection, but it dissipates over a period of several weeks as p24 antibodies are produced. Your negative p24 at two weeks is encouraging, but this is not a definitive test.

The morning-after pill would not affect HIV transmission one way or another. As for anything else to do, the only thing to do is wait for your three- and six-month HIV-antibody tests and also to learn from this lapse in judgment so you never put yourself at such risk ever again.

Good luck.

Dr. Bob



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