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First time exposure to HIV. Am I infected?
Jul 2, 2011

Dr. Frascino, Here is my dilemma. I have been in a monogamous relationship with my boyfriend for three years. Both of us tested negative at the beginning of our relationship. After a heated argument last week, I got pretty intoxicated and ended up having unprotected anal sex with a know promiscuous guy, who claimed he tested negative four and a half months ago. I was topping him, although the act only lasted about 5-10 minutes being that I was drunk. He also went down briefly on me. Not soon after that, I have found out that his partner, whom he's in an open relationship with, is HIV positive. After asking him to show me his papers, he stated that he does not feel comfortable with that, being that they contain his personal information, but that he will be more than willing to have his doctor send them to my doctor. Being that I don't have a primary care physician, this makes it more difficult. He told me that his partner's viral load is undetectable and that he only tops his partner unprotected. I know that this still carries a significant risk and I am beyond freaked out. It has been 5 days since the exposure, and being that I just found out that his partner is infected, it is a little late to take PEP. Should I take the medication anyways? Another thing is that my partner and I started working things out, if I told him what happened, this would mean the end of our relationship. Either way, I would never dream of putting him through any kind of risk. My question is, in your opinion, what do you think my chances are that I have contracted the virus? What do you think is the risk of infecting my partner if a few weeks down the road we engaged in a sexual act? Also, I am uncut, but I clean myself regularly and I took a shower shortly after. Does that still carry a significantly higher risk? I am devestated at this situation and am I not sure what my next step should be. This is the only time that I have ever had a random hookup. If you can, please give me any kind of advice.

Response from Dr. Frascino

Hello.

Unprotected sex places you at some degree of risk for STDs, including HIV. That your random-hook-up-bottom-boy tops his positively charged partner bareback is worrisome. I agree with you this carries considerable risk. What his HIV test results showed four months ago isn't all that relevant now. You need to know his current status. If you're still in touch with him, perhaps he would consider getting a rapid HIV test. The results would be available in just a few short minutes. If indeed he tests negative, your HIV-acquisition risk would be significantly decreased to the relatively remote possibility that he has only recently become infected and is still within his seroconversion window period (HIV infected but not yet making detectable levels of anti-HIV antibodies in the blood). You will still need your own HIV-antibody test at the three-month mark (and again at six months, if your buddy tests positive).

PEP would not be warranted, even if your bottom boy tests HIV positive, as PEP needs to be started as soon as possible and no later than 72 hours after the exposure.

Regarding your boyfriend, I would suggest the old adage "honesty is always the best policy." You report you would "never dream of putting him through any kind of risk." I would advise the only way to do that is to level with him. You can then use latex condoms for all penetrative sex until you get your definitive HIV test result and can confirm your status is negative. This is not only the best way to deal with any guilt you may have; it's also the right thing to do.

Good luck.

Dr. Bob



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