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Risk of infection and clarity on situation MSM unprotected
Aug 12, 2012

Hi Dr. Cordova,

Approximately 25 days ago I had sex with a guy that I had only known for a few days. I was the insertive partner and we started with a condom, but then I stupidly, stupidly took it off and we continued having sex until I ejaculated inside of him.

I had been tested the day before with a rapid HIV test and also a HIV NAAT test (which has since come back negative). I have a completely clear history of any STDs. Before we had sex, I discussed with him my negative status and wanted to make sure that we was also negative - at the time he stated that he was negative and hadn't had unprotected sex with any other guy since his last test.

The next day I freaked out a little and asked him to go and get a test done for my peace of mind. He went and then took a couple of weeks before getting back to me. Yesterday, after I called him, he finally said that 'he was not cool'. Needless to say, I haven't slept since then and have been freaking out. I asked for a copy of the results, and they read as him being reactive to ELISA (with a repeat ELISA also reactive), but negative (no bands) to the Western Blot. I have pressed him to please get another rapid plus NAAT test tommorrow.

From what I have read, this can either be classed as a negative result or inconclusive. From what I have pieced together from him, he says he did actually sleep with another guy as the receptive partner anywhere between 2 - 4 weeks before me. He said this was unprotected but the partner did not ejaculate inside him.

During the week before we had sex, he had 2 days of a pretty bad fever where he was laid out on his bed for 2 days. I'm very concerned that this could have been the onset of ARS and if so, would his viral load be extremely high which would push the risk for me as the insertive partner even higher?

Since yesterday afternoon when I found out from him, I went immediately to have another set of tests. The rapid test last night came back negative, though the duration since exposure was only 24 days. I also had a NAAT and this morning a RNA qPCR test. These will take at least 4-5 days to come back, and in the meantime I am not sleeping and am severely freaking out. I have had no signs of ARS but am now very concerned that something will come up in the next few weeks.

I am circumcised and very fit and healthy, I have no history of STDs, and no visible cuts, lesions or any broken skin on my penis or surrounding areas. I know it doesn't really matter but I thought the more information you have the better.

Could you please, please offer your opinion on the situation; what severity of risk you think I placed myself under given the circumstances, what his test results could mean, what level of reassurance I should have from the rapid test that was done last night and if there is anything I can do in the meantime before the NAAT and PCR tests come back.

I really hope that everything comes back negative and fine, this was the stupidest thing I have ever done.

Thank you in advance, I'd really appreciate your opinion.

Response from Mr. Cordova

Hi, there:

In regards to your partners tests. It would depend on the window period. If someone has a positive ELISA and a negative Western Blot, they are said to be negative. However, if the incident was within three months of the Western Blot, then that would not be the case. The testing must be done outside of the three month window for the result to be considered a conclusive negative result.

It's possible that he was experiencing ARS, but there is no way to tell for sure.

Given the fact that this was a one-time occurrence, and you were the insertive partner, it is likely that transmission did not occur. I would suggest a follow-up test three months from the incident, just to be certain.

It sounds like you are aware of the fact that using a condom for each and every act of penetrative sex is one of the best ways to protect yourself against HIV and many other STD's. Going forward don't take the condom off until you are done have sex.

In health,

Richard



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