140 days negative?

Question

Good morning, Dr. Jacobs, and thank you for your time, hope you're doing well. For I, in the other hand... Are kind of worried, this was my risky episode:

I'm a 23 year old male, and 140 days ago, I had protective insertive vaginal sex with a female sex worker, yet, couple minutes after finishing our session (about 5-10 minutes) the condom broke. I finally got tested today and it's A NEGATIVE! So, how conclusive is it? Is there a need for a 6 months test, or can I move on now?

THANKS!

Answer

Thank you for the kind greeting! I'm sorry that a pleasurable sexual encounter has resulted in so much worry. Good for you for following up with an HIV test 140 days later, which will cover your window period on most standardized testing protocols.

Judging from your question I'm a little confused by the sequence of events in the scenario. Are you saying that the session "finished" - meaning you ejaculated and the condom broke 5-10 minutes after you came inside of it? Or that the condom broke while you were inside her?

Either way, you are wise to follow up with a test. Many RNA tests now being used can detect HIV within 10-21 days. Most antibody tests can pick up a new infection within 8-12 weeks. You waited more than 4 months to get tested, so a negative result pretty much guarantees you did not acquire HIV from the event you describe (http://www.sfaf.org/hiv-info/testing/hiv-test-window-periods.html).

The fact that you did not acquire HIV from this encounter is not really a shocker. It would be very unusual for you to get HIV from one unprotected encounter during vaginal sex. As the insertive partner, you risk of acquiring HIV from one single exposure is less than .5%. (https://www.poz.com/article/HIV-risk-25382-5829). Those are some pretty strong odds in your favor!

So given the accuracy of most tests to capture a seroconversion within 90 days, and given the extremely low risk activity you describe above, it doesn't seem to me to be of high urgency to get tested at the 6 month mark.

However, if that 6 month test allows you a sense of calm, peace, and feeling of self-efficacy, then why not do it? It doesn't hurt to get tested and get validation for yourself that are you still HIV negative.

Going forward, I would consider making sure you are storing condoms at the right temperature and checking their expiration date to reduce the chances of a breakage. And if you find yourself preferring sex without condoms, you may wish to consider if PrEP is right for you. To learn more about PrEP please visit our resource library at http://www.thebody.com/index/treat/tenofovir_prevention.html