Question

Hi Dr. I recently had vaginal sex with a woman with HIV, however the condom broke and I fear I may have been exposed. I went on a PEP drug at the 60 hour mark, so it was rather late but i finished the course. 2 weeks after I finished PEP my glands in my neck and under my arms came up, I had fatigue, muscle pain and oral thrush. I have done full blood tests which show nothing out of the ordinary. 2 weeks after these symptoms came up i returned a negative HIV antibody test. Would 2 weeks be long enough for antibodies to show? My doctor insists that I still dont have much to worry about as HIV is rarely spread from female to male. Should I still be worried?

Answer

Hi,

Most HIV-infected folks will have detectable levels of anti-HIV antibodies in their blood within four to six weeks following HIV primary infection. However, HIV-antibody tests are not considered definitive until at least the three-month mark. For those who have had a significant HIV exposure, the CDC recommends HIV testing at the six-month mark as well for a conclusive result. Your negative test two weeks after completing nPEP (four weeks from exposure) would therefore be encouraging, but not conclusive.

I disagree with your doctor that HIV is rarely spread from females to males! It is certainly more efficient (easier) for HIV to be transmitted from an infected male to an uninfected female. That's just biology and common sense (a load of HIV-infected spunk gets deposited directly into the love canal). However, to claim that female-to-male transmission is rare is just plain wrong! Remember, there are over 34,000,000 HIVers worldwide and all the positive guys certainly didn't contract it from gay sex! Worldwide HIV is predominantly a heterosexually transmitted disease.

Should you be worried? Not excessively, as worry won't help and it certainly won't change the outcome of your HIV tests! You've done everything you could by having safer sex (condom use despite the condom failure) and taking a course of nPEP. All you can do now is wait for your three- and six-month test results. Please note the statistical odds are very much in your favor that you did not contract HIV from this unfortunate sex-perience.

Good luck.

Dr. Bob