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HIV and AIDS

What Are My Risks For HIV Following Numerous Sexual Acts?

02/16/2006

Question:

I recently had unprotected sexual intercourse with my girlfriend last December 10, 2006. Realizing the risks, I had her checked for HIV 1 and 2 twice. The first time using particle agglutination method on December 20, 2006 and the second time on February 2, 2006 using the ELFA method. Both tests came in negative. I had my own test on January 30 ,2006 and was also found to be negative.

I also had oral sex (cunnilingus) with my former girlfriend on January 16, 2006. Since I had a tiny sore on my lower lip I thought there might be some risks, so I gargled with mouthwash and just licked her on the clitoris without going to the vagina area. Just to be sure, I had her also checked for HIV 1 and 2 twice. The first time was on January 28, 2006 and second time on February 10, 2006 using the ELFA method. Both tests came in negative.

Answer:

There is a small risk for HIV transmission around the two episodes of unprotected sex. You need to realize that the word 'risk' is probability estimation, not exact science. Let us analyze each element. First exposure, December 10. You do not state your gender, but I will tell you that the risk per coital heterosexual act is 0.001 per act (1 in one thousand) if one of the partners is HIV positive. The transmission from male to female is 3 to 10 more effective that the transmission from female to male. The transmission from female to female is even lower.

You stated that your first partner tested negative by serological methods for HIV two times, approximately 2 months apart. It is within the possibilities that your partner had recently acquired HIV and was within the "serological window" in which the antibody tests are negative despite an individual being infected and infectious. She should repeat an HIV test 6 months after the last unprotected contact.

Your HIV test was negative around 2 months of unprotected sex. While it is reassuring, it does not completely rule out the possibility of recent infection. Again repeated testing is advised. Your second exposure through oral sex with a different female partner carries a lower risk of transmission, especially if she has tested negative for two occasions. Once again two tests 6 months apart after the last unprotected contact are necessary to reasonably exclude the possibility of acquiring HIV. In summary, your risk of acquiring HIV associated with the described exposures is very low, but not zero. However, having unprotected sexual contact with multiple partners is a high risk behavior. The transmission chances per act may look negligible, but they add up in time. Once transmission occurs, a person is 100% infected, lifelong. You should carefully consider your sexual practices in the future.

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Response by:

Francisco   Gomez, MD Francisco Gomez, MD
Assistant Professor
College of Medicine
University of Cincinnati