the Risk of HIV Infection After Sexual Encounter

Q: the Risk of HIV Infection After Sexual Encounter

According to data from the Centers for Disease Control (CDC) in Taiwan, there are three main transmission routes for the Human Immunodeficiency Virus (HIV)： <br>1. <br>Sexual transmission： Engaging in oral, anal, or vaginal intercourse or other exchanges of bodily fluids with an

What is the likelihood of contracting the HIV virus?

Hello Doctor:
- I had contact with a sex worker on August 16: unprotected oral sex and protected vaginal intercourse.
- About 3 to 4 days after the incident, I felt a slight tingling sensation on the glans and noticed white or clear discharge, so I went to the pharmacy to purchase antibiotics.
- Approximately 25 days after the incident, I started experiencing a mild fever and a burning discomfort in the glans, so I visited a urology clinic where I was prescribed antibiotics and underwent a prostate examination, which showed slight swelling.
- Around 32 days post-incident, my body temperature increased and I felt unwell (unable to work normally), so I went to the hospital's urology department for an examination.
The doctor prescribed antibiotics, administered an injection, performed a urinalysis (which showed no issues), and drew blood for an HIV combo antigen/antibody test (result was negative).
I experienced continuous fever for six days while waiting for the HIV test results, which also caused dizziness, forcing me to take leave and rest at home.
Although the information indicates that the risk of contracting HIV from unprotected oral sex is extremely low, my poor physical condition has caused significant psychological distress.
- Today, approximately 40 days after the incident, my fever and dizziness have slightly improved, but I still feel unwell.
I visited an infectious disease specialist, and the physical examination showed no issues.
I underwent a more comprehensive blood test (which also included the HIV combo antigen/antibody test).
I am really scared that the HIV test result will change from negative to positive >___<.
Of course, I am also worried about other serious infections or tumors.
I understand that everything depends on the test results to know what has happened! However, I still hope to receive positive energy and encouragement from the doctor.
Thank you!

Mr. P, 40~49 year old female. Ask Date: 2023/09/25

Dr. Liao Zhongxin reply Internal Medicine

According to data from the Centers for Disease Control (CDC) in Taiwan, there are three main transmission routes for the Human Immunodeficiency Virus (HIV):
1.
Sexual transmission: Engaging in oral, anal, or vaginal intercourse or other exchanges of bodily fluids with an HIV-infected individual carries a risk of infection.

2.
Blood transmission:
(1) Receiving or coming into contact with blood or blood products contaminated with HIV.

(2) Sharing needles, syringes, or diluents with individuals who are injecting drug users and are HIV-positive.

(3) Receiving an organ transplant from an HIV-infected donor.

3.
Vertical transmission from mother to child: An infant can acquire HIV from an infected mother during pregnancy, childbirth, or breastfeeding.

The incubation period for HIV infection has two interpretations:
1.
It refers to the onset of flu-like primary infection symptoms approximately 2-6 weeks after exposure.

2.
It refers to the period from HIV infection to the appearance of clinical symptoms, which generally lasts 5-10 years (currently referred to as the asymptomatic phase or subclinical phase).
However, as mentioned earlier, the progression of HIV infection can vary significantly among individuals.

During the window period or asymptomatic phase, many patients may not exhibit symptoms, which can lead to continued engagement in high-risk behaviors, creating gaps in HIV prevention and control.
It is evident that infectious diseases have a window period, and HIV has a relatively longer one.
With advancements in testing technology, diagnosis can now be confirmed within 1-2 weeks.
It is advisable to seek further consultation and follow-up at healthcare facilities.

Reply Date: 2023/09/25

More Info

It's understandable to feel anxious after a potential exposure to HIV, especially following a sexual encounter that you perceive as risky. Let's break down your concerns regarding HIV infection risk, symptoms, and the importance of testing.

1. Understanding HIV Transmission Risk:
- The risk of acquiring HIV from oral sex is generally considered to be low, particularly when compared to anal or vaginal intercourse. However, the risk is not zero. Factors that can increase the risk include the presence of cuts or sores in the mouth, the viral load of the HIV-positive partner, and the presence of other sexually transmitted infections (STIs).

- In your case, you mentioned having unprotected oral sex and protected vaginal intercourse. The use of a condom significantly reduces the risk of HIV transmission during vaginal sex. However, if the condom slipped off, it could potentially expose you to the virus if the partner is HIV-positive.

2. Symptoms and Their Implications:
- The symptoms you described, such as a burning sensation, discharge, fever, and general malaise, can be indicative of various conditions, including STIs, but they are not specific to HIV. Acute HIV infection may present with flu-like symptoms, but many people do not experience noticeable symptoms during the early stages of infection.

- It's important to note that while some individuals may experience acute retroviral syndrome (ARS) within 2-4 weeks after exposure, others may remain asymptomatic for years. The symptoms you are experiencing could be related to an STI or another infection, and it's crucial to follow up with healthcare providers for accurate diagnosis and treatment.

3. Testing and Follow-Up:
- You mentioned that you had an HIV combo test (which tests for both HIV antibodies and antigens) that returned negative results. This is a good sign, but it is essential to understand the window period for HIV testing. The window period is the time after exposure during which the test may not detect the virus. For most tests, including the combo test, it is recommended to wait at least 4-6 weeks for accurate results, with a follow-up test at 3 months for conclusive results.

- Given that you are experiencing ongoing symptoms, it is advisable to continue seeking medical attention. A healthcare provider can help determine if further testing for STIs or other infections is necessary.

4. Mental Health and Support:
- The anxiety and fear you are experiencing are valid and common among individuals who have had potential exposures to HIV. It is essential to address these feelings. Consider speaking with a mental health professional or a support group specializing in sexual health and HIV-related concerns. They can provide you with coping strategies and emotional support during this stressful time.

- Engaging in positive activities, such as volunteering or participating in community health initiatives, can also help redirect your focus and contribute to your overall well-being.

5. Preventive Measures for the Future:
- Moving forward, consider discussing safer sex practices with partners, including the consistent use of condoms and regular STI testing. Pre-exposure prophylaxis (PrEP) is also an option for individuals at high risk of HIV exposure, which can significantly reduce the risk of infection.

In conclusion, while your risk of HIV from the described encounter may be low, it is crucial to continue monitoring your health, seek appropriate medical care, and address any psychological distress you may be experiencing. Remember that you are not alone, and there are resources available to support you through this process.

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