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Can protected anal sex still lead to HIV?

Can protected anal sex still lead to HIV?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At January 13, 2018
Reviewed AtJuly 12, 2023

Patient's Query

Hello doctor,

I met a man who was a foreigner. During the winter, one night we went to a restaurant in and after that we went to a bar for some drinks and then to a food store. I had not dressed appropriately for the cold weather and I had no hat or scarf and it was very cold. We ended up going to his place. Next thing, I was fingering him and we had oral sex. I started to masturbate but I am circumcised so it hurt without moisture. He gave me jerkins and I was behind him. I slipped inside him and he came off. Then we put on a condom and did anal. We did mostly cuddling. Then I pulled out the condom with no ejaculation. The next day, I developed a severe headacheso I assumed it was from the alcohol. I was not drunk. The next day, I started to get burst of muscle and joint pains throughout my body mainly when I was indoors. I was caught up with my final exams so I ignored the pains. When the pain went on for some days I went to a sexual health clinicand did a full STD (Sexually Transmitted Disease) test. I got negative for HIV (Human Immunodeficiency Virus) but for acute HIV I had to wait 10 days for all the results. I still had the pains and took no pills. The very next day, I had night sweat and chills. I got so worried that I went at 11 p.m. to a 24-hours pharmacy to buy painkillers. My fever went up to 104°F. I took Tylenol then get a cab at 3 a.m. to go to the ER. The fever went down and I did not see the doctor until 8 AM. and I only got a painkiller. The next day I saw my right leg looked slightly swollen. Since then, my fever has always been low and the muscle painand joint pain was still present. I ended up rushing to other ERs (Emergency Room) for help. Two nights ago, the pain got to me when I tried to sleep. My arms, armpits, neck, collarbone, groin, legs were all paining. I got another HIV antibody/antigen blood test just two weeksafter possible exposure and it came negative. I have been taking Ibuprofen every five hours to reduce the pain but I start to get breathing problems and my bladder areafeels tender with pain in the upper right abdomen. I explained to my friend all my experiences but he was firm that he is negative. We did not have bareback sex and we used a condom. I have no diarrhea, cough, fatigue or rash. Is it possible that I have contracted HIV? I only have sex two times per year without ejaculation. My friend tends to be more active.

Answered by Dr. Sushil Kakkar

Hello, Welcome to icliniq.com.

Protected anal sex and fingering is safe and there is no risk of HIV (human immunodeficiency virus). However, receiving unprotected oral sex carries a very low risk even though saliva is not considered infectious, provided he didn't have oral sores or bleeding gums. You may wait for another four weeks for a repeat HIV 1 and 2 antigen/antibody test. At six weeks it is considered conclusive of CDC(Centers for Disease Control) recommendation. Though I feel that your symptoms are perhaps due to the flu rather than a flu-like illness, you may continue with symptomatic treatment.

Patient's Query

Thank you doctor,

I have already gotten a flu shot a month ago but I am worried that after fingering and then unprotected penetration for a second, rectal fluid was present, would provide a high-risk scenario. The feeling of painwas mainly targeted at my lymph nodes and all of this was within two weeks lasting for more than a week since possible exposure. I had malaise and sleepless nights.

Answered by Dr. Sushil Kakkar

Hello, Welcome back to icliniq.com.

If there was unprotected anal penetration then it does present a high risk of transmission of HIV (human immunodeficiency virus). You may do either HIV, PCR (Polymerase Chain Reaction) or RNA (ribonucleic acid) test or a p24 antigen test even now as they are highly sensitive at two weeks from a high-risk exposure. PCR and RNA have a short window period of nine to 13 days and p24 antigen has a window period of one to two weeks. However, these tests must be followed up by a more specific HIV test e.g HIV Duo test HIV antigen/antibody combination test at four weeks and again at six weeks for a conclusive result or a rapid HIV (Human Immunodeficiency Virus) screeningtest antibody test at four weeks and again at three months for a conclusive result. I think the best for you would be a PCR RNA test now followed by an HIV Duo test at four weeks and repeat test at six weeks for a conclusive result. HIV Duo has a window period of two to three weeks and is highly accurate at four weeks detects 95% of those infected though it is considered conclusive at six weeks with 99.9% Accuracy.

Patient's Query

The day of my possible exposure was December 11. Because of the multiple symtomps I had I assume my viral load is high. I did 4 generation Hiv ab/ag combo test on the 18th, 23rd and 25th of December. They all came back negative. I did another test on the 29th but I haven't received the results as yet I am still feeling muscle pain,tingling in my fingers and little abdominal pain but they are not severe since one of my doctors prescribe taking Ibuprofen every 5 hours of the day. I have no diarrhea, no unusual discharge, no fatigue or cough. I developed a slight soar throat that I think may have resulted from the current harsh winter conditions

Answered by Dr. Sushil Kakkar

Dear Anthony. Thank you. The 4th generation HIV Antigen /Antibody screening test is not reliable within the first 2-3 weeks after possible exposure. Therefore it can be repeated at 4 weeks (as almost 95% of HIV patients will test positive at 4 weeks) and at 6 weeks it is considered conclusive. You may rather go for a RNA PCR test. RNA PCR test may be relied upon early on after possible exposure (it has a shorter window of 9-13 days) as other tests usually have a longer window period (including 4th generation and 3rd generation HIV screening test).

Patient's Query

Thank you I did HIV RNA test and awaiting the results. However, is it common for Hiv symptoms to occur a few days after possible exposure? To be frank, i started to get a severe headache within several hours then body aches as the day progressed

Answered by Dr. Sushil Kakkar

Dear Anthony. Flu like symptoms /seroconversion illness usually happen 2-4 weeks after infection with HIV. Regards

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sushil Kakkar
Dr. Sushil Kakkar

Dermatology

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