Doctor told me I don't need HIV test

August 25, 2012 6:50 PM

Does it make sense for my doctor to tell me I don't need an HIV test, because I'm a heterosexual male and I only had unprotected sex with one person in the last 6 months?

I am a male and I had a drunken one-night stand with a random girl back in February. I didn't use a condom.

I went to my doctor and asked for a full test, but he told me I don't need one for HIV, and if it were any other STI's, "You would most likely have symptoms already." He said that since I am a heterosexual male and it was only one person I had unprotected sex with, that it was a pretty low risk, so no need to test for it.

I read that sexually active people should be tested every 6 months.

Is this normal for my doctor to tell me not to have an HIV test? Isn't this dangerous for the next person I have sex with. I know it was only one girl who I was unprotected with, but I don't know her. What if she had HIV?

I feel weird about this. Should I?

posted by anonymous to health & fitness (33 answers total)

Male to female transmission rates are very low, which I'm sure is what your doc was thinking of.. But you should insist, especially if you already feel weird about it. I can't imagine what the downside is.
posted by supercres at 6:53 PM on August 25, 2012 [5 favorites]

Sorry, I of course meant female to male.
posted by supercres at 6:54 PM on August 25, 2012

Yes, that's super-weird. The odds of you having gotten HIV are very low, but if nothing else a test will give you peace of mind.

If your doctor really refuses to do it, you could a) get a new, better doctor or b) find a sexual health clinic that does testing. I think even Out of the Closet thrift stores do testing.
posted by drjimmy11 at 6:58 PM on August 25, 2012 [1 favorite]

First, a good doctor would spend the time and effort to make you feel listened to, and that your concerns were addressed.

Second, Planned Parenthood has a great online check for what tests you might or might not want to get.

Third, someone will probably break down the math for you, but female to male transmission of HIV from vaginal sex is actually relatively difficult, and if you and your partner are both in a typical demographic to be asking questions here, your chances of exposure are very low. But even so, periodic testing is something that your future partner(s) might expect, and your desire for those is not a wrong thing at all. One of the ways of getting people in high risk groups to get tested has been to try and create an expectation of testing for everyone, whether high or low risk. It creates some unnecessary testing, but hopefully gets some high risk people who would otherwise be reluctant to be tested to come in and do it.

tl;dr: find a non-judgmental clinic and get tested.
posted by Forktine at 6:58 PM on August 25, 2012 [2 favorites]

Agreed that you should insist. I did and it was no problem. I did it do my husband (above) and I could enjoy sex sans condom. Knowing makes perfect sense. Not knowing=scary. If anything, planned parenthood will certainly do it for you.
posted by two lights above the sea at 6:59 PM on August 25, 2012

Husband=supercres! Sorry for the confusion.
posted by two lights above the sea at 7:02 PM on August 25, 2012 [1 favorite]

Is there a concrete reason your doctor would suggest this, such as the test is very expensive and he knows your insurance won't cover it, so because your risk factor is low he thinks you won't think it's worth it? (Not that he's right of course...)

In terms of getting tested regularly, it is a very good idea and definitely recommended. Also your risk factor is low, it is still present.
posted by DoubleLune at 7:08 PM on August 25, 2012

Much greater chance that she would get pregnant than you would get HIV.

But if you want the test, you just tell your doc you want it done and you do it - that's it.

Of course if you have unprotected sex with different partners you should get regularly tested - but then, condoms help to decrease the need to do that.
posted by heyjude at 7:09 PM on August 25, 2012

While your doctor is correct that you're low risk based on this one event, measuring risk like that is most relevant at the population level, not the individual level. Yes, you should have been given a test if you requested one, and he should have not made you insist on it. I echo finding a different clinic or doctor who will give you one. Standard practice is to provide a test to anyone who requests it.

Planned Parenthood or an STD clinic may be more helpful.

Also, that line about STIs is just bullshit. Medically incorrect bullshit.
posted by gingerbeer at 7:10 PM on August 25, 2012 [1 favorite]

That's bizarre. You could certainly be an asymptomatic carrier of STIs like herpes. And yeah, the odds of female to male HIV transmission are very low -- but did your doctor actually refuse, or talk you out of it? If the doc actually refused when you tried to insist on it and need one for your peace of mind, you need a new doctor.
posted by J. Wilson at 7:14 PM on August 25, 2012 [2 favorites]

You know, it's possible that the test isn't effective enough to tell you anything.

Let's say your doctor knowing the details you know about the person you slept with (your location, sadly the race of your partner overwhelmingly affects the probability here etc.) the probability of her being positive is something like .1%. The infection rate for the USA as a whole is estimated to be something like .38%, and that burden falls heavily on men who sleep with men, people in certain parts of the country, etc. It is not outside the realm of possibility that the probability of a woman in your town having HIV is actually vastly lower than .1%.

Anyway, the female-to-male transmission rate through ordinary heterosexual intercourse of HIV is not really locked down, but I think researchers estimate it to be somewhere on the order of .1% to .01%.

So, a random one shot encounter for you might leave you with something like .01% to .001% chance. That is to say, with no testing, you could be 99.9 to 99.99% certain that you do NOT have HIV, and that's with my BS numbers, the actual numbers may be way more in your favor.

That's not my real point though. My real point is that you'd need an extremely accurate statistical measure to add any new information here, because the rate of "true positives" is so exceedingly rare.

Wikipedia says:

"The specificity rate given here for the inexpensive enzyme immunoassay screening tests indicates that, in 1,000 HIV test results of healthy individuals, about 15 of these results will be a false positive."

The number of true positives in a sample of people in your situation may be somewhere between 1 and .1. So you are overwhelmingly more likely to get a false positive than to discover you have the disease.

I'm not very good at statistics, sorry, and I'm sure someone smarter than me and more knowledgable about this will be along to explain where I've gone wrong, but you see what I'm getting at here, right? (a) it is hard to develop tests that accurately tell you when extremely rare things happen and (b) statistics are sometimes counterintuitive. Your doctor may simply realize that the testing protocol isn't capable of adding any information here (I have no idea if this is actually the case).
posted by jeb at 7:15 PM on August 25, 2012 [18 favorites]

indeed, it is possible to have an STI and be asymptomatic.

For your future peace of mind, change doctors and insist that your new doc give you the tests. (I wouldn't trust a doc like the one you describe to know not to give me a z-pack for a common cold, much less great anything serious. I think you are absolutely right to want the tests, and right to be disappointed in your doctor.)


Regarding the point jeb makes: there are multiple tests for HIV. If you test positive on the first, they run a second, to account for false positives without freaking patients out.
posted by bilabial at 7:22 PM on August 25, 2012 [1 favorite]

The CDC recommendation is for everyone between the ages of 13 and 64 to get screened for HIV.

In all health-care settings, screening for HIV infection should be performed routinely for all patients aged 13--64 years.

So to actually answer your questions, it goes against accepted public health standards to not test you. You should feel how you feel about it -- fears of HIV can bring up strong emotions for people. If you go to a Planned Parenthood or STD clinic, you may want to talk to the test counselor there about your concerns.

I would also encourage you to use condoms in the future, when having sex with people for whom you do not know their HIV status.
posted by gingerbeer at 7:26 PM on August 25, 2012 [5 favorites]

"You are overwhelmingly more likely to get a false positive than to discover you have the disease."

I was going to say something almost EXACTLY along these lines, except without the hard numbers that jeb supplied. So thank you, jeb!

The short answer is that the chance of you being HIV+ from a single exposure to one woman is astonishingly low. That being said, if this is really eating at you so much, you should go ahead and get tested in order to get some peace of mind.

http://www.freehivtest.net/

^This site has a few locations where free HIV tests are performed -- however, it is only in a few places across the US. If you are in a city large enough to have an LGBT center or a health clinic aimed at gay men, you could probably get a free or low-cost HIV test as well; some Googling around (or a few minutes on here -- look for "Organizations" in your city) should help you.
posted by lewedswiver at 7:28 PM on August 25, 2012 [1 favorite]

That totally happened to me. When I got my first job that had health insurance, I went in for a check-up. I had to insist to my doctor to do an HIV and STI test. (I wasn't at risk or having any issues, I just feel that responsible adults should have them done before getting involved with a new person.) My primary care doctor, and my OB/GYN both looked at me like I was crazy. I think sadly, since I seem like a "nice girl," ( ha ha ha) both my doctors thought I couldn't be at risk. I found this irritating and insisted on the tests. My OB/GYN still wouldn't do a herpes test, but I wasn't too worried about that one.
posted by Aquifer at 8:08 PM on August 25, 2012

Your doctor is a twit. Insist on getting tested.
posted by deborah at 8:29 PM on August 25, 2012

This frustrates the hell out of me. Last time I started dating a guy who I knew had had unprotected sex in the past, I asked him to get tested, and the doctor would barely give him a thing (he finally did but with a smirk). It's just shitty that we're told all the time to get tested and be safe and then we go to the doctor and they roll their eyes at us. So yeah, I'd get a new doctor and get tested for STIs, at the very least.
posted by stoneandstar at 8:36 PM on August 25, 2012 [1 favorite]

if it were any other STI's, "You would most likely have symptoms already."

This is just wrong. There are some STIs where a person can be asymptomatic & still pass the STI on to his or her partner. New doctor, absolutely.
posted by insectosaurus at 9:09 PM on August 25, 2012 [1 favorite]

I think everyone has already covered the inaccuracy of your doctor's statement about symptoms of STIs.

I just wanted to reiterate what bilabial said about the protocol for HIV testing. It's a really serious diagnosis. Labs do not just run one test and then give you the answer if it is positive without double checking it using a much more specific test, called a confirmatory test.

So although jeb is right that you are more likely to get a false positive than to have the disease, that doesn't mean you will actually receive an inaccurate test result if you get the test done. Definitely get yourself checked, and get yourself a different doctor.
posted by treehorn+bunny at 9:38 PM on August 25, 2012 [3 favorites]

It's your responsibility to the next partner, not his. Get another doctor.

(also, tell this one you're not charmed by his answer. Super duper unprofessional).
posted by Namlit at 11:33 PM on August 25, 2012

You are the main advocate for your own health care. Your doctor believed the test wasn't necessary, and he's right -- it's not particularly worthwhile. If you're not satisfied with that, the onus is on you to assert yourself. If you'd said, "I understand the risk is low, but I would like the test anyway for my own piece of mind. Can you do it for me?" the doctor almost certainly would have said yes without argument.

In short, it doesn't sound to me like you were very assertive with your doctor. You might as well practice on little stuff like this, so that you're better at it if/when you ever have to deal with the really hard decisions.
posted by hermitosis at 11:37 PM on August 25, 2012 [2 favorites]

You can get free HIV tests in your community. And free tests for other sexually transmitted diseases. Just Google!

You've waited a long time to worry about this. I think that is applicable to your doctor's attitude. He's basically telling you to chill out. He's not telling you to take uncomfortable risks in the future.

That said

If you have insurance, I've had my insurance covered docs tell me to get the HIV tests at a free clinic, because going through the insurance carrier is no bueno for legal and financial reasons.

He did you a favor if this test would have been through your insurance. Or so I have been told.
posted by jbenben at 1:12 AM on August 26, 2012

In case this was lost in the thread...

My understanding about HIV tests from doctors is that is is preferable to take that test outside of your insurance coverage.

Your doctor might have not been ballsy enough to tell you this, and equivocated instead.

Get the test from an outside source.
posted by jbenben at 1:16 AM on August 26, 2012 [1 favorite]

There are two separate issues, here, I think.

First, medically when asked whether you should take the test, your doctor said Nay. And he's probably right. Risk is low, symptoms would have shown. He explained that.

Second, you're anxious about the issue. That's a non-medical / non-factual issue. If the doctor didn't know about it, he might not have reacted to it. Maybe for him, low risk numbers are enough, but not for you.

So: get a test done to handle your anxiousness about the issue. Next time, maybe help the doctor understand better, what your issue is.
posted by oxit at 3:09 AM on August 26, 2012

I was uneasy about my ex's sexual activity during our relationship, so I chose to get an anonymous test. I don't want my insurance company to draw any conclusions from my testing choices. disclaimer: I'm kind of paranoid about privacy.
posted by theora55 at 7:21 AM on August 26, 2012

You can find doctors who will provide you with the test because "the customer is always right" but you will not find any doctor who will advise you that it is medically necessary. Your doctor gave you a valid professional opinion. It is statistically useless and a waste of resources to get the test.
posted by mdn at 7:44 AM on August 26, 2012 [3 favorites]

In case this was lost in the thread...

My understanding about HIV tests from doctors is that is is preferable to take that test outside of your insurance coverage.

Your doctor might have not been ballsy enough to tell you this, and equivocated instead.

Get the test from an outside source.

I agree with this interpretation.

I also disagree with the idea that simply because the demographics show that the odds of having HIV is low, that testing is unnecessary. If the odds are higher than zero, then there is still a chance. It's like saying "you don't have to look both ways before crossing the street, because the odds of getting hit by a car are 10,000:1." They are only 10,000:1 because people look both ways!

The HIV transmission rate is low for people in certain demographics BECAUSE they have access to education and testing. The few people that do catch it are able to no pass it along because they know about it.
posted by gjc at 8:51 AM on August 26, 2012 [1 favorite]

Some years ago a friend of mine had a drunken one night stand with a woman he didn't know too well. He's dead now. Maybe it is rare, but it does happen. Go get tested.
posted by spilon at 9:07 AM on August 26, 2012

If the odds are higher than zero, then there is still a chance.

The odds are higher than zero that the test will be wrong - to a higher degree than that the patient is infected. But, clearly what the patient wants is a confirmation of health, and 99.99% assurance isn't good enough, so get a test to get 99.9% assurance, and be done!
posted by mdn at 10:13 AM on August 26, 2012

The odds are higher than zero that the test will be wrong - to a higher degree than that the patient is infected. But, clearly what the patient wants is a confirmation of health, and 99.99% assurance isn't good enough, so get a test to get 99.9% assurance, and be done!

Odds are an assurance of nothing to the individual. Only to a population.

If the odds are 1 in 10,000, you cannot know whether you are the 1 or a member of the 9999. If you take a test with 99.9% confidence and get a negative result, you can be 99.9% sure that you aren't the one. In other words, the odds are 1 in 1000 that you are the 1 in 10,000.
posted by gjc at 11:51 AM on August 26, 2012

You should go get a free HIV/STI test at a local clinic. And honestly I would consider getting a new PCP. Your PCP should make you feel comfortable and go the extra mile for your health. Or give you a good reason why they are not doing that (ie: health insurance).
posted by manicure12 at 12:50 PM on August 26, 2012

Just as a, hm, second opinion on your doctor, I want to say that I always appreciate a doctor who will tell me when something is or isn't worth getting tested for. Now, I believe in this case he's wrong about at least some STIs, but it's really a good thing to avoid unnecessary medical tests.

It depends in part on whether you're thinking about it as testing for your health, for example to get treatment for something, or as testing for your knowledge which is what folks are thinking about when they talk about having a clean bill of health, sexually active individuals being regularly tested, etc. If you're testing 'for your health', then it is SO unlikely you have this disease that no doctor would recommend you get tested. Much as a doctor wouldn't test you for West Nile on the basis of having received a mosquito bite, without any other symptoms. But if there is a concern about future transmission, then you would want a 'clean bill of health' and can get tested at pretty much any clinic.
posted by Lady Li at 10:31 PM on August 26, 2012

I'll third (?) the thing about insurance issues. I have to get tested on a yearly basis for professional reasons, and the first time I did it, my doctor asked me "Are you in a high-risk group for HIV?" (with examples). When I answered in the negative, he told me that, if I wanted, he'd do the test, but it would go on a database which he couldn't vouch for (no guarantees about who could potentially gain access in the future, including insurance companies), and it would be more prudent on my part to get tested in a separate clinic. He then wrote me up as having come in with a cough.

I don't know to what extent he was right to mistrust the database, and to what extent he was right to let that affect the clinical advice he gave, but I have no objection to him taking a broader view of healthcare as long as I'm still an informed patient.

So it might make sense from that point of view - you're low-risk, as others have pointed out, and the procedure may carry some (non-medical) risk for you.
posted by Wrinkled Stumpskin at 1:25 PM on August 27, 2012