What is the risk that I have passed HIV to my boyfriend?
May 17, 2015 6:06 PM   Subscribe

Three weeks ago I drunkenly cheated on my boyfriend with a stranger. I'm a gay man, I was the bottom and we didn't use a condom. During the next 2 weeks I stupidly tried to forget about the incident and continued having unprotected sex with my boyfriend. He is a circumcised top. What kind of risk does he face?

Over the past week I developed a high fever, rashes on my body, loss of appetite, lethargy, and all of my lymph nodes were extremely swollen. I didn't have a runny nose or any of the other usual signs of flu. It has cleared up now but this is what raised alarm bells and made me stop having sex with my boyfriend.

I feel like I pretty much 100% have HIV, what else could it be? That's a messed up enough thing to have to process without also worrying about putting somebody else at risk. God I'm an asshole.

I'm going to break up with him so that we stop having sex, and I'll tell him in 2 months so that at least he can get a result right away and not have to spend months being unsure about his status and freaking out. I feel so fucked up about this, if he's infected I don't know how I'm going to deal with it.

I'm living in a country where my only option for testing is an anonymous clinic who does those 30 minute wait blood tests, it's my understanding that I need to wait about 3 months to get a reliable result from them.

My main concern now is whether or not he could have got it from me just one or two weeks after I was initially infected? I'm not looking for sympathy in this situation, I just want a little more information from people who might be a little more informed about this virus than I am.
posted by anonymous to Health & Fitness (26 answers total) 8 users marked this as a favorite
I'm going to break up with him so that we stop having sex, and I'll tell him in 2 months so that at least he can get a result right away and not have to spend months being unsure about his status and freaking out.

Start. Telling. The Truth. Now.

The absolute worst possible thing you can do to your boyfriend right now is to continue to lie to him, through omission or otherwise. Worst case scenario, you have contracted the virus and passed it on to your boyfriend. So what, you break up with him without explaining why, without explaining the risks, and you let him go and unwittingly have sex with new partners? No. Please do not do this. It's time to be honest.

Take yourself to the clinic available to you and talk to a doctor. Even if it's too early for a reliable test result it's not too early for you to get information and to deal with this responsibly.

If you contact a mod and have them update the thread with your location, other mefites may be able to help you out with more comprehensive resources available to you in your region.
posted by phunniemee at 6:17 PM on May 17, 2015 [56 favorites]

Maybe. Telling him will make the next two months difficult for him but he needs to know so that he isn't at risk of transmitting it to others. That is the only thing to do here. If you need to Memail me afterwards or right beforehand for moral support please don't hesitate.

I'm sorry. This sounds incredibly scary.
posted by sockermom at 6:19 PM on May 17, 2015 [8 favorites]

I can't even imagine how stressful this must be for you, but you need to tell him right now what's going on, don't wait two months. He needs to get tested ASAP as well. It doesn't matter how likely it is that he contracted it, what matters is finding out as soon as possible whether or not either of you have it, no matter how uncomfortable the conversation is.
posted by Huck500 at 6:20 PM on May 17, 2015 [2 favorites]

Go to the doctor and find out your options.
posted by oceanjesse at 6:20 PM on May 17, 2015

He needs to get tested ASAP as well.

HIV takes ~3 months before it is detectable by a test. Sometimes up to 6. So rushing to the clinic is not the answer, but you absolutely must tell him so you can both stop having sex with the possibility of passing it to any partner.

Now, the odds that you have any disease are fairly low, BUT you had unprotected sex with an anonymous stranger so it is up to you to #1 cease sexual activity that can pass anything on until testing can be done #2 inform your boyfriend so he can do #1. There is no other option for you.

Good luck.
posted by OnTheLastCastle at 6:29 PM on May 17, 2015 [7 favorites]

An "acute retroviral syndrome" often develops within the two to four weeks following HIV infection and is characterized by flu-like symptoms. That you've experienced these symptoms isn't necessarily an absolute indicator that you've been infected with HIV, but it's not a good sign. On top of that, the risk of transmission during this period is particularly high, since the immune system hasn't learnt how to rein in the virus yet, so the viral load is high. After the immune response to the virus develops, viral load drops, which decreases the risk of transmission until the infection progresses to AIDS. That said, even if you've been infected, the risk of transmission is still relatively low (roughly ~0.1% for insertive anal intercourse), but not zero, although this 0.1% figure doesn't account for the increased viral load in the acute infectious stage, so the true risk could very well be higher than that.

You're going to have to wait about 3 months following possible exposure for your body to produce enough antibodies before you can get tested, but please get tested ASAP once you hit that 3-month mark. And have the talk with your boyfriend ASAP as well.
posted by un petit cadeau at 6:30 PM on May 17, 2015 [14 favorites]

I dug deeper, and the NIH has something I wasn't aware of:

Some HIV tests can detect HIV directly in the blood before HIV antibodies are detectable. However, these HIV tests cost more and are used less often for routine HIV testing.

You said the country you're living in is fairly limited in the testing options so... hopefully, they can help you out. I would call ASAP instead of waiting for testing as I previously suggested.

posted by OnTheLastCastle at 6:37 PM on May 17, 2015 [1 favorite]

From the aids.gov website: "Within 2-4 weeks after HIV infection, many, but not all, people experience flu-like symptoms, often described as the “worst flu ever.” This is called “acute retroviral syndrome” (ARS) or “primary HIV infection,” and it’s the body’s natural response to the HIV infection."

And most relevant to you: "It is important to remember that with or without symptoms, you are at particularly high risk of transmitting HIV to your sexual or drug using partners during this time because the levels of HIV in your blood stream are very high. For this reason, it is very important to take steps to reduce your risk of transmission."

So to answer your question- yes, you could have given it to your boyfriend 1-2 weeks after infection. However, you won't know if you have it until you get tested.

You said this:
I'm living in a country where my only option for testing is an anonymous clinic who does those 30 minute wait blood tests, it's my understanding that I need to wait about 3 months to get a reliable result from them.

This is partially correct. The good news is that the 30 minute rapid test is good starting 2-8 weeks after initial infection but it may produce a false negative result. It can 3-6 months for an 100% accurate result to show up in some people. I think it's worth going for the rapid test given your experience. Here's a link about different tests and testing windows. Make an appointment with a doctor to ask questions about what to expect and your testing options or walk into the clinic and ask questions of them. Talk to your boyfriend now- please don't wait.
posted by Mouse Army at 6:39 PM on May 17, 2015 [3 favorites]

You need to tell your boyfriend ASAP and you both need to get tested. Breaking up is incidental -- if you do it, you do it, but you both need to be tested, like, yesterday for all the reasons people above have stated.
posted by coppermoss at 6:40 PM on May 17, 2015 [3 favorites]

Yes, you need to tell him right away. Although I am a woman, I spent six months of my life getting HIV tested every month due to an atypical reaction to the CMV virus. I was getting blood tests every two weeks, alternating between liver function and HIV. Not gonna lie, it was scary as shit, but getting regular tests is the best thing you can do for your future self. I was celibate during that time, because there was so much uncertainty. Tell your BF and get regular tests for the next six months. Be kind to yourself and your BF.
posted by Ruki at 7:03 PM on May 17, 2015 [1 favorite]

HIV takes ~3 months before it is detectable by a test. Sometimes up to 6.


I don't know where you are, but if your health system is using more recent combination immunoassays, they may well be able to detect infection already. Third generation assays can detect infection starting around 21 days, and fourth generation assays can detect infection starting around 15 days after exposure. YOU CAN ALSO ASK FOR A DIRECT NUCLEIC-ACID TEST, which is an excellent way to detect acute infection - it can detect infection within 10-15 days of exposure. Negatives on these tests don't mean that you definitively are not infected, but they can tell you if you are infected. TALK TO YOUR DOCTOR. You have had symptoms that crop up with acute retroviral infection (but are not exclusive to acute retroviral infection!), based on your description. GO TALK TO A DOCTOR.

But also, TELL YOUR BOYFRIEND. Yes, he's at relatively low risk by his circumcision status and your behavior. But you cannot ethically not tell him. If you have an acute infection, your viral load is very high (as described above), and you are at an increased risk of introducing infection to your partner. You have an absolute ethical obligation to tell him, so that he doesn't risk exposing others.
posted by amelioration at 7:12 PM on May 17, 2015 [46 favorites]

Gay emergency physician in San Francisco here. Normally I've stopped commenting on Ask Mefi Health posts but I feel the need to correct some misinformation from other commenters, to get you help, and to get your boyfriend help, too.

If you live in a country that has a modern healthcare system, you can absolutely see a physician and get a diagnosis.

If you do have HIV, you have acute retroviral syndrome: it's a strong viral syndrome with the symptoms you mention - swollen nodes, sore throat, fever, body aches, etc. It can have similar symptoms to any other viral syndrome: the flu, mono, etc.

It typically cannot be diagnosed with rapid HIV tests, which look for antibodies to HIV in your blood, because your blood has not made antibodies yet. It can be diagnosed by an HIV viral load test and does not require you waiting months to be diagnosed. Go do this now. The results will not come back for a few days (a rapid test for this does not exist) but this is vital that you do this for your own health and to get started on treatment.

You absolutely need to tell your boyfriend. Go do this now. For his heath and safety, so that he can see his own physician and come up with a plan of action. His risk of contracting HIV is lower than yours since he's the top. It probably matters a little bit if he's circumcised or not, but it's probably a little less than 1% per intercourse for him. Viral load matters, and higher viral load people are more infectious, and people who are just infected have very high viral loads, so you must stop having sex. Now.

Any infectious disease doctor who has practiced in the past 30 years will know exactly how to manage all of this. This has become their bread and butter. If your own physician cannot help you, any infectious disease specialist can.

Finally, I am very, very sorry for you and for your boyfriend. Good luck to you both.

insert usual disclaimer that this is not medical advice but general information about HIV transmission diagnosis and treatment
posted by gramcracker at 7:15 PM on May 17, 2015 [108 favorites]

There is excellent advice given above about the tests you can have done now, and the fact that you need to be honest with your boyfriend etc. Do those things.

I just want to address one bit, your symptoms which resemble acute retroviral syndrome, and how to think about this from a statistical perspective. This shouldn't substitute for actually getting tested, but if you can remove some of the certainty from your mind, you may be more relaxed as you go through this process.

Others have pointed out that these symptoms are common to many viral illnesses, but I'm not sure how much that has hit home.

I have sometimes done an exercise with my intro statistics class that addresses a situation very similar to yours: unprotected sex with a stranger, viral symptoms two weeks later, nobody around seems to have the flu, what are the chances you have contracted HIV? To a one, my students vastly overestimate the chances, because the fever symptoms seem like such a clincher. But then we work out the math. To begin with, I have the students estimate how common these viral symptoms are without HIV exposure. I ask how many have experienced them in the last year. Typically about a quarter of them raise their hands. This is totally hand-waving here, but that works out to about 1 week out of 200 that you might get that kind of random viral symptoms with no apparent cause.

We then have to compare that 1 in 200 with the chances that your sexual partner was HIV positive, not being effectively treated to keep his viral load down, that the disease was successfully transmitted from this one sexual encounter, and that you are therefore experiencing acute retroviral syndrome. All those probabilities multiply well, the conditional probabilities anyways -- so if he had a 1% chance of being infected and untreated, and there was a 1% chance of transmission from a single act, that's a 0.001% chance that you've contracted HIV, or 1 in 1,000. Now, the numbers we work out with my class are for hetero sex in our particular state and demographic, so I know they're going to be differently for you, but you can look them up. But already with the numbers above, it's five times more likely that your symptoms are from a random viral infection than from HIV. If those numbers change, it can be -extremely- more likely that you have a random viral illness; for instance, if you work out that it's a 0.1% chance of infection per intercourse, then it's 50 times more likely that you've just got a random bug.

To reiterate one last time: go get tested. But please don't think you're doomed in the meantime, nor your boyfriend.
posted by wyzewoman at 8:29 PM on May 17, 2015 [11 favorites]

I just wanted to mention that the initial herpes outbreak sometimes comes with symptoms like you experienced. According to the CDC: "The first outbreak of herpes is often associated with a longer duration of herpetic lesions, increased viral shedding (making HSV transmission more likely) and systemic symptoms including fever, body aches, swollen lymph nodes, and headache."

When you go get the HIV test it may be a good idea to also get tested for herpes and other STIs. Like with HIV it takes your body some time to develop antibodies to the herpes, so you should repeat the test in about three months if you get a negative result, just to be sure.
posted by Lingasol at 8:55 PM on May 17, 2015 [3 favorites]

You poor poor thing. This is a terrible thing to be processing alone. MrTaff and I have both worked in this area and he still does. Things have never been better in terms of testing and (early treatment). Here is a link with some helpful info. What you can do now.

If you happen to be in Australia, I can find you all the support in the world if you email me. Big hugs. Really, really squishy mummy hugs for you.
posted by taff at 9:02 PM on May 17, 2015 [3 favorites]

The timeline is a bit fuzzy for me ("in the past week"?) but if you had sex with your partner since getting these symptoms less than 72 hours ago, he may still be a candidate for PEP (post-exposure prophylaxis). That's not a simple thing - it's a heavy drug cocktail every day for a month. If it's been less than three days he could ask a doctor about it tomorrow.

If you end up testing positive, you should also contact the person you slept with to make sure they are made aware of their status.
posted by amaire at 9:05 PM on May 17, 2015 [10 favorites]

Tell him immediately. At the very least he can go to a doctor and see if they want to try post-exposure prophylaxis on the very off-chance that you didn't actually expose him to the virus until the past 72 hours.
posted by schroedinger at 9:37 PM on May 17, 2015 [2 favorites]

Please don't discount these calls to seek immediate testing/treatment with handwavey "we don't have that option here"; you seem kinda ill informed on your options and there is possibly a lot more options than you think. Doing that would also be really self sabotaging, you know? Please let a mod know where you are so they can update or memail one of us.
posted by Iteki at 10:13 PM on May 17, 2015 [4 favorites]

> YOU CAN ALSO ASK FOR A DIRECT NUCLEIC-ACID TEST, which is an excellent way to detect acute infection

> It can be diagnosed by an HIV viral load test and does not require you waiting months to be diagnosed. Go do this now.

Just wanted to emphasize and highlight these two comments.

If this is really the acute phase of HIV infection, unfortunately, this is absolutely the most infectious you will ever be. It's hard to estimate exactly how much more, but the estimate I'm familiar with gives the risk as 26-fold higher than normal. Since he's a circumcised top his baseline risk is something like 0.6% which puts the per-sex-act probability at around 15-16%. In other words, it's definitely a real risk. He needs to be told now so he can seek out the appropriate testing and/or treatment, and so he doesn't expose anyone else (especially if you are going to break up).

I'm sorry. This is a really tough situation and it must feel really awful. Please know that the diagnosis, treatment, and prevention options for HIV are very good these days and that they are continuing to get better every year.
posted by en forme de poire at 10:24 PM on May 17, 2015 [3 favorites]

I'll tell him in 2 months so that at least he can get a result right away and not have to spend months being unsure about his status and freaking out.

You should tell him immediately, so that he doesn't put someone's life in danger by having unprotected sex with them.
posted by hal_c_on at 10:38 PM on May 17, 2015 [7 favorites]

if you had sex with your partner since getting these symptoms less than 72 hours ago, he may still be a candidate for PEP (post-exposure prophylaxis)

THIS YES. You need to walk away from the computer and tell your boyfriend right now what has happened. Because:

1) He might maybe possibly still be viable for Post-Exposure Prophylaxis. It's expensive, and--based on a friend of mine who had to do it--it will fuck with your body for a month. And it's better than possibly having HIV long term.

2) He might well be off having sex with other guys. That needs to stop and/or not start.

Waiting two months to tell him, just no. So very much no. So many bad things can happen.

Are you able to contact this random partner at all? If you can, please do, and have a really adult conversation about risk factors and his testing history.

But first: tell your boyfriend right now. Stop reading. Go tell him.
posted by feckless fecal fear mongering at 11:06 PM on May 17, 2015 [5 favorites]

Clearly tell him. I'm glad people have pointed out the possibility of testing earlier than 3 months. Yes!

All sorts of viral infections (can) present in the way you describe. My fibromyalgia came on just like that. Also: West Nile. Mono. Flu. Cold. Herpes. Lyme bacteria. Etc.
posted by persona au gratin at 1:40 AM on May 18, 2015

I am so sorry you're in this situation. There is so much good advice above - and yes, HIV testing, treatment, and prognosis is SO much better than it ever has been. Get tested right away. Tell your partner right away. Nothing good can come from waiting.

He is a circumcised top. What kind of risk does he face?

Since I'm Canadian, all of my HIV-related stats come from an agency called CATIE. They note that, "Circumcision does not protect most men who have sex with men, although it may provide some protection for men who engage only in insertive anal sex (topping)" (reference)

They also provide some stats around the likelihood of HIV infection through various methods of exposure. Note that this info is from 2012. There are a lot of variables that contribute to the likelihood of HIV infection - so even with a high-risk or a low-risk activity, those variables can make the transmission risk higher or lower, still.
posted by VioletU at 7:17 AM on May 18, 2015 [1 favorite]

You must be in a pretty dark place right now. I am sorry for what you're going through.

I want you to notice that nobody here is telling you that you are a bad person. Nobody is judging you. All of us are focused on the moral imperative to protect your boyfriend, and anyone else he may come into contact with. There are two different truths you will have to own up to: the truth about the risk he is under right now, and the truth about your behavior and what that means about you. They are both important, but the first is way way more important. Likewise in this thread, none of us are focused on how you behaved and what it means. All of us are focused on containing the damage. Try to focus on that too, if you can.

For example, one way to have this conversation is to not have it at all. Leave a letter explaining the risk and don't take his calls until you're ready. It's less than he deserves from a partner, but it does the most important job. If you want you can leave out the details of how it happened. Just make sure he knows the timeline as precisely as possible.
posted by PercussivePaul at 12:00 PM on May 18, 2015 [8 favorites]

I want to echo PercussivePaul above. Going to see a doctor ASAP and not in two months will also allow you to get the EMOTIONAL support and counseling you'll need to deal with all that this might entail, from treatment to communicating your status with future partners to dealing with whatever guilt you might be feeling over this. Tell your boyfriend ASAP then go see a doctor, ASAP.

I am really sorry you have to deal with.
posted by Brittanie at 3:06 PM on May 18, 2015

OP, just wanted to check in and let you know I'm thinking about you. I hope you told your boyfriend so that he saw a doctor today and had a chance to ask about/start PEP if applicable. And I hope you get the care you need soon. *hugs*
posted by amaire at 5:09 PM on May 18, 2015 [5 favorites]

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