QUESTION
I had anal sex without a condom with an HIV-positive man. Three days later I found out I had chlamydia. I am afraid that I also contracted HIV, but I’m scared to get a test. What should I do?

ANSWER
There is no way to do a proper diagnosis via email. The only sure way to know your status is to get an HIV test from a local provider - doctor, clinic, or HIV testing site. If the standard antibody test is negative, you can ask for an RNA test to be done that detects HIV viral load, which is can detect virus soon after a risky encounter. An HIV RNA test is the most accurate test currently available and was recently FDA-cleared for HIV testing. You can find a testing site near you by typing in your zip code at the CDC's HIV Testing site.

HIV is most commonly transmitted through unprotected anal sex. At highest risk is the receptive partner, but the insertive partner can get HIV from unprotected intercourse as well. As for chlamydia, symptoms usually appear from one to three weeks after infection, but then go away, even if left untreated. Many people infected with chlamydia never have any symptoms at all. That means that it's possible you got chlamydia from a sexual encounter that happened earlier than the one you described in your letter.

If you are HIV positive and have chlamydia, inflamed genital tissues contain highly concentrated amounts of the virus, causing 8-10 times more HIV virus to be shed in your semen or vaginal secretions, making it much more transmissible. If you are HIV negative and have chlamydia, your immune cells are especially susceptible to HIV if your partner is carrying the virus and you are exposed. Having rectal chlamydia may increase your chances of getting HIV ten to twenty-fold.

See your medical provider or STD clinic for a full STD/HIV work up. You may also have to return in 3 months for re-testing depending on what type of HIV test is done. If you are in San Francisco, see SFcityclinic.org for clinic hours and services.

To your health,
Dr. K