[Question #10886] Potential High Risk Event
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19 months ago
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Greetings,
I'm a 41 year old male who recently decided to explore bisexuality. My curiosity is satiated, but now I also feel like I've placed myself at needless risk.
I had an encounter with a male my age, I performed unprotected fellatio and protected anal sex (myself as the bottom). The condom was rolled on by myself and intact at the end. We discussed STDs prior as I had a previous positive reaction to an HSV2 test about a decade ago. He showed me negative results he said were from a week before.
No matter how enlightening and enjoyable the experience I am now wracked with concern, especially worried over exposing my regular heterosexual female partner to significant risk by not being careful enough both from HIV and other STI's.
Am I letting fear override my better judgement or should I consider post exposure treatment?
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Edward W. Hook M.D.
19 months ago
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Welcome to our Forum. Thanks for your questions. By discussing prior STIs and testing prior to your encounter, you did things right. When you add that to your use of a condom throughout the receptive rectal intercourse portion of the encounter you made this a very low and close to no risk encounter. Your partner probably told the truth about testing- most people do, and you verified this by seeing his test results (I presume they had his name on them). Condoms work. As for oral sex, the risk of acquiring HIV from fellatio is very low- on average chances are estimated to be about 1 in 10,000 for Acquistion of HIV, IF your partner had untreated HIV and that is unlikely. Your risk of acquiring HIV is so low that if I saw you in my clinic, I would not be willing to prescribe HIV PEP.
Your risk for other STIs is also quite low but not zero- you might have acquiring oral gonorrhea from performing fellatio. (chlamydia is very, very rare at the throat).
As to the way forward, you may want to test although, other than a throat swab for gonorrhea I do not feel strongly that it is needed. If you do choose to test I would suggest the following- a rectal swab for gonorrhea and chlamydia, a throat swab for gonorrhea (chlamydia will be done at the same time almost automatically), a blood tests for HIV and syphilis. The tests for gonorrhea and chlamydia will provide reliable results any time more than 3 days after your encounter, the blood tests will be close to conclusive at 4 weeks and entirely reliable at 6 weeks.
I hope this information is helpful- you took appropriate precautions and your risk of having acquired any STI, including HIV is close to, if not, zero. I see no medical need for post-exposure prophylaxis. EWH
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18 months ago
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Doc,
Thank you for the quick response. The partner in question indeed made this easier with just a simple set of questions beforehand.
My concerns are as limited as yours I think at this point. I had a sore throat within 24 hours but Ive also got some post nasal drip. Pretty sure STI's dont live in the nose haha.
Thanks for relieving my concerns
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Edward W. Hook M.D.
18 months ago
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Glad I could help. EWH ---
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18 months ago
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So, as I have the third response, I guess out of curiosity's sake, I see alot of risk calculations for HIV on the forumn (i.e 1 in 10000 for performing oral sex) but rarely see that done for most other STIs. Is there a reason for that?
In the situation I described above, near as I can figure mathematically, with what I assume are the more conservative numbers I can find
- say 5.6% of MSM have gonorrhea
- compound that with on the high side 10% of infections happen with tests a week old so the other partner truly may not know as of yet
- say oral infection occurs 7% of the time
Would put my risk at 1 in 2500 ish. So, low, but not so low to avoid testing. Do I have that generally right?
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Edward W. Hook M.D.
18 months ago
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There have been more studies on the prevalence of HIV in different populations, as well as HIV transmission rates than there have been for other STI‘s. Estimates of STI transmission are based on very far more limited data, much of which is more than 50 years old. In addition, reporting of HIV is more accurate so the basis for the estimates is better as well. I cannot verify the figures that you use for your calculations although few studies suggest that the province of oral gonorrhea among MSM is as high as you suggest.
Most importantly, testing is easy and accurate. If you have concerns, you should test.
This will complete this thread. I wish you the best. EWH
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