[Question #11215] HIV Risk
16 months ago
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Hi Doctors,
I recently hooked up with someone I met online for the first time in a long time. I felt like I was ready for this and at the time I felt like I took appropriate precautions but now my anxiety is getting the better of me and I wanted to ask a few questions to help me understand the risk. I talked to my partner before the encounter and he said he was HIV negative and always used condoms for anal sex. We engaged in mutual masturbation, he performed oral sex on me, I fingered him and we had protected sex (I was the top). The condom was on the whole time and I checked it afterwards and it was intact.
My questions are:
1. Is it still the case that insertive fellatio is essentially zero risk for the penile partner and there are still no documented cases?
2. When condoms are described as "99% effective" or similar language, does that reflect the fact that sometimes condoms split or burst, or does that mean a correctly worn, intact condom is still only 99% effective, i.e. can HIV sometimes get through or around intact latex?
3. Is there any risk from fingering?
4. What would be your risk assessment of my encounter generally?
I plan to get tested at the 6 week mark but any reassurance you could offer in the meantime would be helpful.
Thank you.
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H. Hunter Handsfield, MD
16 months ago
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Welcome back to the forum. Thank you for your continued confidence in our services.
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I think you're aware that these questions are similar, some virtually identical, to those discussed in your previous threads -- quite a while ago. In any case, it seems you're doing things entirely right: you discussed HIV risks and safe sex with your partner, determined as best you could that he has been careful in the past and is very unlikely to have HIV, and using a condom for anal sex. There is no realistic chance you were exposed to HIV -- or were infected, even if your partner has HIV. To your specific questions:
1. Yes, still true: we remain unaware of any scientifically documented cases of HIV transmitted oral to penis. That doesn't mean it's zero risk, but obviously the infection risk is very low. As perhaps discussed in the past, one estimate from CDC -- based on how people thought they were infected (which often is wrong) -- was a risk of one in 20,000 if the oral partner is infected and not on treatment. That's equivalent to receiving BJs by infected partners once daily for 55 years before HIV transmission might be likely.
2. Good question and worthy of a careful reply. Condom effectiveness can be measured in two ways: biological effectiveness (perfect use, no breakage, etc), which is close to 100%; and "use effectiveness", which addresses how commonly regular condom users may catch HIV (or conceive, or get any other STI). Use effectiveness takes improper usage, breakage, and so on into account -- and of course is less than biological effectiveness. For example, straight couples who depend entirely on condoms for contraception have, on average, a 90% reduction in pregnancy rates -- not bad, but not the 100% efficacy of hormonal contraception or IUDs. Use effectiveness is the reasons: people are human and make mistakes, and no condom is completely free of a chance of breakage. No, HIV or STIs cannot pass through intact latex. "Around" probably happens, but mostly for the STIs transmitted skin to skin (herpes, HPV, syphilis) and rarely if ever for those transmitted through sexual fluids (HIV, gonorrhea, chlamydia).
3. Like oral sex: no reported or known cases of HIV by fingering, whether vaginal or anal.
4. The events described were zero risk for all practical purposes. Feel free to be tested at 6 weeks if you like, but honestly I see no need and personally would not do it if somehow I were in your situation. However, I also understand that nervous people often are more reassured by negative test results than by professional opinion, no matter how expert. (I won't take it personally if you go ahead with testing!)
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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