In my country (Europe) there is not much education about HIV/STIs, and because I am a bit of a hypochondriac, I tend to worry and would like to get information from experts like you.

1 - The first question is about a semen test to detect chlamydia, gonorrhea, etc., which came back negative. My question is whether a semen test is as valid as a urine test, for example. I had the semen test because I am in the process of trying to conceive with my wife.

2 - The second question is about transmission from women to men. I have read many of your answers, which have given me a realistic perspective based on experience and scientific evidence, unlike Google, Reddit, etc. Is it true that most cases of heterosexual transmission occur in women whose partners engage in risky behavior such as sex between men or drug use? And that is very rare to see an straight men with HIV from a casual vaginal sex in USA or Europe?

3 - As I mentioned, I have a wife and we have unprotected sex. I have never gone to an escort for sex, but I have had an erotic body-to-body massage three or four times, both of us naked, and I'm not sure if there was brief penetration during that genital rubbing because my penis was so lubricated. I know what penetration feels like, but in this case I can't be entirely sure, so my question here is: even so, the risk would be very low, right?

5 - The final question, and please forgive me for asking so many questions, is that whenever my wife has any possible symptoms, I become alarmed and concerned. For example, she has had diarrhea for two days now, but she has not had a fever or a sore throat. I understand that this do not suggests we may have ARS or the disease itself, and that the most important thing is that my encounters were so risky right?

Appreciate so much all your help 

Best regards

1.  A semen test is unnecessary and no better or no worse than a urine test for gonorrhea and chlamydia 

2.  HIV is relatively uncommon among men who do not have sex with other men or very risky women such as those who use IV drugs.  There is transmission of HIV from untreated, HIV infected women but it is relatively uncommon 

3.  Erotic massage without penetration is a no risk activity and even with lubrication if penetration had occurred, you would know it.  This was discussed with you on our exchange 6 months ago.

4.  You have acknowledged that you worry to much.  The exposures you describe are no risk.  You cannot have given your wife HIV

Please don’t worry.  EWH

Thank you very much for your response, doctor.

1 - I did the semen test because an integrative doctor recommended it, saying that if there were any bacteria, it could affect fertility. I understand that if it is negative, it would also be negative in urine. 

2 - So, I understand that you have seen few heterosexual male patients who have tested positive from casual vaginal sex? The clinic here that did the above-mentioned test told me that the risk was practically zero. I understand that if you are in a relationship with a woman who has HIV, it could end up being transmitted.

3 - It is clear to me that genital rubbing without penetration, even with fluids, is not a risk, but I am asking in case it ever happens in the future (I hope not). I understand that even in the case of brief accidental penetration during massage, the risk would still be very low, right?

4 - I know, doctor, and your advice helps me a lot. I also understand that diarrhea and feeling weak are not typical of ARS without fever, for example, right?

Obrigado

One follow up remaining.  EWH

1 -Yes, I underwent a specific test for these types of STIs using a semen sample, and the results came back negative. From this, I understand that a negative result in semen would also indicate a negative result in urine, meaning I don't have any bacterial infection, right?

2 - Therefore, based on your extensive experience, you've encountered very few cases of male patients acquiring the infection through vaginal transmission from a woman, correct? This would indicate that the CDC's estimated transmission rate is likely accurate and reflects the real-world scenario.

3 - I understand that even if, hypothetically, there were a brief accidental penetration lasting only a few seconds with the masseuse in the future, the risk of transmission would still be very low—insufficient to justify testing or to impact my personal life, correct?

4 - Reading your responses, it’s clearer to me now that not everyone shows symptoms, and that the most common ones are fever, sore throat, muscle pain, and sometimes a rash or diarrhea—but not just a single episode of diarrhea with fatigue?

I would appreciate one final clarification from your side, I truly value your expert opinion, especially given your clinical experience and direct work with patients. It helps me better understand the actual risks of this and allows me to continue living my normal life with my wife with peace of mind

Obrigado

1.  Correct

2.  Correct

3.  Testing is always a personal choice. You are correct that the risk of infection from a single penetration would be very low.

4.  Correct

This thread is now complete and will be closed. EWH.