[Question #13734] Gay Massage Center Again

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1 months ago
Dear Doctors,
Before reading my question, kindly head back to my previous question as the encounter this time was with the same guy.

So another day at the massage center with the same gay man.

While i try my best to do everything protected, this time i don’t know how he ended up being behind me in a doggy style position and inserting his penis between my legs without condom. I am 90% he didn’t penetrate but i believe he was close enough to anus and might touched it and kept moving back and forth. Then, we swapped the positions and i came behind him doing the same thing but between his legs.

I keep asking myself, what if, what if, what if? So please i really need your advice regarding what is my risk here regarding all STDs, STIs and especially HIV before i get close to my wife.

Do i need to test for any kind? Do i need to start taking HIV PEP?  

Many thanks for your cooperation.
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1 months ago
I forgot to mention that i had a small cut around my anus
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H. Hunter Handsfield, MD
1 months ago
Welcome back. FYI, we pretty much always search for previous questions the user might have asked.

As you realize, this exposure was much like the previous one. Genital apposition without penetration may indeed have small risk for STI, especially those infections transmitted primarily by skin-to-skin contact. However, it is important to understand that "skin-to-skin" doesn't mean any and all skin contact is risky. The term refers to the mechanism of transmission during insertive sex; it is not meant to imply risk when there is no penetration. It sounds unlikely there was anal penetration by either of you; I can't imagine how that could happen without your being aware of it. It also sounds neither of you ejaculated near the other's genitals or anal area -- is that right?

So I would say there might have been very low risk for those STIs' transmitted primarily skin-to-skin (herpes, HPV, syphilis) and realistically zero risk for the ones transmitted in genital fluids (gonorrhea, chlamydia, HIV). For sure you should not seek PEP to prevent HIV. I would not advise testing for anything either. If somehow I had been in your situation, I wouldn't be tested for anything, for sure would not seek PEP, and I would not delay sex with my wife. If you want to add a margin of safety before sex with your wife, you might wait up to 2 weeks to assure you haven't developed genital sores or blisters (or penile discharge, although that's nearly impossible given your description of the events).

All that said, reassurance alone is a valid reason for testing even when the risk is nil. If you prefer not to rely entirely on my judgment and advice, feel free to have urine and anal swab tests for gonorrhea and chlamydia (any time more than 4-5 days after exposure) and, after a few weeks, blood tests for HIV and syphilis. As I said above, personally I wouldn't feel the need but it's up to you.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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1 months ago
Thank you very much Dr Hunter.

Actually i ejaculated while in between his legs (thighs) but im sure it was far from the anal area down. Would that still expose any kind of risk? 

Also for rubbing or rimming anal area (penile to anus) is still very low risk for STIs, is this correct?

So i am thinking of waiting a week or two to see if i develop any warts or symptoms to rest assure, is this enough to completely make sure i did not catch anything?

Again, your effort is really appreciated.
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H. Hunter Handsfield, MD
1 months ago
An internal ejaculation might increase STI risk for the recipient, but obviously ejaculation cannot raise the risk of the ejaculator. I already answered about rubbing and rimming:  little if any risk. (Rimming risks gastrointestinal infections but is low risk for STIs.)

It takes 2-6 months for warts to appear:  anything in the next couple of weeks would have nothing to do with the events described here.

Absence of symptoms by itself is never enough to be "completely sure" about any STI. But the combination of no symptoms in two weeks plus the inherently low risk of the events should be very reassuring.
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1 months ago
Thank you agin Dr Hunter,

To my understanding that even if I ejaculated far from anal area such as between his thighs there is little risk for sti infection but for the recipient only?

So all in all and based on my encounter, if you were me, would you practice your life normally sexual wise or would you stay away from wife for sometimes until you make sure about any infections?

Also can we rule out HIV infection?
Im not planning for testing since i believe my encounter was little to no risk if i am not mistaken.

If i may have any final advice wherher to move on or test for any kind and assessment of my encounter i would really appreciate it.
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H. Hunter Handsfield, MD
1 months ago
"To my understanding....?" Correct.

There was no risk for HIV. If I were in your situation, I would not be tested for HIV or anything else and would continue my usual sex life with my wife.

However, I'm not you. The tone of your questions suggests you will remain concerned despite my advice and that negative test results might help you stop worrying. If so, by all means get tested. Reassurance alone is a valid reason for testing even when there is little or no risk.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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