1. I took 200 mg of doxycycline within 1hr. What bacterial STI’s am I still at risk for?

2. Is there a meaningful risk of HIV in this case?

3. With the penetration lasting only 10 seconds with no thrusting am I at risk for HSV 2? I have used the western blot in the past and have been confirmed negative for HSV2 so I’m very worried about this.

Could/should I continue unprotected sex with my wife without putting her at risk?

Completely anonymous anal sex between male partners is just about the highest risk type of sexual activity imaginable. However, even sex with known infected partners with most STIs does NOT result in transmission, so the odds are in your favor. If the glory hole partner has untreated HIV, your chance of being infected would be estimated in the range of one chance in a thousand. For gonorrhea, maybe up to a 50% chance. No data exist on risks of chlamydia or syphilis. The very brief duration of anal penetration probably reduces your risk.

1. Doxycycline post-exposure prophylaxis (doxy-PEP) is intended for exposures just like this and 200 mg is the correct dosage. Having taken it within an hour, you are nearly 100% protected against chlamydia and syphilis, but there's only about 50% reduction in gonorrhea risk.

2. The answer here depends on how high risk you would consider "meaningful". Most experts probably would agree that HIV post-exposure prophylaxis with anti-HIV drugs is not warranted. However, PEP for HIV is a personal decision and some people would opt for treatment. This decision needs to be made with an experienced health care provider who understands the epidemiology of HIV in your immediate geographic area. If you decide on PEP, it needs to be started ideally within 24-48 hours of exposure and for sure before 72 hours, so I would advise an immediate visit to suitable clinic (public health, STI, and many urgent care clinic) -- a call or line info from your local health department would be a good source of such advice.

3. The chance of HSV2 in this situation is exceedingly low, probably under on chance in many million.

The provider with whom you discuss PEP will also be a resource of possible STI testing. As implied above, gonorrhea is the main risk of importance. If no symptoms (urethral discharge, painful urination) within 5 days, you can be pretty sure you don't have it -- but even without symptoms most experts would advice a urine test for gonorrhea any time after 2-3 days. (Chlamydia testing is automatic with gonorrhea, so that probably will be done -- even though there's really no need following doxycycline.) Syphilis testing after a few weeks also is recommended, although because of the doxy you can be nearly 100% confident in a negative test result. I would not advise testing HSV or any other STI.

My final comment is to suggest you carefully consider your behavior pattern. In addition to this event, one or two of your previous questions also describe "unexpected" potentially risky exposures. It seems likely that you are signaling to your partner that you are a willing participant. Something for you to think about -- and maybe keep condoms with you when potentially in such situations.

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

HHH, MD

I have been prescribed PEP and also received an injection of Rocephin.

If I was HSV2 neg prior to this exposure is it safe to still consider myself negative?

Can I continue unprotected sex with my regular partner without putting them at risk for HIV and HSV2 in addition to the aforementioned bacterial STI’s? 

Thank you for your assistance 

You were at little or no risk of HSV2 regardless of your negative blood test.

From the standpoints of bacterial STI and herpes, your partner would not be at risk and no problem to have sex with them. However, standard advice is that anyone at sufficient risk of HIV to be taking PEP should avoid sex for the duration of treatment and until a negative HIV test about two weeks after completing PEP, i.e. ~6 weeks from now. At a minimum, if you want sex with your partner, you owe it to them to explain the situation so they can participate in a decision whether or not to proceed. You should discuss all this with the clinic/doctor who provided PEP.

Thank you again and I will follow all guidelines regarding PEP