[Question #14015] RISK

1 months ago

Dr HH I have put myself in a similar situation many years back. I am a generally faithful husband and made 2nd mistake in 15 years. I am a white male living in South Africa and the other night I met a white female in a bar. We were both drunk and she was pretty rough in my opinion. We took our clothes off and because I didn't have a condom I got on top of her and grinded my penis up and down between her labia and tried not to penetrate. There was a lot of grinding and she was super wet. She was actually a squirter. At one instance I felt the head of my penis go close to penetrating but I pulled back. It felt like the head of my penis nearly went in but then we stopped and gave each other mutual maturation and she then gave me oral and let me finish in her mouth. Its 6 days post incident and I have had no symptoms. I did take 200mg doxypep 62 hours after but im more worried about Hiv and possibly herpes. Im totally guilt struck and scared to sleep with my wife but I know shes going to start wondering why. As I say this is my second incident in 15 years and ive learned from experience to stay calm. As I said 6 days post incident and no symptoms. Please can u give me some advice as to what I must do and what STDs I could contract including HIV. There was a lot of fluids and secretions during the frottage. Can u also tell me what percentage of people experience ARS and would I have had symptoms by now if I contracted herpes ? Thanks

1 months ago

The grinding and wet frottage did continue for a while and I was on top

1 months ago

Sorry for the 3rd message doc

To simplify im asking

1. Which STDs am I at risk of contracting including HIV?

2. After 6 days no symptoms regarding herpes is that encouraging?

3. In your expert opinion how many people get ars symptoms and if I get past 2 weeks without them is it more encouraging?

4. Its going to be hard to hold off with my wife because id need to wait a month to get tested. What advice can you give?

1 months ago

Please dont forget to answer my question

H. Hunter Handsfield, MD

1 months ago

Apologies for the unusual delay in responding.

Given the details of the exposure, this obviously was very close to the STI risks associated with unprotected vaginal sex and that's how I would manage the situation. Probably not as high a risk as with true penetration and intercourse to completion, but perhaps higher than simple genital apposition. In general, even when an active STI is present, the actual transmission risk varies widely from one STI to the next: with unprotected vaginal, fair estimates are 20-50% for gonorrhea and chlamydia, one chance in 2,000 for HIV and maybe HSV2 and syphilis as well. These are only if your partner is infected -- and I have no way to estimate those chances (and probably you also do not). Absence of symptoms within 6 days is good evidence you didn't acquire gonorrhea and also makes herpes unlikely -- but this interval says nothing about HIV or syphilis.

One reasonable approach might be to contact your one-off partner if you are able: you might find she's just as concerned about STIs as you are. If you were to be tested together for gonorrhea, chlamydia, HIV and syphilis, you would know neither of you was at risk. (HSV testing isn't accurate enough to be useful in this situation; you'd just have to take your chances on herpes.)

Those comments take care of questions 1 and 2. As for no. 3 ARS symptoms, they occur in about half of all persons with new HIV, typically starting 1-2 weeks after exposure. But since half get no symptoms, feeling well at 2 weeks is only slightly encouraging at best -- definitely no guarantee against a new HIV infection.

Question 4: Assuming no further contact with your one-off partner, you can have a urine gonorrhea/chlamydia test any time now; negative results will be reassuring. Accurate syphilis and HIV testing will need to wait til ~6 weeks after the event. What you discuss with your wife in the meantime, if anything, is up to you.

Final advice: See a local STI expert in person. Such a physician or clinic will have a much more accurate estimate than mine about the chance a partner like your bar pick-up might be infected, and resulting personalized advice about testing and its timing. Such clinics and providers are readily available in your major population centers like Johannesburg, Cape Town, etc.

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

HHH, MD

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1 months ago

Thanks for answer doc. I see you are a lot more cautious with your responses because I am in South Africa. Previous replies from you to similar situations are more confident not to worry. I fully understand your more hesitant approach to this. The reason for mentioning that we are Caucasian is because white Caucasians do only make up 1% of the HIV infected in SA. However having said all of this. No matter where you live the risk for HIV for an exposure is 1 in 2000 with a positive female?

I have no contact with her. I have no idea of her status but I would imagine if I didnt have penetrative sex and even if I did the chances remain the same from a single exposure ?

I am 7 days post exposure and still no symptoms. I did take the doxypep 62 hours after just in case.

Personally do you believe chlamydia and herpes is unlikely?

Also u have moved your goalpost from 4 weeks to 6 for an HIV test?

Ive also read that frottage has never been proven to transmit HIV.

A little clarification on all of these would help. Thanks

1 months ago

I still feel my risk was fairly low but should I do a PCR Viral load test just to calm my mind

H. Hunter Handsfield, MD

1 months ago

I was aware of your race and it's true I'm no expert on the epidemiology of HIV is South Africa. However, I would assume the frequency of HIV in whites is higher than in the US and Western Europe. In other words, I agree your risk is lower than it would be for most black South Africans, but still perhaps higher than it would be in say Seattle or Liverpool. And I also would assume higher geographic variability in HIV prevalence/risk in your country in all population groups. Hence my continuing belief it is important for your to consul with a local expert in HIV prevention and epidemiology.

I've already given my best guesses about chlamydia and herpes. Both unlikely but certainly possible.

There have been few if any studies on frontage per se as an HIV transmission risk. What we know with some confidence is that even the busiest HIV/AIDS clinics and providers generally say they've never seen. use in someone in whom frontage was the only possible exposure. Same of other quasi-sexual contacts like fingering, kissing, etc.

We stopped citing 4 weeks as conclusive for the HIV AgAb (4th generation) blood tests 10 years ago, maybe more. It rarely requires more than 4 weeks, but there are well documented delays to 6 weeks or 45 days.

This forum is not a suitable resource for your final decision about whether and when to be tested for HIV (and other STIs) and the specific tests to consider. But yes, these days the HIV RNA PCR test is commonly used, considered conclusive after 11 days. Once again, I come back to my advice to see a locally experienced doctor or clinic.

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1 months ago

Ok thanks for advice Dr HHH.

Tomorrow will be day 11 since the exposure and I will go and have a RNA PCR test at our local private pathologist just to settle my mind. Hopefully I won't be the first identified case of infection via Frottage

H. Hunter Handsfield, MD

1 months ago

You won't. In addition to that statistic, in the 21 years of this and our preceding forum, with thousands of questions from persons worried about HIV after a possible exposure, nobody has yet tested positive. If or when it finally happens, it will not be from a near zero risk exposure like yours, but from a genuinely high risk event; think unprotected anal between two men, for example.

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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