[Question #2218] High risk

47 months ago
I was high risk exposure in thailand. I gave fellatio to transsexual and condom protected receiving anal (i was bottom), but if there was minor traces precum via hands outside of condom . I have done testing and  quite sure everytihing else but hep b. 

HIV DUO 4,9,20, 34week
Syphilhil 4,9,17, 20, 23week
Hep c antibody 8,18,23, 34week
HBV PCR DNA <20iu 4,23, 34 week
Hbasg 4,9,13,23,34 week
Gonnorhhea/chlamydia 2, 18 week

Is it possible that have been hep b positive/infectious to others, anytime during this 34 weeks?  

47 months ago
I also had hemorrhoids at that time and they might bleed little bit.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Welcome to the forum. Thanks for your question.

While I understnad your concerns, this really was not a very high risk exosure. My first response is to congratulate you for the wisdom of using a condom for anals ex. This event could have been very risk, certainly:  receptive anal sex (bottom) with males at risk is just about as high an HIV risk there is. (Your partner may be female by intent and lifetyle, but she is anatomically male, which is what counts for purposes of judging risk). However, condoms work, and the amount of exposure by exposure to pre-ejaculate fluid carriles little or no risk. Having hemorrhoids did not elevate your risk. Also, giving oral to infected males is extremely low risk, even without protection. On top of all that, you don't know that your partner had HIV or other STDs:  statistically, it is likely that she did not.

Having said all that, I understand your desire to getting tested. However, you have overdone it in a big way. HIV:  Your first duo test at 4 weeks was nearly 100% conclusive, and the 9 week result definitely was 100% relable. The 9 week syphilis test also was conclusive. You had far more HBV testing than ecessary:  the negative DNA and HBsAg results at 4 weeks were conclusive.

That leaves gonorrhea and chlamydia. Presumably you had a urine test, right? If so, the 2 week test was conclusive evidence that you didn't acquire a urethral infection. However, your main risk for these infections was from the receptive anal sex, if the condom failed. For 100% assurance against those infections, you need testing by anal swab. (The risk is low enough, since the condom didn't break, that I don't actually see a need. But I thought you should at least know the theoretical need in case you want to seek those tests.)

In response to your closing quesiotn, it is not possible you have HBV or that you could have transmitted that virus to anyone.  Anyway, if you are Thai (or from most industrialized countries) and under 30 years old, I would think you were vaccinated against HBV in childhood. If so, you are immune to ever catching it, and all those tests were a waste of money. If you have not been vaccinated, I would recommend you do that now.

I hope this information has been helpful. Let me know if anything isn't clear. Best wishes and stay safe--    HHH, MD

---
47 months ago
Thank for you reply doctor 

She was sexworker also. 
I know hep b s conclusive, but is that even real risk if there was minor traces of precum  via hands outside of condom?

I have no vaccines agaist hep b, but i will get those. 

I also had Azithromycin (2 x 500mg) and Cefixime (2 x 200mg) just in case. 
Comdon stayed on and did not brake

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
I already wrote "the amount of exposure by exposure to pre-ejaculate fluid carriles little or no risk".

There was really no need for the antibiotic treatment, but it would have prevented gonorrhea, chlamydia and syphilis. Having done that, there was no point (and it was a waste of money) to be tested for those STDs.

Good move to be immunized against HBV. While you're at it, if you are under age 26, you should also be vaccinated against HPV.


---
47 months ago
So, no need futher testing?  Just to be sure. 

You have been great help, thank you!


47 months ago
In your opinion, was it possible precum outside condom (anal) bigger risk of hep b than unprotected vaginal sex?  This is my last one!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
I wonder if there is a language issue here. Precum is informal slang for pre-ejaculate fluid. As I said both in my original and second replies, it carries little or no risk for transmission of any STD, including hepatitis B virus. But the risk at the time of exposure doesn't matter:  your test results prove you were not infected with HBV, regardless of how high the risk was at the time. I have already said you do not need additional testing for any STD.

That concludes the two follow-up comments and replies included with each question and so concludes this thread. Best wishes and stay safe.

---