[Question #2757] Need STD/HIV assessment
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94 months ago
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Hi doctors! A bit of a background:
- 37 yo heterosexual male, living in a big city in Germany.
- I date non-exclusively several girls simultaneously, and in average I have sex every week, with either one
of them or with girls I meet in bars etc.
- Being from the "generation of panic", I ALWAYS have safer sex: protected vaginal/anal and unprotected
oral. I am very serious about it.
- Every year I have a full STDs panel in my primary care doctor, including HIV, HEP-C, syph and urine tests
for gono and clamydia.
- Last time I tested was 3 months ago.
- I have never been diagnosed with an STD.
All right, then something very weird happened 4 days ago. I was walking home after partying with my friends and near my place I was approached by a young guy in the street, asking me for info on morning buses. We talked for a while, and I invited him to my place so he could wait until the first bus would depart from the nearest station. Then, for some strange reason (probably alcohol mixed with curiosity) I ended having a sexual contact with him.
The facts:
- We were naked in bed, touching each other's bodies and deep kissing.
- He gave me unprotected oral sex, for a long time and sometimes very deep.
- He rimmed me, also for a long time.
- At some point I inserted my index finger in his anus, only once and very briefly.
- He rubbed his penis against my buttcrack, but I didn't like that stopped it.
- I jerked him off with my hand, he also jerked me off.
- I didn't suck him.
- No anal sex of any kind.
In short: I applied every safer sex caution I usually apply in all my sexual heterosexual encounters (and more, because I didn't give oral and no anal) but for some reason I am feeling worried about this.
Should I test for STDs and/or HIV? Can I continue having safer sex (unprot. oral, prot. vaginal/anal) with my girlfriends? What do?
- 37 yo heterosexual male, living in a big city in Germany.
- I date non-exclusively several girls simultaneously, and in average I have sex every week, with either one
of them or with girls I meet in bars etc.
- Being from the "generation of panic", I ALWAYS have safer sex: protected vaginal/anal and unprotected
oral. I am very serious about it.
- Every year I have a full STDs panel in my primary care doctor, including HIV, HEP-C, syph and urine tests
for gono and clamydia.
- Last time I tested was 3 months ago.
- I have never been diagnosed with an STD.
All right, then something very weird happened 4 days ago. I was walking home after partying with my friends and near my place I was approached by a young guy in the street, asking me for info on morning buses. We talked for a while, and I invited him to my place so he could wait until the first bus would depart from the nearest station. Then, for some strange reason (probably alcohol mixed with curiosity) I ended having a sexual contact with him.
The facts:
- We were naked in bed, touching each other's bodies and deep kissing.
- He gave me unprotected oral sex, for a long time and sometimes very deep.
- He rimmed me, also for a long time.
- At some point I inserted my index finger in his anus, only once and very briefly.
- He rubbed his penis against my buttcrack, but I didn't like that stopped it.
- I jerked him off with my hand, he also jerked me off.
- I didn't suck him.
- No anal sex of any kind.
In short: I applied every safer sex caution I usually apply in all my sexual heterosexual encounters (and more, because I didn't give oral and no anal) but for some reason I am feeling worried about this.
Should I test for STDs and/or HIV? Can I continue having safer sex (unprot. oral, prot. vaginal/anal) with my girlfriends? What do?
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H. Hunter Handsfield, MD
94 months ago
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Welcome to the forum. Thanks for your confidence in our services. And congratulations for your responsible dedication to safe sex.
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That said, you get into a new realm when you start to have sex with men in addition to women. First, in western Europe, by far more men are likely to have HIV or other STIs than the average sexually active female. Second, some sexual practices among men are inherently more risky, anal sex. That said, oral sex carries little or no risk for HIV; there has never been a proved case of HIV transmission mouth to penis. However, there is risk for some STIs, especially herpes (due to HSV1), gonorrhea, and nongonococcal urethritis (NGU). The risk is lower than for unprotected vaginal or anal sex, but still present. Rimming carries little or no risk for the rimmed partner; by far the main risk is for non-STD gastrointestinal infection for the rimmer. Fingering and hand-gential contact carry no measurable risk of any infection, and I also would not worry about the penis-buttock contact.
Should you be tested? Strictly from a medical or risk perspective, it isn't necessary. But such decisions are personal and emotional as much as medical. If you feel you would worry less with negative test result, then I would recommend you have a urine test for gonorrhea and chlamydia, which are valid any time more than 2-3 days after exposure (chlamydia not needed, but routinely included with gonorrhea); and perhaps blood tests for syphilis and HIV (valid at 6 weeks).
Similarly, continuing sex with your female partners is low risk, but I cannot say it is zero risk. If somehow I were in your situation, I guess I would go ahead with those partners once I knew my urine gonorhrea/chlamydia results were negative. The chance of HIV and syphilis is too low for worry about it.
I hope this information is helpful. Let me know if anything isn't clear.
HHH, MD
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94 months ago
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Hi Dr. Handsfield. Thanks for your reply.
Despite this episode, sex with men is not a realm I am really interested to explore. But if somehow I do it in the future, I will certainly remember your words. I wonder, how do gay and bisexual men manage to stay free of STDs? I would have imagined they follow similar safer sex precautions than heterosexuals.
I have had oral herpes since early childhood, so the possibility of contracting herpes due to HSV-1 doesn't concern me. What about HSV-2 however?
I will follow your advise: next week I will test for gono and chlamydia (or earlier if I show symptoms, none right now after 5 days) and I will have HIV+syphilis tests 6 weeks after exposure. I can expect these tests to return negative right? I know myself and If I start worrying too much about HIV I will end having expensive RNA tests and then worrying about the negative results only to test again in a rather silly spiral.
By the way, when this happened I had an almost healed pimple near the base of my penis, on the trunk. Does this change your assessment in any way?
Despite this episode, sex with men is not a realm I am really interested to explore. But if somehow I do it in the future, I will certainly remember your words. I wonder, how do gay and bisexual men manage to stay free of STDs? I would have imagined they follow similar safer sex precautions than heterosexuals.
I have had oral herpes since early childhood, so the possibility of contracting herpes due to HSV-1 doesn't concern me. What about HSV-2 however?
I will follow your advise: next week I will test for gono and chlamydia (or earlier if I show symptoms, none right now after 5 days) and I will have HIV+syphilis tests 6 weeks after exposure. I can expect these tests to return negative right? I know myself and If I start worrying too much about HIV I will end having expensive RNA tests and then worrying about the negative results only to test again in a rather silly spiral.
By the way, when this happened I had an almost healed pimple near the base of my penis, on the trunk. Does this change your assessment in any way?
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H. Hunter Handsfield, MD
94 months ago
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The premise of your question is mistaken: many (most? nearly all?) gay and bi men are not successful over the long run in avoiding STDs. On average, safer sex is much less common among men having sex with men than in most heterosexuals.
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Correct that having HSV1 protects you from a new infection with it. Condoms are reasonably effective against HSV2, but not perfect. If I correctly understnad your sexual lifestyle and practices, you'll probably remain free of HSV2, but not completely.
You can expect all the tests I have recommended to be negative. Exposure of pimples to genital fluids etc probably carries little or no increased risk of transmission.
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94 months ago
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All right, all clear! :)
Thanks a lot for taking the patience to answer my questions. Have a great day!
Thanks a lot for taking the patience to answer my questions. Have a great day!