[Question #3073] Knowledge

40 months ago
Hi doctor. All my life I've slept with women.  I always use condoms. The only time I didn't use condoms was when I was married or when I've been in a long term relationship. Last unprotected sexual encounter I had was in January with a female friend of mine. I had a Oraquick Hiv Test in April and it was negative. Now I see that most people ask questions about encounters they have had. Mine is different. I'm bi sexual and I want to start exploring a little further. I've never penetrated a man or vice versa. I know its risky behavior, but I want advice on how to stay HIV negative. To this point I've given oral and received oral. I know that the HIV risk is almost zero when it comes to oral. At this moment I don't want to have anal sex, but if I ever do I would be the bottom. Is their a risk if If me and the other person rub our genitals together or he rubs his penis against my anus? or If I swallow when he ejaculates. I'm not going to do this with just any random guy I meet. Its someone who I've taken the time to get to know and he says he is HIV negative. If I ever decide to do anal I will make sure he wears  a condom. I'm sorry if my questions are graphic, but I just want to make sure I don't make a mistake. I know its a higher risk. 
One last questions. I had an Oraquick test in April and it was negative. I haven't had unprotected sex after since January with my female friend. And it was one encounter only.. I had a reoccurring sore throat for like 3 months with no fever earlier in the year. And last month I had a sore throat with a fever, but everyone in my household had the flu so I might have gotten it from someone in the house. Now I'm fever free but my sore throat has comeback. Does it sound like ARS?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Welcome to the forum. Thanks for your question.

Congratulations on your very safe approach to sex outside monogamous relationships. And congratulations (and thanks) for making the effort to understand HIV transmission risks; it sounds like you've done a great job in your research.

The combination of care in choosing your partner(s) plus your planned sexual practices will provide virtually 100% protection against HIV. There is no risk from kissing or genital-genital contact without penetration, and you are correct that oral sex carries little or no risk. The greatest risk will come if and when you have anal sex, in the event of condom breakage -- which although not an everyday occurrence, isn't all that rare with anal sex (perhaps especially for early experiences, before your anus and rectum accommodate to penile pentration. But even this risk can be minimized to zero, or close to it, by discussing HIV status with partners and assuring sex only with men who know they are HIV negative or, if positive, are on effective antiretroviral treatment with low viral blood load. (Most infected and treated persons will accurately know this information.)

The odds you were infected from a single contact with a female partner is exceedingly low, especially if you're confident she isn't an injection drug user, commercial sex worker, etc. The frequency of HIV in most sexually active women remains very low in the US and most industrialized countries -- and even if she was infected, the average transmission risk for vaginal sex is around 1 in 2,500 if the female is infected. Finally, the Oraquick test is highly reliable by 3 months after the last exposure. And the test results always overrule both exposure history and symptoms. You can be 100% confident you don't have HIV and that something else explained your sore throat with fever -- almost certainly a cold or influenza, exactly as you state.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

---