[Question #3752] HIV transmission Anal Sex

87 months ago

Hi there.

I have spent a lot of time reviewing these forms before I engaged in the sexual activity I am going to describe and I implemented the safer sex practices as a direct result of the review. I am pretty sure of your answer regarding my questions but wanted to ask anyway so I have my specific situation addressed.

I am a male and I recently had protected anal sex with another man for the very first time. I was the receptive partner. I am 100% confident that the condom did not fail and was utilized properly. Additionally, as an added layer of precaution I advised my partner to not ejaculate while he was inside me and he complied with that as I witnessed the actual ejaculation. As I stated this was my first and only anal sex event. My partner definitely has had numerous partners but said that he always wears a condom. We did discuss STI status and he advised he was STI free. Prior to this event I had been tested for all the main STI and all were negative including HIV.

I recognize that we could not have made this sex act any safer.

My questions are:

1. (1) If my partner had been HIV positive, what were the chances of passing to me during this encounter. My guess is that I have a better chance of getting hit by lightning or winning the powerball lottery than of contracting HIV from this encounter.

2. (2) Unless I engage in additional sex acts, I am not planning on testing again for HIV. Anything in this encounter suggest I should test again?

3. (3) Generally, how safe is safer sex (condom protected)?

I am not having major anxiety over this just looking for information to quell the minor anxiety I am feeling. Finally, just want to say thank you all for the resource you provide. This and the ASHA website are the only sources of information I trust.

H. Hunter Handsfield, MD

87 months ago

Welcome to the forum. Thanks for your question, and for your confidence in our services, both in following our advice and asking this question.

The bottom line (no pun intended) is that you indeed "could not have made this sex act any safer" than it was. Directly to your questions:

1) I would judge this event, as described, to be zero risk for HIV even if your partner is HIV positive.

2) I agree you don't need HIV testing on account of this event.

3) There are no data on which to base a precise answer. A good estimate (from a survey done several years ago by CDC) is that a single episode of unprotected anal sex, with an insertive (top) partner known to have HIV, is around 1 chance in 250. The survey was done before the era when most HIV infected men in the US and other industrialized countries were taking anti-HIV therapy, which is the case now. So as a guess, maybe now 1 in 1,000? The effectiveness of condoms can be anywhere from 90% to 100%; in your situation, 100% or very close to it. The risk of HIV despite condom use is generally due to obvious condom failure or overtly improper use, such as insertive exposure some of the time and only using a condom during ejaculation.

Thanks again for coming to the forum. Let me know if anything isn't clear.

HHH, MD

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87 months ago

Thank you Dr. Handsfield for the detailed response.

This is the response I expected based on reviewing this forum but feel better having addressed my exact situation. Again, I want to say thanks to all of you here at Ask the Experts for taking the time to provide this valuable resource. As I indicated, I actually used this forum to educate myself about safer sex practices so I was better prepared when I decided to engage in this activity. I have no follow up questions.

H. Hunter Handsfield, MD

87 months ago

Thanks for the thanks. I'm glad to have helped. I'll leave the thread open a few more days in case something else comes to mind.

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