[Question #4481] STD HIV

29 months ago
Doctor,

I understand naturally my encounter is high risk and I defiantly plan on getting tested once the appropriate time has passed. I bottomed for another male with a condom for which I think the condom  did not break. He did not cum inside me but did finger me and use lots of his saliva as lube. In addition, we both performed oral sex on each other without a condom. He says he is negative and I know I am. Should I be reasonably worried about catching something from this  single exposure. Does the HIV virus transfer via ejaculation or just skin contact inside the rectum.  what are my associated risks with this encounter and what would you recommend as a course of action. 

29 months ago
would you recommend PEP? what are the downsides
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
Welcome to the forum. Thanks for your confidence in our services.

Bottom line:  There is virtually no chance you are at risk for HIV from this event. It is conceivable the risk of other STDs is somewhat greater, but probably not very high. Here is why:

First, congratulations for having safe sex. That's the key issue here. Second, people rarely lie about HIV status when asked directly, so it is unlikely your partner is infected. Third, even with entirely unprotected receptive anal sex (bottom) with an HIV infected partner, the odds would be in your favor. The best estimate is that in that situation, the transmission risk is around 1.4%, i.e. 1 in 72. That's high on a population basis:  10,000 such exposures would mean 140 people becoming infected, which is why HIV is so much more common in men having sex with men than in straight men or women. But it means that any single exposure is very unlikely to result in a new infection. Add in the low chance your partner has HIV plus the condom, and I would judge the chance you caught HIV as well under one in a million.

Other STDs? Hard to judge without knowing more about your partner. The risk could be high or low. But here too, the condom is the main issue of importance.

To answer your specific quesiton, HIV is transmitted primarily through infected sexual fluids and blood. Skin contact --either skin to skin or skin contact with rectal lining -- is not an important route of transmission.

A single exposure is rarely a valid reason to be tested for HIV or other STDs, unless one partner is known to be infected. So I do not recommend testing at this time. That said, some anxious persons are more reassured by negative test results than by expert opinion based on probability and statistics. If that applies to you, consider testing. Alternatively, discuss things again with your partner. Perhaps the two of you would agree to be tested together. You might find he is as concerned about the risks to him from you and you are from him.

I hope these comments are helpful -- and more important, reassuring (as intended). Let me know if anything isn't clear.

HHH, MD
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
I didn't see your follow-up question until after posting the above. I definitely would not recommend PEP, and I doubt you could find an ethical doctor or clinic willing to prescribe it in this situation. Don't go there.---
29 months ago
Dr,

I agree, the numbers and statistics are on my side. Using a condom and he did not ejaculate in me which would further drive down those numbers. What about acute infected partners. How would that change my likelihood of contacting the disease. From my exposure, which STD's are going to be of most concern.  also, I understand PEP is for emergency use only, but if there are minimal side effects, why would it not be used more frequently? If i were to get it, how would that change my testing window in four weeks when I do get tested.

Thank you for taking the time to answer my question.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
The rate of transmission by unprotected anal sex, cited above (1.4% chance per exposure) is an average, and based on data before most infected persons were taking anti-HIV treatment (which prevents transmission). If a partner's HIV viral load were known, the risk undoubtedly would be higher for some partners, including those recently infected; and lower for most partners. If you knew your partner had HIV and especially if it were acquired recently, your risk would be higher -- but still low by virtue of the condom plus no intra-rectal ejaculation.

It is true that PEP is very safe, but not 100%. Even if dangerous side effects might occur in only 1 in a thousand cases, if the risk of HIV is less than that, why take the chance? And you have put your finger on the other downside of PEP, which is often forgotten:  if PEP fails, i.e. HIV takes hold despite treatment, in theory it can prolong the time to conclusive testing, and most experts continue testing to 3 or even 6 months. So instead of reassuring proof at 4-6 weeks, the period of anxiety is extended to 3 or even 6 months.

All PEP decisions should be made locally, and my advice for or against it should not be your deciding factor. If you're seriously interested, see a local expert, who might have a different assessment about the risk associated with the kind of event you describe. However, PEP must be started within 72 hr of exposure, and preferably 24-48 hr, so you may already be outside that window.
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