[Question #4605] Risk Assessment MSM

29 months ago
Hello, 

I am a 35 year old male. I have one regular sexual partner (female significant other).

About 36 hours ago I made a mistake after drinking too much. I had a sexual encounter with a gay male also about 35 years old. I performed oral and received oral, and he briefly penetrated me unprotected for about a minute anally. Because he wasn’t wearing a condom, I had him pull out. He did not ejaculate inside of my, but rather ejaculated via masturbation.

I am very concerned about HIV and other STDs. What type of risk do I have for HIV and other STDs? Would you recommend I get tested?
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
Welcome to the Forum.  I'll be happy to comment.  This was a somewhat risky encounter largely because of the rectal penetration,(the risk from oral sex is substantially lower for the oral infections). While it makes common sense that the longer the exposure and ejacualtion would increase risk, any penetration can transmit infection and testing is warranted.  You can be tested at this time for Gonorrhea and Chlamydia at the penis, the rectum and the throat and I would suggest this.  I would also suggest that in 4-6 weeks you have a blood test for Syphilis and for HIV. Any of these infections can occur without symptoms so testing is the way to go.

The fact is that the risk in only modest as most people do not have STIs and STIs are usually not transmitted following a single exposure but  you will feel better  with negative re is no need for testing of any sort for herpes unless you develop symptoms.

I hope this comment is helpful.  EWH
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29 months ago
Thank you this is helpful.  Hey will follow your advice and get tested.

Are you able to provide an estimated percent risk of the exposure for various STIs? For what it is worth, he indicated via text that he doesn’t have any STIs. 
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
His reassurance is helpful and lowers your risk for infection as it makes him somewhat less likely to be infected although as mentioned above, any of these infections can be asymptomatic, making testing a good idea.

Different sorts of exposure, as well as different bacteria or viruses are associated with different risks, if the person has an infection.  This has been best studied for HIV and are as follows:
Partner with HIV - receipt of oral sex.  There are no proven infections
Partner has HIV - performance of oral sex risk is less than 1 infection for 10,000 exposures
Partner has HIV - performance of insertive rectal sex, risk is about 1 infection per 1000 exposures
Partner with HIV - receptive anal intercourse, risk is about 1 infection per 100-200 exposure

Other STIs, like Gonorrhea nare more easily transmitted than HIV but the estimates are imprecise although the generalizations relating to ease (as opposed to numerical risk) of transmission are probably correct.  EWH
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29 months ago
I’m considering an HIV RNA at 11 daysbpost exposure as I’m looking to have results ASAP, and then follow up with additional testing later. Any issues/concerns with RNA testing besides cost?
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
The false positive rate for the RNA tests is slightly higher than for the combination HIV antigen/antibody tests that are used at later time points.  That said the rates are still quite low.m expense is considerable.  I am confident a RNA test will be negative and when it is, it should be believed.

As you probably know, we provide up to 3 responses to each question.  This is my 3rd response.  Thus this thread will be closed shortly.  Take care and please don't worry.  EWH
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