[Question #5361] hiv/syphilis

22 months ago
Hi Doctor(s)

I am a married man who has encounters with other males. I try to only have safe sex. I never have intercourse with males. my last encounter a week ago has me concerned. I was kissing another male and he was rubbing my anus with his fingers. (i think). He tried to penetrate me and may have by a small degree, say an inch or so. I immediately thought it might be his penis so i pulled away. If he did penetrate me it was only for a couple of seconds. My concerns are that what if it was his penis, and also 3 days later I developed 3 blister on the inside of my lips. My worry is about HIV from the frottage/slight penetration and syphilis on my lips from kissing him . My anxiety is through the roof and I cannot seem to think about anything else.
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
Welcome to our Forum.   I'll be glad to comment and hope that my replies will help to address your concerns.  The exposures you describe are unlikely to have put you at risk for HIV.  As I suspect you are aware, neither frottage nor kissing have ever been proven to lead to acquisition of HIV- they are safe sex.  As for the attempted rectal penetration, it is not clear if his attempted penetration was with his finger or his penis.  if it was his finger, again, this falls into the general category of masturbation and is a no risk event.  If it was his penis, then there may be a small risk although I am skeptical that your partner achieved penetration.  Typically "slight" penetration past the anal sphincter quickly leads to full penetration leaving no doubt that this has occurred.  It sounds from your description that this not occur.

Even if this did.  I presume that you do not know you partner's HIV status.  If you can contact him asking him if he penetrated you and if so, with what as well as if he is HIV infected would provide valuable information.  If he is infected, you would want to know if he is on therapy and what his viral load is.  Persons with HIV who are on therapy and have undetectable viral loads do not transmit infection to others.  If you cannot contact him your risk is low but there is a slight risk which would warrant testing at 4-6 weeks after the contact.  The risk for transmission of HIV from receptive rectal sex is less than 1% per exposure, if your partner had HIV and was untreated.  In your case, the brevity of the exposure would make your risk still lower.  

Finally, the lesion on your lips has occurred too early to be syphilis.  Syphilis lesions take, on average about 3 weeks to appear and would not be expected to occur in just three days.  This time frame is compatible with type 1 herpes however so if you do not already get cold sores you may wish to have a swab for HSV PCR testing performed.

I hope these responses are helpful.  If there are further questions or clarifications, please use your up to two follow-up questions to seek clarification.  EWH 

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22 months ago
Hi Doctor.

I am pretty sure he did not get past the anal sphincter. I could just feel pressure on it as if he were trying to penetrate with his finger or penis.I was standing up and i did not bend forward to try and  accommodate him.. he had a fairly large penis and I think it would have been difficult to get full penetration without lube. Also he did not ejaculate...( because he did so a minute or so later). would this have been necessary  for potential infection. I don't want to go through the stress of testing  if it is not necessary.  Am I taking a significant risk by not testing? Can I just try and forget the incident. By the way the blisters on my lip have virtually gone now  so they appeared and went within a week so I can rule out syphilis. It's just that when you have high anxiety you think you have caught anything and everything.
Thank you.
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
I agree with your assessment that it is unlikely that penetration occurred. That being the case I really see little need for testing unless your anxiety drives you to do so.  I also agree with your assessment that is that is that the sore on your lip has gone away essentially rules out the possibility of sepsis. In my opinion, I would be fine for you to put this in counter behind you to go forward without testing.  EWH---