[Question #5601] Worried / MSM

21 months ago
I am a bisexual male who is married to a woman.

Approximately 10 days ago, I had unprotected sexual contact with a man I met.  We are both white males in our mid 30s and reside in Northeastern USA.  Prior to any sexual contact, I had a frank discussion regarding STI status, and he confirmed to me that he is, in fact, HIV negative and free from all STIs.  Furthermore, he indicates that he is tested every 6 months and that he is due for his testing this month (June 2019, which jives with a semiannual assessment).

There were two encounters in consecutive days, both consisting of unprotected oral sex, kissing, and brief (2 minutes or less) of unprotected anal sex.  I was the insertive partner in both cases, and I am circumcised.  I understand that makes a difference in terms of single exposure risk.

I have no reason to believe my partner was lying as to his status, but given this is my first time engaging in anal sex of any kind, I’m concerned.

I do not have any symptoms to speak of that would suggest Chlamydia or Gonorrhea.  No pain on urination, no discharge of any kind, nothing.  I do feel like I have some enlarged nodes in my armpits and groin, and in general, I feel like my skin is itchier than normal, but no other ARS type symptoms.  No fever, sore throat, fatigue, etc.  And on the itchy skin, there is no organized rash like I have seen online.  I also feel like I’m looking for symptoms, so anxiety is definitely part of it.

Today, I was tested for Chlamydia and Gonorrhea in addition to HIV.  I realize it’s early for HIV, but that was part of the battery of tests administered.

I’m just looking for a general risk assessment based on statistical data that exists and your experience as clinicians in this field.  As further background,  there are fewer than 50 cases of HIV diagnosed in my state each year, and even fewer in my age range.

Any information you can provide would be greatly appreciated.  


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Welcome to the forum. Thanks for your question. And congratulations for a responsible approach to your sex with other men, at least in this instance -- and, I hope, in the future. It will stand you in good stead and keep you at low risk. That said, I strongly urge you to use condoms for anal sex with other men, even with an apparently safe, uninfected partner.

Let's address HIV first. The latest calculation is that if receptive (bottom) partner in anal sex has HIV, the average risk to the insertive (top) partner for one episode of unprotected anal sex is 1 chance in 909. Don't let the apparent precision fool you:  these are soft data, based on infected pesons' best estimates of when and from whom they were infected. Also, "latest" doesn't mean recent:  this analysis is several years old. Very important, it was done back when most infected people were not taking anti-HIV treatment, so the average risk probably is a lot lower today. But we can sort of look at 1 in a thousand as your risk, if your partner had HIV. But almost certainly he did not, for the reasons you describe. If we guess there's one chance in a thousand he did in fact have HIV, your risk of being infected would be 0.001 x 0.001 = 1 in a million. (Good odds in your favor!) And actually lower than that, because of the brevity of the anal exposure. As for oral sex, there is for sure no risk oral to penis (no proved cases, ever), and very low for your oral exposure to his penis (only a handful of reported cases). The infrequency of HIV in yoru state also goes along with a low risk your partner is infected.

The risks of other STDs are higher, but still low for any single exposure, also considering your partner's likely low chance of being infected. And that you have had no pertinent symptoms (urethral dsicharge, painful urination penile, anal or oral sore, etc) is reassuring.

Do you need testing for anything? From a strict medical/risk perspective, no. However, some people are more reassured by negative test results than by clinical experience, probabilities, and statistics, no matter how expert the source. You're the only one who can make that determination. If you decide to be tested, gonorrhea/chlamydia testing is valid any time (4-5+ days after exposure), and could include urine and rectal and throat swabs. HIV and syphilis testing are valid any time 6 weeks or more after the last possible exposure. Even if you get tested, I definitely do not recommend you wait that long to resume sex with your wife. The chance you are infected is low enough to take that miniscule risk, in my opinion.

Another approach is to re-contact your male partner, and for both of you to be tested (without any further wait). It sounds like he's due for his semi-annual routine tests anyway. And for all you know, maybe he would be reassured by knowing you have negative test results. If all negative, you'll both know you're home free in regard to the recent exposure.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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21 months ago
Thanks Dr. H!  Appreciate your insight into what is no doubt a poor decision on my part.  I am, however, glad that probability and statistics are dramatically on my side.  

As I stated in my original post, I have been tested for HIV (too soon, but just part of the tests ordered), Chlamydia, and Gonorrhea.  I’m awaiting those results, and expect in the coming days.

Is there anything that can be learned from a negative HIV test that was administered only 10 days post exposure?  

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
The HIV test won't mean much. With the now-routine antigen-antibody (combo) test, only 20-30% of newly infected people would be positive at 10 days. Gonorrhea/chlamydia will be valid, assuming correct anatomic site(s) were tested -- as discussed above, based on your exposure, you should have had tests on urine (or urethral swab) and rectal and throat swabs. Those will all be valid.---
21 months ago
Thanks again, Dr. H.

Got my results back on testing.  As expected, all were negative.  Chlamydia and Gonorrhea are conclusive given more than 5 days from the encounter.  These were urine tests given I was the insertive partner.  

1.  I’ve never bottomed, so I’m guessing an anal swab isn’t necessary for Chlamydia / Gonorrhea?

2.  Can you describe ARS based on your clinical experience?  I realize my encounter was statistically very low risk, so this is just for my own information.  It sounds as though, based on my own reading, that the symptoms are often confused with other “garden variety” illnesses.

Again, appreciate your taking time to answer my questions.  


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
1) Correct, no rectal testing needed.

2) Sorry, this goes beyond what's practical on a forum like this. You can find lots of information about ARS symptoms etc on line. 

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful.
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