[Question #5912] Lifestyle risk

19 months ago
I will be frank - I have had A LOT of deep kissing and mutual masturbation partners. Sometimes receiving condom protected fellatio too. With online apps/sw sites and such, I have been able to have multiple new partners each year - women ranging from late 20s through their 50s. ( i am a straight male in my 30s) But I have hung my hat on safety of the acts. But it occured to me, am I tempting fate because number and lack selectivity of partners, despite "virtually no risk" or "theoretical risk" acts? With theoretical risk I have been thinking a lot lately, if you are outside under a tree every time there is a thunderstorm, you very well could get struck by lightening.

 My question is.. Is there a false confidence in safety of acts (deep kissing, mutual masturbation and receiving condom protected fellatio) if you are NOT being selective w/ partners and there is a large number of partners.. Esp sw partners. Btw, I have tested for HIV consistently every year, GC/CT q 1-2 years. It has been several years since testing for syphilis.

Since previously testing negative for HIV, GC/CT,  just last month, my risks are mutual masturbation, deep kissing and receiving condom protected fellato w/ a handful of partners..  Should I test for syphilis? With HIV, GC/CT I am thinking do not re-test, but please tell me otherwise if you think so. 

I do have a lot of HIV related anxiety, but I also have a somewhat high sex drive. I am having a hard time coming to a conclusion for a happy medium to be at ease on both fronts. Also FYI, times when I have been in a relationship, I have NEVER been unfaithful. But when I am single, I tend to go "all out" w/ these online sw resources, but am deliberate about being strict about sticking to these particular "virtually no risk" acts. I am thinking I would be lucky to settle down w/ one amazing woman and never worry about this again!
Edward W. Hook M.D.
Edward W. Hook M.D.
19 months ago
Welcome back to the Forum.  I'm sorry that you continue to worry about this issue.  As you describe it, you are quite committed to safe sexual encounters focused on lots of kissing, including deep kissing, mutual masturbation, and condom protected receipt of oral sex.  If I were to re-phrase your question I might say something like, if a person has enough partners and enough exposures, can they make no risk exposures into low risk.  I think not,  On one hand each of the activities you describe has a tiny/infinitesimal  potential risk of infection which could lead to infection of someone somewhere despite the fact that there are no proven instances in which any of the activities you list did lead to HIV infection.  Could you be "the one" - I suppose.  Is it something to worry about- no.  So how to deal this.  My suggestion is to continue the safe sexual activities to which you have committed and then periodically (once a year or one every six months at most), get a sexual health check up in the same way that you should be periodically be getting your blood pressure checked.  Testing at that time would include tests for gonorrhea and chlamydia (including a throat swab given recent but controversial data that deep kissing my result in gonorrhea transmission)as well as blood tests for HIV and syphilis (not herpes).  I would anticipate that such testing would be negative but would also provide reassurance regarding you continued health and safety.  

Perhaps my thoughts on this will be helpful to you.  I do understand your desire to come to a conclusion that you can be confident in.  My guess is that the combination of occasional negative tests at check-up time and your ongoing commitment to safe encounters will help you to build confidence.  EWH
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19 months ago
Thank you so much Dr. Hook. 

1) Strictly for HIV,  in the context of safe activities with no vaginal, anal or unprotected oral sex.. Would the function of periodic testing be solely for anxiety relief but not because of actual risk/medical need? Can this be distinguished from periodic testing recs for those w/ multiple condom protected vaginal and anal partners?

2) Is there any risk stratification for HIV between the safe activities? I believe massage, kissing skin(breasts, legs, neck etc) and receiving handjobs without any bodily fluid are truly no risk.. Like along the lines of shaking hands, environmental contact, sharing food etc. 

Deep kissing, fingering vagina  are theoretical risk for HIV, negligible, but not truly zero like shaking hands and such.  The theoretical risk for HIV w/ deep kissing for sure is lower than the theoretical HIV risk w/ performing cunnilingus or getting an unprotected BJ. Receiving condom protected BJ is prob a lower theoretical risk for HIV than deep kissing.

Would you agree with risk my assessment

3) Since my last negative 4th gen HIV test last month.. given deep kissing, mutual masturbation and getting condom protected BJs w/ a handful of casual female partners, would I be correct to assume I am still not at risk of HIV at this point in time? If it matters, w/ the deep kissing episodes, they were quite prolonged.. Though I never tasted blood nor did I have any oral sores. If I do not have subsequent risks moving forward, would there be any need to re-test for HIV? Or could I forget about these episodes and move on?

4) If I am to find myself in a committed relationship someday.. What are the testing recs for monogomous couples?

5) Is there any HIV test that provides a 100% conclusive result earlier than 6 weeks? 

I have concluded  it will be healthier for me to focus on finding a monogomous partner and foregoing the casual encounters.  I thank you sincerely, Dr. Hook.

Edward W. Hook M.D.
Edward W. Hook M.D.
19 months ago
Straight to your follow-up questions:
1.  There is no known risk for HIV from any of the activities you describe.  hence the primary goal here would be reassurance. 
2.   You are correct, massage, kissing skin(breasts, legs, neck etc.) and receiving handjobs without any bodily fluid are truly no risk but so is deep kissing and masturbation of the vagina (fingering).  We have to believe the science here- there are no proven cases in which any of these activities have led to HIV acquisition.
3.  Correct.  I would consider your situation to be no risk at the present time.  Even if you had tasted blood, this would still be considered no risk.  I see no medical/scientific reason for further HIV testing at this time.
4.  For monogamous couples, I would recommend testing early in the relationship, then no need for further testing as long as monogamy can be assured.
5.  Not really.

Finally, I think you need to continue to move forward with relationships but don't force yourself into a monogamous relationship that doesn't personally satisfy you.  If you do force yourself, the monogamy may not be longstanding.  You'll know it when it happens.  EWH

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18 months ago
Your input about relationships really resonates with me. 

When it comes to risk and new partners, do you have any input on guaranteeing safety from HIV ? I am in an area of the country with a higher HIV rate, the San Francisco area. I recently met someone who told me she had a past male partner who is bi. And she is in a healthcare role where she is prob at some small baseline risk of workplace exposure to HIV. Nothing sexual has happned between me and this woman.  

But if in the future if it gets to that point.. Before having vaginal sex - confirming testing status would seem appropriate because even consistent condom use doesn't guarantee complete safety, correct? But with deep kissing, mutual masturbation, etc. I am thinking it would probably be too extreme to try confirm testing status and may stop a relationship in its tracks because it would make one seem too paranoid. Especially before a first kiss, that would totally ruin the moment, right? Plus it would be unneccessary because they are no risk activies. Is this the correct mentality?

As a general rule, with safe activities - deep kissing, mutual masturbation, etc. is it safe to say one should never be worried about HIV, even in the San Francisco area and not totally certain of a partner's status? 

Thank you, Dr. Hook.

Edward W. Hook M.D.
Edward W. Hook M.D.
18 months ago
Good questions.  The answer in some ways depends on the partner.  if you are entering into  what you hope will be an ongoing relationship, a good practice is to suggest that, as a couple, you go for a sexual health check together..  The reason for this has as much to do with respect for one another, along with the understanding that STIs are not a sign of being a "bad" or "promiscuous" person but that stuff happens and STIs can be asymptomatic.  With mutual negative results, you have just eliminated any reason for concern and have a factual basis for mutual trust and respect.  OTOH, in more casual situations, this practice is often a bit more difficult to pull off.  

As I said above, deep kissing, mutual masturbation, etc. are no risk events with no reason to be worried about an STI and therefore no medical reason for restraint early in a relationship.  

Finally, one additional comment. While you are right that HIV rates are higher in the Bay Area, most of those infections are occurring among men with other men as sex partners  This does not do anything regarding your concerns related to a partner whose prior partner(s) may have been bisexual but it is helpful related to heterosexual.

Hope these comments address your continuing concerns.  As per Forum guidelines with this, third reply this thread is now complete and will be closed shortly.  EWH
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