[Question #6119] HIV/STD Risk Assessment - Please!

70 months ago

Hello Good Doctors,

I am in desperate need of help! I had a sexual experience with a gay man two weeks ago. Since the experience, I barely sleep, periodically vomit, can’t function at work; I can think of nothing except that I may have contracted an STD/HIV.

I performed oral on a man but I insisted that he wear a condom. I touched his penis beforehand, possible that some precum came into contact with the condom’s exterior before it entered my mouth. Oral lasted for 5-min, the shaft of his penis touched my lips occasionally (he tried to push to the back of my throat). He did not ejaculate by oral, I stroked him until he finished while wearing the condom.

It’s possible some semen came out of the base of the condom onto my hand. I then tried to masturbate, the technique used involved vigorous rubbing of the penis head which may have pushed any semen on my hand deep into my urethra. I did not ejaculate.

I have read hundreds of your articles on the forum and know the risk of contracting HIV by oral sex is estimated 1:10,000.. frightening! Thousands of people win the 4-digit lottery every day (1:10,000). And I also stupidly tried to masturbate.

I know you cannot absolve me of my guilt. I have a beautiful wife, two children and one on the way. My wife is hurt that I won’t have sex with her. They are my everything and I’m horrified to lose my family, the thought of hurting my wife is unbearable. I’m tearing myself to pieces, can you please help me assess (possibly quantify) the risk?

Edward W. Hook M.D.

70 months ago

Welcome to the Forum. I'll do my best to help but, as you point out, I cannot resolve your guilt. The exposure you describe was a no risk event. The one in 10,000 risk relates to unprotected sex with a person known to have untreated HIV. In the exposure you describe, you do not know your partner's HIV status and a condom was used. Likewise, your hypothesis that you may have transferred his pre-ejaculate on your hands to the outside of the condom is not viable since HIV becomes non-infectious upon being outside of the body and is exposed to the environment.

My sense however that my assurances and science based response will not alleviate your anxiety. Get tested. At two weeks and HIV RNA test will effectively rule out infection and, I am confident, demonstrate to you that you were not infected.

I hope this information is helpful to you. EWH

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70 months ago

Doctor Hook,

Thank you for the quick reply, I will take your advise and get tested for HIV.

In the meantime, and to help address my concern (anxiety?), could you help me understand my risk from masterbating after performing oral? Since I may have had some semen on my hand, this seems as though it would be similar to ‘mutual masterbation’ which doesn’t seem to have a clear answer on the forum. Also, since I rubbed the head of the penis vigorously while semen may have been on my hand, would you say this is cause for concern?

Lastly, could you help me understand ARS? As you know, I’ve been vomiting, had night sweats, very little sleep, and I’ve had a bad cough for a a few days with very little phlegm brought out.

I’m just trying to understand my level of risk a bit more before being tested.

My heartfelt thanks for the tireless work you and your colleagues put into this forum, it’s appreciated more than you can ever know.

Edward W. Hook M.D.

70 months ago

I believe you were worrying about events which have not been associated with risk for HIV. During sex of any kind, transfer of genital secretions on one persons genitals on hands to another persons genitals is a no risk event. As mentioned previously the HIV virus becomes non-infectious upon exposure to the environment. That you vigorously masturbated makes no difference.

The ARS is a syndrome which occurs as the body begins to produce antibodies to HIV at a time when large quantities of circulating virus are present. The interaction of newly forming antibodies and the virus lead to a syndrome called the ARS which is comprised of fever, severe sore throat, and flu-like muscle aches. This syndrome typically occurs between 10 and 20 days following exposure. Isolated fever, sore throat, or in your case, night sweats are not the ARS. Similarly cough is not part of the syndrome. EWH

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70 months ago

Doctor Hook,

My final questions (obviously). But first, thank you for your patience and consideration. I understand that you’re a physician, not a counsellor but my panic has subsided to the point that I’m not vomiting and I actually slept for a few uninterrupted hours last night. I’m very grateful to you.

My last questions, it sounds as though you find it highly unlikely that my episode has put me at risk for HIV.

What is your assessment of risk for other STD’s? Chlymidia? Gonnorea? Syphillis?

Again, I feel like I’m most at risk for the masterbation afterwards (was there semen on my hand??).

What is the timeframe for accurate testing for these STd’s (Some sites say 90 days for Syphillis!?!).

Lastly, I have a small discomfort in the head of my penis, as though there’s a small obstruction in the urethra. It’s been there for a few days but no other symptoms (I.e. discharge). Is this possibly due to an STD.

Again, thank you for your patience, kindness, and understanding. It may simply be assessment and advice to you but it’s profoundly appreciated guidance to those you help. Thank you.

Edward W. Hook M.D.

70 months ago

Let me rephrase your statement. I do not find it unlikely that you are at risk for HIV. Rather I am confident that you are not at risk for HIV from the encounter you describe.

Similarly, I am confident that you are not at risk for gonorrhea, chlamydia or syphilis. That you masturbated after touching the condom and your partner's penis makes no difference.

Tests for gonorrhea and chlamydia will be reliable at this time. Blood tests for syphilis will take 4-6 weeks to be reliable.

The discomfort you describe does not raise concern for any STI.

I'm sorry you are suffering this degree of anxiety over your misstep., I hope my comments will help you to move forward. EWH

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