[Question #6209] HIV risk and PEP

16 months ago
Doctors,

I am a gay male and had protected receptive anal sex with a stranger. Prior to sex, I did ask if he knew his HIV status. He indicated he was tested a few weeks ago and was negative. I pressed and discovered he did have unprotected gay sex after testing. My assumption was he was the insertive partner based on varying things he said. He was also uncircumcised. We had a good amount of foreplay where there was a lot of rubbing bodies, and he did have a good amount of precum. I am sure precum was on our bodies. Prior to the insertive sex, I put on the condom and used water based lube. Prior to ejaculation, he pulled out, took off the condom and ejaculated. The ejaculate was not near my anus. 

I am beating myself up as I don’t do this often with complete strangers. My question is should I consider PEP under these circumstances or is using an in tact condom sufficient preventative measure to have a relatively small exposure to HIV? Could you somehow quantify the risk? I know there are a lot of major assumption including his prior sexual partners were in fact HIV positive. I just don’t know if he had those up front conversations with them or not. 

Additionally, are there any STI risks with anal fingering using saliva as lubricant?

Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago
Welcome to our Forum and thanks for your confidence in our service.  I'll,be glad to comment.  I also want to complement you on your commitment to safe sex- you did everything right, asking about his status, using a condom, etc.  to get to the "punch line" right away, I see no need for PEP related to this exposure for a number of reasons which I will describe below. Mathis was a very, very low risk event.  The reasons I say this are:
1.  Yes asked and he stated that he was tested recently and was negative.  Most people tell the truth.  Further, if he managed to keep from getting HIV thus far, it is reasonable to presume that he did not acquire it in the interval sine his last test.
2.  Non-penetrative activities.   Your mutual masturbatin and frottage were no risk events despite getting each other's pre-ejaculate and ejacuate on each other.  Not one has ever gotten HIV or other STIs from non-penetrative sex of this sort, you will not be the first.
3..  Penetrative sex.  You used a condom, it remained intact.  This reduces the already very small likelihood that you were exposed to HIV to close to zero.

Putting all of,these factors together, I see no reason for concern or testing related to the event you describe.  I would not worry.  EWH
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15 months ago
Thanks Doctor. Would your analysis change not knowing the other person’s number of partners since his last test and if he could have engaged in unprotected receptive sex? The assumption here is he has had many partners and could have in protective receptive sex during the period since testing. 
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago
Your follow-up question really boils down to "what is the chance that he had become infected since his last test".  The answer is that the chance is low and your penetrative sex was condom protected to my assessment is still unchanged.  While PEP is always a personal choice, my advice is unchanged- no unprotected penetrative sex, superficicial exposure to genital secretions only thus no indication for PEP.

EWH
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