[Question #6796] His risk?

13 months ago
Hello,I   was given oral with condom on March 18th . Before I asked if he was hiv negative. During the oral, we briefly stopped, and I dipped him  for few seconds him with condom on but no was no real penetration. He continued with oral and I still had my condom on. At the end  I removed condom  and I ejaculated my semen on his face.  Afterwards I noticed he tongue was all white. I don't know if that is an hiv sign and also he couldn't care much that he had semen on his face. 
1 week later I gave protected oral to a bi guy and also asked for his status which he claims to be negative. I did put on his condom, but he adjusted it a bit. I don't know if his hands were clean, it was bit dark. He had baby wipes and I used a wipe to clean the condom.  Then I dipped him also but for a few minutes and also no real penetration. Then he took condom off and he was masturbating. I took a step back and since it was dark I don't know if I had drops of his semen straight in my eye. The moment itself I didn't actually feel something but afterwards my eye stings for several days. I still had my condom on when he ejaculated and I think the condom was still intact when I ejaculated.
Today a guy gave me twice protected oral and condoms were still intact. Yesterday my steady girlfriend, who is absolutely hiv negative wanted unprotected vaginal intercourse and we did have it.1.
 Could the  first guy infect me with hiv with such a tongue and who I think that he is uncareful to let him spray in the face?
2. I felt stupid to wipe condom off with baby wipe because condom could break of it I think. I think it was still intact. Could he infect me when he adjusted the condom with something? And is a drop (or drops) of semen in the eye dangerous for hiv ?
3. My girlfriend is the only one I have unprotected with and my last hiv duo test was from March 11 . I tested at 28 days. 

Greetings
Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago
Welcome back to our Forum.  I. One that you were last on the site just 9 days ago,and that many of the sorts of exposures you describe are quite similar to your earlier interaction with Dr. Handsfield.  Consequently my responses will be brief and somewhat general.

1.  Congratulations on your commitment to relatively safe sex.  Your practice of asking partners and using condoms for many of your exposures is a good way to stay safe.

2.  FYI, condoms break about 1% of the time they are used.  Breakage is more common with rectal intercourse (thus “dipping” is somewhat, although low, risk.

3.  Oral sex.  There are no cases that we are aware of that persons acquired HIV fro receipt of oral sex.  OTOH, cases do occur RARELY when HIV negative persons perform oral sex on persons with HIV- about 1 n 10,000 exposures.

3.  Ejaculate in the eye. Ejaculation on the face very rarely leads to acquisition of HIV, if ever.  The blink reflex and other reflexives are highly protective.

4.  Manipulation of condoms,as long as the condom stay on is not a problem

I hope these responses are helpful.  I note you raised the topic of PrEP in your discussions with Dr. Handsfield.  Given the frequency and variety of your exposures, you might consider it.
EWH 
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13 months ago
Hi doctor, 

I know protected oral isn't a risk but I wanted to provide  all the info for risk assessment about my 4 previous episodes. I saw an answer from you here where someone had unprotected vaginal intercourse and the person didn't have to retest hiv duo test at for 6 weeks. Dr Handsfield replied in my previous post that for real conclusive status I should retest at 6 weeks. I mean all was protected intercourse with unknown partners except with my steady girlfriend. Is it because I am bisexual and therefore more at risk? I thought dipping, it was more frottage than dipping, was zero risk with an intact condom? Myself didn't have receptive anal. For the semen in the eye, I stood 1,5 meter from the guy. 
No breakage of condoms occurred which would be obvious I think. 

I am scared to become infected and surely don't want to infect my girlfriend. Also I read here that vaginal intercourse where the man is hiv positive, there is a chance 1 in 2500 to become infected. But I have read stories where women were infected the very 1st time. 

Should I retest in your opinion? 

Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago
Several comments.
1.  Dipping means different things to different people.  Dipping however for most people does involve penetration, unlike frontage which does not.  Dipping while wearing a condom is a no risk event.

2.  Testing at 4 weeks will detect over 99% of recent infections.  Neither of us has ever seen or heard of a person who became positive after a negative test at 4 weeks but our colleagues at CDC indicate they have.  We honor their experience and recommendations.  Hence our statements that to be absolutely conclusive, testing should be done after six weeks.

3.  I do not feel that you need retesting at this time based on the events you describe.  That said, given the variety and number of encounters you describe, your lifestyle places you at somewhat greater than average risk, hence the suggestion by both of us that you consider PrEP.

You are correct that the unprotected encounter with your GF was low risk.

Hope this clarifies things.  If not, you have one more follow up.  EWH 
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13 months ago
Hello, 

Thank you for the response. In my previous post Dr Handsfield scared me a bit that I was at high risk if I have receptive anal because condoms can fail. And anal with condom is highly reliable against hiv but not 100% he also wrote. Since then I didn't have receptive anal and I won't have it or want it anymore. On the other hand he did reassured me with his good advice. 

Now you state that I have more than average risk but I always use condoms and the dipping was more frottage. I didn't actually do insertive anal. And I always ask for my unknown partners about their status. It was mostly protected received and given oral. 
I am confused now about my events when it comes to safety against hiv. Today I looked at posts at medhelp and poz.com and the community there states that a condom that doesn't fail is 100% risk free. Are they giving not the right info? But the opinion of Dr Handsfield and you Dr with all your experience, I value more. 
What can I do to have events and enjoy as well without worries? 

In your opinion I don't need to retest, so you mean that I don't have hiv?? 

This was my last follow up, so hereby thank you in advance and Dr Handsfield for my previous post. 

Edward W. Hook M.D.
Edward W. Hook M.D.
13 months ago
As I said before, based on your previous recent test results and your commitment to condom use you do not have HIV and do not need to retest.

Both Dr. Handsfield and I have indicated that you are at somewhat higher risk than average based on your variety and number of sexual encounters with other people. We congratulate you on your commitment to safe sex and condom use.  Wihen condoms are used correctly and consistently throughout sexual activity they are virtually 100% effective. However, condoms do break, about 1% of the time they are used.  Breakage is more common with new partners and with insertive rectal sex.  From the sound of things you take appropriate precautions and those have protected you. At the same time, stuff happens. People get struck by lightning.  I know people who do not go out in lightning storms because of their concern regarding lightning strikes. I do.  FYI, The average American male has 8 to 10 lifetime sexual partners. Men who are bisexual or have exclusively male sexual partners on average have higher numbers of partners. More partners, more risk.  We each need to make our own decisions and to do so with this much information as possible.  We do not judge.  We try to help our clients be as well informed as possible.  I sincerely hope that the information we have provided is helpful to you.  EWH
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