[Question #6973] Protected condom sex, unprotected mutual oral

11 months ago

So im a male and 14-15 days ago I had sex with a tranny(male) prior to the act I unfortunately did not ask for the status of the individual, but a week later I did , and they said that health wise they have felt great, and don’t have anything(could be a lie, but who knows) But anyways on to my risk factor It was a bit of deep kissing, and unprotected oral on both sides that lasted 10-15 minutes, and as we were in the deep kissing he put his finger around my anus, maybe went inside for a second, but I don’t believe it did , and also as we were in the kissing his penis slightly touched my asshole without a condom i’m 95% sure it didn’t insert my anus, so we continued on, and I was the only one that did the fucking But it was all with a condom, When I ejaculated I pull out, and inside the condom, I went to the bathroom with better lighting to make sure it was in tact and no breakage, and I saw none, I even did the water test after I took it out, filled the condom with water , and clearly no visible holes, I even recorded it , and looked at it again, condom seemed in tact. Everywhere. Read did not recommend pep, so I did not go for it even tho I kinda wanted to. So I was feeling great doc, thinking I did everything the right way forgetting about the incident almost, and boom today which is 14-15 days after the incident, I started to feel a bit of a sore throat, and my lymph nodes on the side of my neck felt slightly tender and hot, also my head feels slightly hot as well,  And I even have slight reddening on my face, my gf said it looks like you might break out a bit, and I feel nauseous and a bit of a headache and almost threw up an hour ago, and I am one never to throw up, I had to take an ibuprofen to relieve the symptoms,  I am freaking out that I am in the beginning stages of ars help doc with my questions


1) what are the chances you think I have acquired hiv from this encounter?


2) Could You get hiv from unprotected oral in this situation, from receiving and the gici

11 months ago
Doctor I guess my story was long, as I was trying to get every little detail in so that I get the best advice possible, it did not give me space to get to the actual questions, I hope this doesn’t count as one of my two follow up questions, but back to my questions
2) what are the chances I got hiv from the unprotected oral both giving and receiving?
3) what are the chances I caugh hiv from the deep kissing? The possible finger in my anus? Or the possible one second rub of his unprotected penis on my anus?
4) Do you think this is ars?
5) I forgot to mention we rubbed our penises together for about 20 seconds, could I have gotten hiv like that if he had slight semen, and it got inside my urethra?
6)Would you have recommended me taking pep for this situation? 
7) what are the chances I have gotten another std from this encounter? So far have seen nothing unusual on my penis
Edward W. Hook M.D.
Edward W. Hook M.D.
11 months ago

Welcome to the Forum and thanks for your question.  I'll be glad to comment.  The exposures you describe were virtually no risk events.  Your partner states that they did not have HIV and most people tell the truth; HIV is not transmitted by receipt of oral sex or masturbation; the risk for infection from giving oral sex to an infected person is less than 1 infection for every 10,000 exposures (i.e. like having sex with an infected person once a day for more than 27 years) ; and condom protected sex is safe sex as long as the condom did not break (and when condoms break, they break wide open leaving no doubt that they failed).  I would not be worried in the least about this exposure and suspect it is far more likely that you have one of the common, every day, non-STI viral sore throats that most people get from time to time.  Thus my answers to your two initial questions are

1.  Virtually zero

2. See above.  No risk for HIV from receipt of oral sex, close to no risk from giving oral sex to an infected partner although a very few (too few to be able to study them) cases have been reported.   It is extraordinarily rare and you do not even know you partner was infected.

In answer to your somewhat repetitive follow-up questions:

2) what are the chances I got hiv from the unprotected oral both giving and receiving?
See answer 2 above.

3) what are the chances I caugh hiv from the deep kissing? The possible finger in my anus? Or the possible one second rub of his unprotected penis on my anus?
Zero. 

4) Do you think this is ars?
No.  The ARS is characterized by HIGH fever, SEVERE sore throat, and muscle and joint aches. 

5) I forgot to mention we rubbed our penises together for about 20 seconds, could I have gotten hiv like that if he had slight semen, and it got inside my urethra?
No, this was no risk.

6)Would you have recommended me taking pep for this situation? 
If you came to my clinic with this situation I would decline to give you PEP.  Further and FYI, it is now too late to consider PEP.  PEP muct be started within 48-72 hours of an exposure.

7) what are the chances I have gotten another std from this encounter? So far have seen nothing unusual on my penis.
There is a very small (but higher than your risk for HIV) that you might have acquired gonorrhea or chlamydia from giving or receiving oral sex.  when they occur these infections typically do not cause sore throat and are asymptomatic but if you wish to be tested, the right tests would be both a urine test and a throat swab for gonorrhea and chlamydia. 

I hope this information is helpful. this was a very, very low risk event.  I would not worry and as I suggested, I suspect your sore throat is unrelated to the encounter that you describe.  EWH
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10 months ago
Thank you for the fast response Doctor, I know it has been 4 weeks, but I stopped worrying, and am getting tested next week, not just for this encounter, but several other with women, just because it’s been a while. But I do have another question for you assuming I test negative, I have been thinking that I would like to engage in this again, but it will only be a time to time thing, since I am more into women, and this would just be a here and there thing. I will obviously continue to use condoms, but sex with msm scares the crap out of me(and in the off chance that a condom breaks, which it has a few times before with me, luckily with women though)and I never have wanted to take prep, but I somehow stumbled across something, on a post on a Dr Hhh question, and it said something about prep on demand, I looked on google, and barely saw any info on in, but it seems to be the perfect thing for what I want, instead of having to take a pill every single day, when I won’t be doing this every single day, and probably not even a weekly thing. 
1) can you tell me more about prep on demand? How exactly does it work? Who or what situations is it recommend for? That effectivness rate, when do I start taking i before an encounter? Do you recommend it over prep daily? 
2) what happens if I take it, and an encounter postpones for another day, for example they postpone for the next day? How about an example if they postpone for 2 days after I thought we would engage in the act, thank you doctor, I want another back up plan besides condoms for msm, with women, I think I will be fine just using condoms. 
Edward W. Hook M.D.
Edward W. Hook M.D.
10 months ago
You are asking important questions. 

1.  PrEP on demand is better than no PrEP at all but not as good as the daily prep. It has been studied only for sexual encounters amongst men who have sex with other men. It is less likely to be effective for male female vaginal sex.  The dosing is to take two Truvada pills between 24 and 2 hours prior to sex (The closer to 24 hours before six, the better) then one pill at 24 hours and a last pill 24 hours later (for this reason this dosing schedule is called two-1–1).  The estimated effectiveness of this regimen in studies was an 86% reduction in risk for acquisition of HIV. Condoms when they do not break and are worn throughout the encounter Arthur to provide nearly 99% protection.

2.  There are no data on what happens if the sex is is delayed however if persons have two exposures with an a one week period.  For the second exposure the first dose is only one Truvada pill, not two.

As a generalization, my advice is that you are safer asking your partners about their status and, irrespective of the response, using condoms. Should the condom break, you might take PEP ( a 30 day course of anti-retroviral therapy started no later than 72/hours (sooner is better) After exposure.

I hope this information is helpful. EWH
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