[Question #8415] Risk Assessment and Advice

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45 months ago
Hello Doctors, hope you've been doing well.

Would appreciate your advice and evaluation for this event: I had my first msm experience today with an older male (he's 30, I'm 25). I was the insertive partner and had a condom throughout the entire length of intercourse (I also know from the threads that the risk for the insertive partner, even with an unknown/infected partner has lower risk than the receiver). The condom remained intact all throughout the end, although he rolled it off me after the sex for some mutual masturbation. We also had unprotected oral both ways before the sex (there was lots of saliva involved) and that was pretty much the entire encounter.

I asked him about his HIV status prior to intercourse and he told me that he was negative, although I felt like I didn't have the right to ask how often he got tested or how his sexual habits were. I know the risk for oral is little to virtually no risk based on other threads, but since this is a MSM event, does this change your risk evaluation? What I am worried about:

- I have a small healed cut on my left index finger that I'm worried may have been exposed to any anal secretions.
- I have a white coloured healing wound just next to my molar at the back of my mouth and am worried precum may have found its way into it.
- After the condom was rolled off, I'm worried that any precum or anal secretions may have come in contact with my urethra - this is making me anxious, to be honest.
- I know it's pretty much useless, and when condoms break the break wide open, but the water test I did didn't reveal any leaks or punctures.

May I please know if you would advise me to get PEP or if this event warrants testing?

Many thanks and kinds regards, as always.
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45 months ago
Forgot to mention that I afterwards gargled with mouthwash as I had previously read that it may contribute to killing any potential STIs, and thoroughly wiped my penis with an antibacterial wipe.
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45 months ago
One last thing - sorry, wish there was an edit button! - I've had a bit of post nasal drip cough this past week that was a bit strong and dry (better now), but I'm worried that maybe coughing too hard can cause  'rips/tears'?  in my throat that can make infection via oral more likely?
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Edward W. Hook M.D.
45 months ago
Welcome to our Forum and thanks for your questions.  I’ll be glad to comment.  Let me start by telling you that I would not prescribe PEP for you based on the description you provided.  There are many reasons for this, including:

1.  Your partner said he was not infected.  Most people tell the truth (incidentally, in future encounters you might also ask partners when they last tested.
2.  You used a condom for rectal intercourse and it did not break.
3,  as you point out, the risk for HIV from oral sex is very low.  No one has ever acquired HIV from receipt of oral sex and the risk from performing oral sex is estimated to be less than one in 10,000 exposures if your partner has untreated HIV.  This is the case even with the gum disease and recent coughing you report.
4. Exposure to genital secretions during mutual masturbation is a usual occurrence and does not change the risk calculation.

In summary, I see no scientific or medical reason for PEP or even testing related to the event you describe.  I hope you find this perspective helpful. EWH 
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45 months ago
Thank you very much Dr. Hook for your reply and perspective.

Just to clarify, I did not have gum disease but a healing injury on the back of my cheek because I accidentally bit myself a couple of days ago while eating - does it make a difference, risk-wise?

"4. Exposure to genital secretions during mutual masturbation is a usual occurrence and does not change the risk calculation."

Even if he were to accidentally have any on his hand(s) and masturbated me? Or if his hands went over the head and/or urethra?

Also, no testing at all? Not even for chlamydia or gonorrhea? I could not see any lesions/sores/etc. anywhere on his penis or face, by the way.

Thanks again.
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Edward W. Hook M.D.
45 months ago
Your cheek wound is, if anything, less risky than gum disease.  Neither is a risk or a problem.  No change in my assessment.

My statement stands.  The sort of inadvertent introduction of genital secretions is not a concern.  Experts are unanimous that mutual masturbation with exposure to partner’s secretions is not a risk.

Testing of your throat for Gonorrhea and chlamydia is reasonable.  No concern about HIV which is what you asked about.  EWH 



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45 months ago
Thank you Dr. Hook. When's the soonest I can test for Gonorrhea and Chlamydia please? Should I wait a while until tests are conclusive?

No additional questions after this, thank you.
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Edward W. Hook M.D.
45 months ago
Tests for Gonorrhea and chlamydia will provide conclusive results at any time more than three days after your exposure.  EWH ---