[Question #8774] HIV risk from one time unprotected anal
 |
40 months ago
|
Dear Dr. HHH.
I am here for re-assurance for myself. I know you have
answered others questions similar to mine and you even wrote to someone once to
quote
" The wording of your question shows you have read some
other threads. It is hard for me to imagine why you would think the similar
replies would not apply to you. But they
do. "
I am 40 straight happy married with kids. but 2 weeks ago on
a drunken night i went to see my massage guy and he does massage nude, one
thing led to another and i ended up i don't know why but having unprotected
anal (i was the top) for max maybe 1-2 mins and finished inside. after this we
cleaned up and i went home. He did use lube.
He told me twice as it was happening he was clean. it happened
so fast. next day i was super anxious and felt guilty and i had to ask again. i
texted him to ask if he is clean and his exact reply was "yes i get
regular testing and i am clean, so you have nothing to worry about"
i believed him and moved on. but days later i started
wondering what if he didn't know he was recently infected or seroconverted
later and than the anxiety started all over again.
Please tell me
1. do i need to test from this one time encounter in my
life?
2. can i just forget the whole thing and move on with my
life and have unprotected sex with my wife?
This is the 1st time I did something so stupid
its killing me. He seems like a clean guy who is a musician @ does part time
massage. Hes probably 33.
 |
H. Hunter Handsfield, MD
40 months ago
|
Welcome to the forum. Thanks for your question.
People generally do not lie about HIV status when asked directly. Therefore, it is unlikely your massage partner has HIV. In addition, your question suggests he understand your concern and would not intentionally mislead you. Could he be in the window period? Of course this depends on whether he's had similar exposures to persons at high risk-- but probably most of his massage clients are at low risk for HIV (men like you). And if he has HIV, the chance you were infected was well under one chance in a thousand.
So all things considered, I see little risk here. Should you be tested for it? Yes: not because there is a serious chance you were infected, but because the negative result probably will be more reassuring than anything I can say based on epidemiology, statistics, and other scientific analysis. But in the meantime I advise you to continue unprotected sex with your wife -- that's what I would do if somehow I were in this situation. And stay relaxed: perhaps you would like to know that in the 18 years of this an our preceding forum, with thousands of questions from people concerned about sexual exposures that could result in HIV, not one person has reported that they tested positive. You're not likely to be the first. If and when that happens, I expect it to be from a truly risky exposure, not a low risk event of the sort you have experienced.
However, I also would suggest a urine test for gonorrhea and chlamydia: you are at far higher risk for those STIs than for HIV. (Plenty of time has passed for conclusive test results.) You also could have a syphilis blood test in a few weeks -- again, more for reassurance than for actual significant risk.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
--- |
40 months ago
|
Thanks Dr. HHH for the quick reply. just a few follow up questions please...
I forgot to mention this event was in Canada where we both live.
i will take your reassurances that i do not need testing for HIV and move on with my wife and life.
2. do i need testing for the stds from a risk or mental reassurance? i am okay with your reassurances if that apply to stds as well.
3. lastly i did have a short exposure to unprotected oral from him. maybe 2-3 mins.
thanks so much god bless.
|
H. Hunter Handsfield, MD
40 months ago
|
2,3. Receptive anal sex is the highest risk for STD of all possible sexual exposures, and the overall frequency of gonorrhea, syphilis, and chlamydia is highest (by far) in men who have sex with men. However, I was mistaken in yesterday's advice about urine gonorrhea/chlamydia testing -- I was forgetting that your exposure was anal, not urethral. On the other hand, now you have clarified that indeed your urethra was exposed by your receipt of oral sex in addition to receptive anal. So I would suggest both rectal examination and testing and urine testing; and blood tests in a few weeks for syphilis and HIV. Alternatively, if you can contact your male partner and he agrees to testing, you both could be tested now -- and then you both would know you could not have infected the other.---
|
40 months ago
|
Sorry Dr. HHH i am confused and worrying now...
I was never the bottom partner. my anus was never exposed. i was never penetrated, the only exposure i had was brief 1-2 mins of unprotected insertive (i was the top) and maybe 2 mins of receiving oral sex from him. that's it.
1. does your first reply of not needing any hiv testing from this exposure and i can continue to have unprotected sex with my wife still stand?
2. do i still need std testing from this exposure?
|
H. Hunter Handsfield, MD
40 months ago
|
Oops -- my mistake again. I replied without re-reading the original question. Sorry!
I don't consider 2-3 minutes (or even 1-2 minutes) as "brief" as exposures go. The central fact is that you had unprotected insertive anal and oral sex, which are inherently risky exposures in regard to STDs (except the oral exposure carried little or no risk of HIV).
1. "Need" is relative, as discussed above. Let's guesstimate the odds about HIV. What is the likelihood a partner like yours has HIV? -- MSM inherently implies high risk of having but his assurance he isn't infected suggests low risk. So let's say there's 1 chance in a thousand he has HIV. Transmission risk for insertive anal sex with an infected partner carries an estimated 1 in a thousand chance of transmission for any single exposure. 0.001 x 0.001 = 0.000001, or about a one in a million chance you have HIV. Is that low enough to skip testing? Up to you. But as discussed, even such a low risk may keep you up at night, so you should consider testing. However, holding off on sex with your wife for several weeks probably would be challenging.
2. For urethral/penile STDs, absence of symptoms within ~10 days would be pretty good evidence you did not acquire gonorrhea, chlamydia, or herpes; and absence of a chancre (the sore of primary syphilis) by 3-4 weeks would be reassuring in regard to syphilis. But for 100% assurance, testing is necessary.
I did not advise you to continue sex with your wife: all I can do is let you know the risks so you can make your own decisions. As I have said above, the quickest resolution might be for both you and the other guy to be tested. If that doesn't happen, you could have 100% reliable results for gonorrhea and chlamydia with a urine test 3-4 days or more after exposure. It will be quite a bit longer before you can have conclusive HIV and syphilis blood tests.
--- |
40 months ago
|
ok doctor can you please confirm the below than i can move on.
1. i only need hiv testing for psychological reassurance not from a real risk? and if you were in my shoes you would skip the testing? this is how i read your first reply and i was at ease with that.
you did say in first reply i can continue sex with wife? But in the meantime I advise you to continue unprotected sex with your wife -- that's what I would do if somehow I were in this situation. "
2. my only risk is for std but its been 2 weeks and no symptoms so far. so i can also skip this too?
if you are okay with it your reassurance is enough for me to drop this and just move on.
|
H. Hunter Handsfield, MD
40 months ago
|
Be clear: there is definitely real risk for HIV and other STDs. But those risks indeed are low, and if I were in your situation, at this time I would continue or resume unprotected sex with my wife. But I would be doing so knowing there is a small chance of later learning I had been infected, in which case I would have to discuss the situation with her in detail. Only you can decide whether this approach works for you.
That concludes this thread. I hope the discussion has been helpful.
--- |
40 months ago
|
Thanks doctor sorry if it sounded I was forcing you to say what I wanted to hear it's how my ocd brain works I am taking meds for it.
I never doubted your advice just my ocd wants to hear it a certain way. I will just move on knowing the reassurance you have given me.
It was not my intention to force words . Thanks so much for the service you provide all.
|
H. Hunter Handsfield, MD
40 months ago
|
Thanks for the thanks. I'm glad to have helped. Take care and stay safe.---