[Question #9650] Protected Condom sex

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30 months ago
Hello Doctor I am a male and I am here because I am super worried about recent encounters. So I have been avoiding alot of male on male or trans on male because of my terror of hiv. But I finally gave in after always backing out of tempation for the past year and admit I was a bit drunk yesterday . And basically yesterday While drunk I had a 3 some with two trans/ males and 5 hours later with another individual trans/male. I admit I did not get the status of the individuals, and probably won’t be able to since it was all discreet. But basically my risks were receiving oral from all 3 , mutual masterbation with one penis on penis no condoms for these acts. But for the anal penetrarion on all 3 I did use condoms, and the condoms did not break, and to be extra safe I did the water trick, and all were in tack. I also sucked one of them and I have a huge hole in my mouth, these were all in the last 12-16 hours so my questions are as followed. 
1) Since these were in the past 12-16 hours even with condom for anal penetration use should I consider taking pep, I know it has a 72 hour window, so am wondering if you would recommend it for a situation like this. 
2)what are the chances you think I acquired hiv from these acts?
3) chances of other stds from this encounter
4)chances of hiv from giving head to penis with no condom, and have a huge hole in my mouth which requires dental work
5) chances of stds or hiv from mutual masterbation with their fluids touching and possibly going inside my urethra
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30 months ago
Hey Doc I hope this doesn’t count as a follow up question but I got an email saying you answered my question about an hour ago, and it’s no where to be found, any reason It may have been deleted thanks in advance
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H. Hunter Handsfield, MD
30 months ago
Twice I answered, and both times my reply did not stick. We're looking into it. (Hoping you see this explanation....)

HHH, MD
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30 months ago
Thank you I just saw your explanation one, but not the other answers. It’s weird because I can see your replies on everyone else's recent questions just not mines. Hopefully it is resolved soon thank you 
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H. Hunter Handsfield, MD
30 months ago
While the admin team attempts to retrieve my reply (or I write it again), because of the short time frame for PEP, here is the gist of that part of my reply.

Probably PEP isn't necessary; I would not recommend it. Your risk for HIV is extremely low, under one chance in thousands if not a million or more. However, the risk isn't zero, and PEP decisions are best left to local experts who understand local HIV epidemiology and risks, e.g. the likelihood of infection in partners like yours. It also depends in part on the exposed person's anxiety level. Best to see a nearby public health clinic, HIV clinic, or urgent care center with such experience.

I also described an often-forgotten downside of PEP. If it doesn't work, it prolongs the time of uncertainty and perhaps anxiety. The window for conclusive HIV testing starts with the last dose of PEP, and although 6 weeks after that probably is conclusive, some experts recommend 3 months. So the time until confirmation one isn't infected can be up to 4 months following exposure, instead of 4-6 weeks. Perhaps something to consider; and to discuss with the provider if you seek local professional advice about PEP.

HHH, MD
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H. Hunter Handsfield, MD
30 months ago
It appears the problem has been identified and my inability to upload a more complete reply resolved. Hoping this works -- sorry for the problems!

Congratulations on using condoms for anal sex, regardless of being "a bit drunk". (Just a bit?) It transmuted a risky setting to low risk for HIV and all STDs. However, the "water test" was irrelevant to sexual safety. We always recommend against it. The existence of microscopic defects small enough to be invisible but large enough to permit transmission of viruses and fluids is an urban myth; even if you had seen a drop of water leak through, it would not have meant your exposure unprotected. If a condom doesn't break wide open, protection is complete. As for other exposures mentioned, unprotected oral sex risks gonorrhea, herpes, syphilis, and nongonococcal urethritis (NGU). The risks are low, but not trivial. Hand-genital contact, however, is truly zero risk, even if genital fluids or saliva is used for lubrication; the absence of known cases indicates that not enough fluids or infectious agents are carried to be a significant risk of infection. To the numbered questions in your initial post:

 

1) PrEP:  Discussed above.

 

2) HIV risk: Under one chance in thousands, maybe less than one in a million.

 

3) Other STDs are mentioned above. Absence of symptoms like urethral discharge, penile sores, oral sores, etc is good but not certain evidence you were not infected. You could have throat swab and urine testing for gonorrhea and a blood test for syphilis in 6 weeks.

 

4) See no. 3. I don't understand what the "hole" may be, but I doubt it makes any difference in risk.

 

5) Zero risk; see above.

 

Sorry again about the technical glitch. Let me know if anything isn't clear.

 

HHH, MD

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