[Question #9787] anal frottage and symptoms

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29 months ago

Hi. I grew up in the 90s and had some HIV scares over the years mostly to relatively low risk acts. I am bi and have oral, frottage and insertive anal with men. Haven’t had receptive anal. 4 years ago, I decided to go on PREP and it eased my mind until now.  Recently, I have engaged in anal frottage (4 times), allowing men to rub their penises on my anus, simulating sex poking against my anus. I don't think there was penetration. Most of what I read says you’d know if this had happened. Being on PREP, I figured this was safe except for other STD's. There were also oral acts but not as worried about those.  My concern is 18 days after the last act of anal frottage, I got sick. Started as a dry cough and in 2 days became a wet cough. I have some body aches, malaise, nasal congestion and lots of green phlegm when I cough. Temp is mostly normal - the highest it got was 99.6.  Symptoms for 6 days now. No headache, no sore throat, no rash. Went to doctor and got neg results for covid\flu. I mentioned my concerns about ARS and they weren’t concerned. I've read you say that cough is not a symptom for ARS but I can find sites that say otherwise (I know – don’t search the internet).  I can’t stop thinking, what if it slipped in and anal frottage became anal receptive.  And timing of this illness was perfectly in line with the incubation period for ARS. What else could it be is what I keep telling myself.  I took oraquick test 3 days after symptoms (21 days after the incident) knowing it’s too early to be that useful. (Negative). I know odds are in my favor but due to window period, I won’t know for a few more weeks and I will torture myself thinking about it. So what do you think?  How worried should I be?  Should I refrain from sex until I have a negative test?  It's disappointing that I got on PREP to avoid the worry and yet here it is happening again just like it is 1992.  Thanks.

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Edward W. Hook M.D.
29 months ago
Welcome to our Forum.  Thanks for your confidence regarding the information we provide.  I'll get to the bottom line first, then provide more comments.  There is little here to contribute to risk for HIV and strong evidence that you were not infected by the encounter you describe.  To expand:

1.  If there was no penetration, there is no risk.. As you note, if penetration had occurred, you would know it.
2.  Even if there was penetration, you do not know that your partner had HIV.
3.  With penetration, if your partner had untreated HIV, less than 1% of exposures would lead to infection (in other words, more than 99% of exposures to infected partners would NOTA lead to infection.
4.  You are taking PrEP.  PrEP is almost entirely protective for exposures to persons with HIV
5.  Your symptoms do not suggest HIV.  The cough and other respiratory symptoms are not suggestive of recently acquired HIV.
6.  You have negative tests.  When persons are experiencing the ARS, virtually all persons will have positive tests within 2-3 days after the onset of symptoms..

I hope this information is helpful.  Than together this is strong evidence that you are not at risk for HIV from the encounter you describe.  Please don't worry.  EWH 
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29 months ago
Thanks for your response.  So because the oraquick test was taken 3 days after symptoms started, a negative result is proof that those symptoms aren't ARS?  And you think this holds true even for someone on PREP?  
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Edward W. Hook M.D.
29 months ago
First, if you were on PrEP at the time of your exposure, your risk for HIV was virtually zero.  In addition, if symptoms had been present for three days and your test was negative, this too is strong evidence that your symptoms were not due to the ARS.  EWH---