HIV - Prevention Expert Forum
Exposure Risk
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Exposure Risk

I'm a 28 year old, bisexual male, concerned about an encounter I had with a Cuban man I met at a nightclub traveling abroad 5 days ago.

I didn't know his status, so I tried to limit the encounter to safer sex. However, the specific circumstances have given me a lot of anxiety.

Here is what we did:
- Lots of French kissing, including tongue play
- Mutual masturbation/frottage while naked without condom (handjobs, penis-to-penis rubbing, and he rubbed his penis against my anus)
- Several attempts by him to stick his fingers in my anus; don't think he got in
- He performed oral on me (not more than 1 minute, probably less b/c I pushed him off as I didn't want him to do that)
- Ending with mutual masturbation/penis rubbing with both of us ejaculating on/near each other's genital areas

Here are my specific concerns:
- It was dark, so I couldn't see if he had any sores or cuts on his hands or genitals
- After the encounter, I noticed that I had a 5 mm long cut on the top of my foreskin, like a paper cut (I'm not circumsized, and neither was he). This must have occured at some time during the encounter.
- I also had several small scrapes and cuts on my lower back, which I believe were caused by my back being up against an exposed stone/brick wall during parts of the encounter. His penis/pre-cum may have made contact with this area during anal frottage, after the scrapes and cuts probably occurred.
- I applied antiseptic to all of these cuts and scrapes an hour or so after the encounter, and they burned, suggesting relatively fresh cuts. The scrapes/cuts on my back were more substantial than the penis cut (they scabbed over and are still a little sore today), but they didn't seem particularly deep & I never say them actively bleeding.

Based on the activities above, plus the possibility that his pre-cum or semen made contact with these cuts/scrapes, what is my HIV risk? Should I test for this specific exposure? Test for any other STDs?
Welcome to the Forum. I'll try to help.  One of the remarkable things about STDs and HIV is just how difficult it is for them to be transmitted from one person to another.  None of the activities you describe carry any known risk for acquisition of HIV- despite the tear on your foreskin and abrasions which might have been contaminated by your partner's genital secretions.  Such lesions are remarkably common, as is getting one another’s genital secretions on each other in the course of mutual masturbation yet there has NEVER been a case of HIV shown to be transmitted in this way. There is no need for concern and no medical reason to seek testing.  

As for other STDs which might have been transmitted through contact with lesions such as syphilis or herpes, while theoretically possible such transmission is extraordinarily rare as well.  Syphilis, worldwide, is relatively rare and not transmitted in this way and herpes generally acquired that back and forth action related to sexual activity for transmission to occur.  Again, unless you develop lesions at a site of contact in the next two (for herpes) to three (for syphilis) weeks, I would not worry,  In the absence of lesions, testing will be little help as well.  

Bottom line,  I congratulate you on your commitment to safe sex.  It has almost certainly done what you have hoped and prevented you from development of infection.  Try not to worry.  EWH
Thanks for your quick response, Dr. Hook.  It has put my mind at ease regarding HIV risk, as I was quite concerned about semen coming into contact with cuts and abrasions that may have occurred during the sexual contact.

In the absense of any symptoms, I will just plan on getting checked for STDs at the usual interval (in fact, I had just gotten checked about a month before this encounter).

Speaking of symptoms, given the anal frottage, I assume it would be difficult to see any lesions in that area.  Would these lesions manifest pain?  Or should I still go to a doctor to have the area inspected.

the lesions of syphilis can be painless.  As I said, infection is unlikely but visual examination is part of a through evaluation.  EWH
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H. Hunter Handsfield, M.D.Blank
University of Washington
Seattle, WA
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