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Need for testing and HIV transmission after radical prostatectomy
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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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Need for testing and HIV transmission after radical prostatectomy

I am a 60 year old man with stage 3 prostate cancer who underwent a radical prostatectomy  My PSA was undetectable until this past November.  The news left me depressed but I am dealing with it.  But at the time I said to myself “try new things while I have the chance”. In the past I thought about what it might be like to have a sexual encounter with another man and several weeks I did with a man my age.  

As for the encounter, I did press my finger on his anus but did not insert it.  I did masturbate him.  He wanted to  give me a blowjob but I told him not to.  He wanted to masturbate me using his saliva as a lubricant but I told him not to.  But before I knew it he put my penis into his mouth and I IMMEDIATELY had him stop.  Ordinarily I would not consider this a “blowjob” but my penis was in his mouth just the same.  Should any blood have been in his saliva (I think not but who can be sure) there would be a risk for HIV infection.  He did masturbate me and I realize that residual saliva could have come in contact with my urethra.  So my two questions:

I read that the risk of HIV injection from insertive fellatio is about 1 in 20,000.  Some websites are adamant that it does NOT warrant HIV testing but other websites that are much less committal.  It is hard dealing with getting the results of my PSA tests and I’d prefer not to have to go through the anxiety of an HIV test if it isn’t necessary.  Given my encounter is testing warranted from a medical standpoint vs peace of mind standpoint?  If it is not I am confident I can put it all this behind me.

Secondly, can a man who has had a radical prostatectomy infect a woman through unprotected intercourse?  Since I can no longer produce semen or pre-ejaculate there would be no exchange of body fluids to speak of. I feel guilty for having cheated on my wife and the the thought of possibly infecting her is unsettling.



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Welcome to the Forum. As you have already noticed, unfortunately, you can get different assessments of HIV risk from different sources.  The fact is however that all too many "official" sources choose to err on the side of conservatism (I suppose feeling they cannot “afford to ever be wrong) and use the sorts of estimates you mention.  In reality, while I suppose that someday it might happen, there are no cases in which HIV has been documented to have been spread through receipt of oral sex. There are a few (2 or 3) cases in which HIV may have been acquired by persons performing oral sex (fellatio) on infected partners.  Further, there are no instances in which HIV has been transmitted through mutual masturbation, even when saliva is used as a lubricant and even when participants get each other’s genital secretions on one another, including each other’s genitals.  Thus, your experience is a NO risk event.  

As for the possibility of HIV transmission were you to become infected, while I know of no such data for or against, I would suspect that genital secretions from sites other the testes or prostate could still transmit infection to another.  As i said however, I am not aware of any data on this.

I hope this comment is helpful to you. Please do not worry about the exposure you describe. There is no reason for concern and no need for testing.  EWH
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Dr Hook,

I truly appreciate your thoughtful reply to my question.  Needless to say the emotionality associated with a situation can cause considerable (and often unnecessary) anxiety regardless of how familiar one is the data.  It was for this reason I sort out the advice of a medical expert vs. a layperson.  I will take your advice, refrain from testing, and move on to the more pressing issues in my life.  Be well and thanks again!
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Glad I could help. Take care. EWH
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