Unprotected Anal with No Ejaculation -- Need Some Hope!

Of course, like everyone else here I'm freaking out about a recent possible exposure to HIV. After being celibate for a long while, I started becoming sexually active again over the past six months. Unfortunately, I ended up "making up for lost time" in the worst way possible.

Two days ago, I was a bit drunk, and ended up sleeping with a casual acquaintance. Unfortunately, he and I (I'm male) did not share our HIV status. (I know, BIG mistake.) We ended up having anal sex twice that night, for about 10-15 minutes each session, with me the receptive partner.

Unfortunately, he was very blaise about condom use, and I had to instigate he put one on. Ultimately, he entered me twice for a few seconds each time, before wearing a condom. What's more, at the end of the first session, when he pulled out the condom "slipped off." I have no idea for how long. Since I'm already suspicious upon reflection, I wonder if this was not intentional somehow. (Though I did see him put it on both times and enter me, for whatever that's worth.)

Lastly, he did eventually ejaculate inside me but with protection, and I did see him pull out with the condom on and the semen contained within. (He did not ejaculate during the first 'session.")

Also, the sex was somewhat rough at times, so I felt somewhat "raw" in my rectal area, but I saw no blood that night or subsequently.

I know, this was horribly risky behavior, and a huge wake up call. But in the meantime, I'm a bit of a mess -- I've never been like this before, even when I've made mistakes (such as unprotected oral sex). I've never done unprotected anal at all, so this has all thrown me doubly for a loop.

My questions are...

1. I know I am at risk and will get tested, but just how risky was my stupid behavior? Is there any hope or am I likely doomed to contract HIV?
2. Am I right to wait three weeks to get tested, then follow it up with subsequent tests at 6, 8 and 12 weeks?
3. Lastly, are there any obvious signs a person has HIV/AIDS? I know you can't tell just by looking at someone, but he did have a couple of round brown splotches on his penis, and some skin patches on his arm and back that were unusual and white-ish and around an inch or so in diameter. I know, I'm being way paranoid. But I'm trying to remain calm...

BTW, I was last tested for HIV and all other STDs in mid-June and was negative. I've only given and receive oral sex twice in between that test and my most recent encounter, and both times from known HIV-negative men.

Thank you!

[H. Hunter Handsfield, M.D.]

There are no data on the relative risks of HIV acquisition through receptive anal sex with or without ejaculation.  Logically the risk probably is higher with ejaculation than without it.

1) Pretty risky, that's for sure.  Your partner's blase attitude about condoms isn't reassuring.  However, even if he had HIV, the risk of transmission for any single episode of receptive anal sex is no higher than 1 chance in 100, with ejaculation--probably lower without it.  That's high on a population basis, but the odds remain strongly in your favor.  Still, you should make an effort to contact your partner and see if he will be more forthcoming.  If he tells you he has HIV, you probably are a candidate for post-exposure prophylaxis (PEP).  If that doesn't work, consider seeing an HIV-knowledgeable provider immediately, or call your local health department, to discuss whether you meet their guidelines for PEP.  But you're already on the late side; to be effective, PEP needs to be started within 72 hours of exposure.

2) Three weeks is a bit early for testing; you could do it then, but 4 weeks is better for the first test.  If that's negative, one more test 8-12 weeks later is all you need, unless you find a knowledgeable provider who advises otherwise.

3) For well trained health professionals, there are some signs of advanced HIV infection that may be outwardly visible. But in your situation, simply asking is the most reliable approach.  Outside of the immediate sexual situation, most people don't lie when asked directly.

You're not acting paranoid at all, i.e. your concern is entirely reasonable.  Not that I'm happy you took the risk, but I wish this forum had more queries by people at real risk rather than imagined risk of catching HIV.

I have an expectation, a prediction, and two hopes for you.  The expectation is that you didn't get infected this time.  My prediction is that if you continue this sort of behavior on a regular basis, you are guaranteed to catch HIV someday.  My hopes are that you won't be infected and that you will take the lessons to heart in the future, about knowing your partners, exchanging HIV status, and using condoms.

Good luck-- HHH, MD

[Brian123]

Having read "exciter's" situation, I can only relate and understand...I had the situation several months ago.
From what is known after having read this forum's queries:
(1) the person would have to have HIV
(2) No "real" ejaculation occurred...but maybe with the presence of pre-***.
(3) You would have needed sufficient virus to become infected.

My understanding is that if you test a month (4 weeks), the HIV antibody test is approx. 95% accurate.  If you are negative then, thats a great indicator for your prelminary result for the 8-12 week test.

P.S. You cannot tell if someone is HIV+.  I have and currently know many people who are HIV + and look like "normal", healthy individuals.

Good Luck.
B.

[anotherdummy]

Dr H,
Although I am sure my posts have possibly irritated you in the past, your reply here was very well done and showed alot of character if only by text.

Kudos to you for that and good luck to exciter.

[Alex73]

I sympathise and understand what you are going through. But as the good Dr. said the odds are in your favour, even though your risk was significant.

I am also trying to put my experience down as a life-saving or life-biulding one. Hope this is the case with you.

[exciter]

Hello everyone. Thanks to all for the very supportive and kind comments. They are greatly, greatly appreciated.

Thanks to your advice, Dr. HHH, I starting putting it all in perspective and calmed down enough to start thinking more clear-headed. I immediately went to see my practioner, and I was eligible for PEP. Since the possible exposure occured around 3:30am early Sunday, I was able to make it within the 72 hour timeframe.

I've been put on a dual prescription of Reyataz twice daily, plus Truvada once daily. For a total of one month. So far, I'm feeling fine. A little lightheaded and slightly flush, but no major side effects yet.

So can I ask a couple more questions?

1. I know that there are no concrete or extensive statistics on the success rate of persons exposed to HIV who go through PEP. But am I right to assume that my odds have just gone up considerably? I am still preparing myself for the very real possibility I am and will remain infected. However, given that I don't know my partner's HIV status, the lack of unprotected ejaculation and now PEP, could lady luck may very well be on my side?

2. Unfortunately, i was a bit sick when I started my PEP meds. Nothing serious, just a slight achy feeling and a minor scratchy throat. (I've suffered from chronic throat infections for the past twelve months.) Unfortunately, I've now developed a terrible cough in the past day, to the point where I'm losing my voice. I don't really feel feverish, but do any of the potential side effects of Reyataz/Truvada include exacerbating a current illness, such as a sore throat?

Lastly, to anyone reading this, take it from me -- whatever momentary pleasure one derives from "being a drunk slut," it is NOT worth it. Not only was it recommended that I don't put the meds on my insurance (thus my resultant one-day medical bill was a lovely $2,200 out of pocket), but far more importantly, I've already started to undergo a massive sea change in my attitude to my own health and self esteem. I simply did not stand up for myself that night, and demand respect -- for and from either of us. The real tragedy is that it took this to switch that light on.

Plus, I was never able to contact my ex-partner. Despite calls to two so-called friends, none would help me get in touch (in fact, one still hasn't even called me back). Definitely another eye-opener of the highest order.

Of course, I hope to god I don't contract HIV. But if I don't, I will forever be grateful for this learning experience. Just the education I've given myself on the real risks involved iwith various behaviors that so many of us take for granted, or don't even pay attention to -- it's priceless. (I know, I sound like a bad American Express commercial, but I mean it.)

If nothing else, hopefuly someone may read this and, if in the same situation, won't repeat my mistake. So thanks again, Dr. HHH. I won't forget this.

[who_dis]

I wish you well.  I'm just curious as to why you wouldn't put this on your insurance, though.  If the worst happens and you become HIV +, you'll certainly have to use your insurance.  And it's not like somehow your insurance company will somehow use the fact you recieved PEP against you.  It's common enough to be tested, and not unusual for someone to get PEP (like medical workers who have an exposure).  
Are you thinking that your insurance company will in some way contact your employer and tell them you were tested and got PEP?  That does not happen.  Insurance companies get thousands upon thousands of claims each day.  They don't have someone waiting in the wings to seize on people who got tested for HIV and got PEP, to tell their employers.

It's still possible to submit those claims for reimbursement, even if you paid them.  $2200 bucks is a ton of money to shell out.

Best of luck to you.

[H. Hunter Handsfield, M.D.]

Thanks for the thanks.

Good for you for getting into PEP.  The odds are strong you aren't infected, and PEP will improve the chances further.

I agree with who_dis about using your medical insurance.

Other than that, I can't help further.  I am not an expert on HIV therapy, and have little experience administering PEP myself.  You should direct your questions about its effectiveness, other symptoms, potential side effects, etc. to the doc who prescribed it.  Excellent information also is available at thebody.com.

Regards-- HHH, MD

[NSTUFF]

A related discussion, where do all these people go? was started.