anal sex

[anxiety65]

the past 8 weeks I had protected vaginal sex with three sex workers.  I also performed oral sex by licking their clit.  however 11 days ago I had sex with a transsexual.  Everything was protected but when I was on top with anal penetration, after a three or four strokes I stopped, did not ejaculate, but then I noticed my condom had come off.  not sure when that occurred but I might have inserted by penis with the condom off.

I had an hiv test 8 days after the event and it came back negative.  I have begun to develop genital herpes.  no other symptoms.  I am extremely stressed and my face flushes occasionally.  

I am stressed to the max.   I have asked the trans to get a test and has some sort of instant that she said was negative.  

do I need to wait three long months for a result.  I have had great anxiety.  so much exposure.  I had a herpes breakout on my lip two weeks ago and now am having a breakout of genital herpes.

any help or advise would be greatly appreciated.  The doctors here have been wonderful.

thanks

[H. Hunter Handsfield, M.D.]

Knowing your partner is HIV negative should have resolved any remaining concerns you had.  All is well -- there is no way you were infected.

That will end this thread.  Best wishes.

[anxiety65]

I meant heartache

[anxiety65]

Thanks.   just to let you know the trans partner went and took a quick HIV test yesterday.  they did a pin prick to get blood from his finger and the results were negative.

I also took the pin prick instant test yesterday.  16 days after my last exposure and it was also negative.  

I met a really nice lady, but am concerned about having sex with her until my 3 months is up.

thanks for your help and comfort.  This past year has been one of extreme hardache. I plan to use better judgment going forward.  Maybe abstinence is the only answer

[H. Hunter Handsfield, M.D.]

I'm glad things are working out.  Thanks for the thanks about our services.

The threads linked in my original reply explain why your doctor is recommending a test at 3 months even though earlier results are conclusive.  You can understand why most practicing physicians like to foliow official guidelines.

[anxiety65]

Dr. Handsfield.

thanks.  it has been rough and I certainly did not make it any easier.  I did visit a doctor who has an STD testing clinic. He diagnosed my penile sore as  folliculitis and not genital herpes.   I also had him test me for all STD's.  I should have my results by Wednesday.  I did receive a HIV Elisa test with a negative result 8 days after my exposure with my trans partner and although that certainly is too soon for a result it did showed a negative test for those exposures that occurred 6-12 weeks prior.  The doctor I visited said that a negative 3rd generation test at 2 weeks would provide an indication of non-infection followed by another at 3 months.  didn't sound right but that is what he said.  I like your suggestion about a duo test if my trans partner does not get his test done.

thanks for everything.  I apologize for not having patience. I do like my odds and thanks for the explanation.


s

[H. Hunter Handsfield, M.D.]

Patience, patience.  The moderators are not on call 24/7.  We attempt to answer new questions within 8 hours and follow-up comments within 24.

Sorry to hear about the loss of your wife; it sounds like you're going through a difficult time.  Thanks for the clarifications; sorry I misunderstood some of the details, although you did write you "have begun to develop genital herpes".  But I agree your description doesn't sound like herpes, either oral or genital.

Even if your recent partner had HIV, a single episode of unprotected insertive anal sex carries an average HIV transmission risk something around 1 chance in 500 -- so even in the worst case scenario, the odds are strongly in your favor.  (How much would you wager on a 1 in 500 bet in Las Vegas?)

In any case, I'm glad you have asked your trans partner to have another HIV test.  If that happens and the result is negative, all your HIV worries will be over.  If not, I suggest you not arrange testing on your own, but see a doctor or clinic with experience in HIV management and let them call the shots.  One common sense approach would be either an HIV RNA/DNA test or a duo test (for both HIV antibody and p24 antigen) around 10 days after the anal sex event, and another duo test at 4 weeks.  If the first (10 day) test is negative, it will be ~90-95% conclusive and the 4 week test 100%.

[anxiety65]

Dr. Handsfield,
would you please respond to my last post?  thank you

[anxiety65]

I know that post like mine you have seen a million times.  please send me one last response for reassurance and I will be eternally grateful.

thank you

[anxiety65]

sorry my last post was a little long winded.  I read your posts about testing with results sooner than 3 months.  thanks.  any other reassuring thoughts about my high risk exposure?  my counselor will help me through the loss of my wife and exposure regardless of how low the risk is.  I would appreciate your words to get me through the next two weeks so I can test at 4 weeks.  

[anxiety65]

Doctor, as always thank you.  my cunnlingus exposure took place over the past 8 weeks not 8 weeks ago.  I have had oral herpes for many years and have been diagnosed for that.  have never been diagnosed for genital herpes.  the anal sex with the male, although he said he had tested negative it was a while ago and said he would go get tested but has not in the last couple of weeks.  I did not have a herpes breakout during my exposure.  not sure that is what this is.   I had one pimple like bump at the base of my penis a few days ago and today another slight swelling further up the shaft.  I will tell him about the breakout.  so I do not know what his hiv status was, so I am worried.  to your comment about the habit of having sex, I have put myself into counseling for that.  it has been very traumatic this past year.  I lost my wife last year and have had all these encounters these past 8 weeks.  they did not help and now I have added worry.  your have been such a help in the past that I just wanted to reach out to you.  I knew about the low risk exposure but the high risk exposure is what I have been concerned about.  I appreciate all the help you may give me.

thank you so much

[H. Hunter Handsfield, M.D.]

Welcome back to the forum.  However, I'm concerned you've gotten into the habit of having sex -- generally of a low risk sort -- then coming to this forum for reassurance about it.  Probably you have observed a pattern:  we tell you your exposure was very low risk; that most female sex workers don't have HIV; that your symptoms don't suggest HIV, and even if they did, symptoms are never a useful indicator of a new HIV infection; that the way to be sure is to have an HIV test, which we often recommend for reassurance even when the risk was low; and that the standard HIV test (or combination of tests) is conclusive sooner than the official advice you will find from CDC and other sources.

Most of that implies to the current situation.  The cunnlingus episode was no risk; HIV has never been reported to be transmitted by oral-vaginal contact, and in any case your negative test result 8 weeks later shows you weren't infected.

The condom failure in anal sex with another man (transgender sure, but anatomically male) could be high risk -- but apparently your partner had a negative rapid HIV test, so you obviously were not exposed.  Your risk of HIV indeed would be higher if you have genital herpes due to HSV-2 (but not HSV-1) -- but not an issue since your partner doesn't have HIV.

Have you had a definite diagnosis of HSV-2 (genital) and HSV-1 (usually oral)?  Having a recurrent outbreak 8 days after sex doesn't suggest you caught HIV.  In fact, the biggest STD transmission risk in this event, if indeed you have genital herpes, is the possibility you infected the sex worker.  You have an ethical obligation to tell her about your herpes, if you haven't done so already.

So all things considered, I see no cause for worry about HIV.  However, because of the condom failure, it would be a good idea to be tested for other STDs.  I suggest a gonorrhea and chlamydia urine test and, after a few weeks, a syphilis blood test.  I see no need for HIV testing -- but of course you are free to do that in a few weeks if the negative result would be reassuring.  As noted above, and as you have been told in other threads, you don't need to wait 3 months; 4-6 weeks is enough, depending on the specific test(s) done.  Below I have provided links to two threads that discuss the reasons HIV testing is reliable before the official 3 months interval.

http://www.medhelp.org/posts/show/1704700
http://www.medhelp.org/posts/show/1891685

You're welcome to keep returning to the forum, as long as you follow the rules about multiple questions (maximum 2 every 6 months -- see Terms and Conditions).  But given your multiple discussions with much the same advice each time, it really shouldn't be necessary.

Best wishes--  HHH, MD