Gay Man - Reckless Evening

Hello Doctors:

First I think this is a great service you have and applaud your actions.  Second, I tried looking for this answer but could not find it.

Here's what happened:  I went out for gay pride, and while out saw a guy I used to date/play with, but had not seen in a long long time.  We talked and ended up getting a room at the local bathhouse because I couldnt verily bring him to my aunt's house.

We did the usual play of kissing making out and such, and in the heat of the moment, I, the top, asked if I could "stick it in."  He agreed, lubed up and in it when (without the rubber)...Half way through intercourse I realized what I was doing, and psychologically stopped myself from cumming (I faked an orgasm).  I pulled out, dried off, looked for the cuts/abrasions, and got out of there (he stayed). We both said we were negative (I was last tested in April neg). Now the encounter was on Saturday and I have not noticed any discharges or anything.  

Ive asked my friends for advice and almost all say that I am fine.  That the risk, if any is like 1 in 200 or 1 in 500; one friend, a nurse, said that there is almost no risk for a top without cuts because the virus cant travel up the urethra. Of course I will test, but I have two questions for you:

1. What do you think? Esp. on the top v. bottom part.  Also, what if the bottom was poz or undetectable...would it change the chances then?  
2. I have heard some doctors say the "window" for testing is 1 month, some say 2, some say 3, some say 6. Can you advise what you think on the window?

I wanna believe them and I wanna stop having my mind do backflips.  

Please advise when you can...and yes, a serious self talk is in order.  

Thanks very much.

[Edward W Hook, MD]

Welcome back to our Forum.  I'll address your questions in the order you asked them.

1.  Experts agree that the risk for a bottom partner in ano-genital exposure is higher than for a "top".  The difference in risk if rather small. About 1 infection per 100 exposures for the bottom and 1 in 200 for the top, IF your partner was positive.  He said he was not infected  and was probably was not, most people do tell the truth.  BTW, your friend who says there is no risk without cuts or abrasions in incorrect.

2.  In the U.S, so called "Duo tests" are now available which are more sensitive than ever before.  These tests detect both HIV antibody and the p24 antigen of the virus.  A negative Duo test at 6 weeks is proof that you did not get HIV for a standard antibody only test, at 8 weeks you can be sure that you are not infected.  There is no need to test out to 3 months.
Hope these comments help. EWH

[wellington1800]

Thank you for taking the time to respond.  Thank you for advising on the window period and I will make an appointment today 6 weeks from this last saturday for such a test. I think given what you have said I am most likely fine but will follow through just the same.

Thanks.

[wellington1800]

Just to confirm...i just re-read your post and you said that my friend was/is incorrect...so then I could assume that you are saying there is always a risk, but that the risk is low, correct?

Just to confirm....now its a waiting game until six weeks. Argh!

[Vance2335]

I think it depends what you think is low risk. Is 1 in 200 low risk? Is 1 in 10,000 low risk? Is 1 in 1,000,000 low risk. If you want to take 1 in 200 as low risk that is your prespective but I would not consider it low risk as compared to other forms of possible transmission.

[Edward W Hook, MD]

Then I said your friend is incorrect, I was referring to the statement that "there is almost no risk for a top without cuts because the virus cant travel up the urethra",  This is wrorng.  HIV can be transmitted without visible cuts or scrapes.  EWH

[wellington1800]

I understand.

So to confirm, your advice is to get tested at six weeks for peace of mind, but given what I have reported and what happened (story is true), while there is always a risk, my risk is 1 in 200.

I am reading all this stuff and my mind is backflipping.

Thanks for your help in advising. I am sure this might get repetitive for you? I read a post from Dr. HHH (or maybe you) recently that said that even in the most perfect of circumstances, it is still very tough for someone to be infected in general (viral load, other STDs present, use of drugs present, etc.), provided they are positive.

Thanks Dr. Hook.

[Edward W Hook, MD]

Yes, the 6 week test will be meaningful for you and the result, which I anticipate will be negative should give you peace of mind.  EWH