Protected anal sex with a transsexual/CD

[freebird843]

About 24 hours ago I had an encounter with a man(crossdresser) who had posted an ad in craigslist.   She performed oral sex on me for a couple minutes, and then we had  anal sex with a condom and astroglide as lubricant for a 2-3 minutes until I ejaculated.   I was the insertive parter.   The condom was intact when I removed it.  I left and washed my hands and penis probably 10 minutes later because I was somewhat disturbed by the whole thing and wanted to leave quickly.    
           This was an extremely out of character thing for me to do.   I am recently separated from my wife, but since we might get back together, I am distraught over the possibility of contracting HIV.  
            Based on my narrative, how do you assess my general risk?   Should I try to get PEP before the 72 hour window elapses?     Should I get a p24 or HIV RNA test?     I realize that this was a relatively high risk encounter, given that the I didn't know the person, and she was probably high risk.      
             If my wife and I get back together, should I wait 6 months(with testing) to have sex with her again?   She still breastfeeds our 16month old, and I am extremely worried that I could possibly infect them.  

Thank you in advance for your answer.  I'm suffering a huge amount of anxiety over this indiscretion.  

[freebird843]

Thank you Doctor.   I hope I summed up all the pertinent facts well enough.  I've never had anal sex, so I hope I didn't make some mistake that I'm leaving out.    Thank you, for your advice.  

[Edward W Hook, MD]

Welcome to our Forum.  I will try to help and as you will see, I do not believe that you need PEP related to these exposures for the reasons I will explain.  However, decisions about PEP are a personal decisions in which one should consider the likelihood that infection will occur, the likelihood of drug side effects, one's personal anxiety and the cost of the drugs (expensive, typically in the neighborhood of $1000).   If you choose to try to find someone to provide you with PEP (and for better or worse, I am sure you can find someone who would write the prescription), please hold them accountable for all that goes with it (i.e. follow-up, answering your questions, etc).  

In your case, the exposure you describe was low risk (your partner was not but the exposure was).  Even if your partner has HIV, there is no credible evidence that HIV is transmitted by oral sex and your rectal intercourse was condom protected and therefore did not put you at risk either.  Thus, there really is no need for concern about this exposure or for testing at this time.  Nor is there any reason to be concerned that you  may have gotten something that you could spread to your wife or you child.

I hope this comment is helpful to you.  EWH