Specific risk of HIV infection

[restlesssleeper]

Doctor, this is an excellent service not only for those anxious about a potential health problem (like me), but for general education to the potential at-risk public.

I am a 47 year old very healthy male who had an encounter with a pre-op Transsexual escort aproximately 5 days ago.  She indicated being on hormones for 15+ years and that she was HIV negative.  I have no cuts or sores on my body and I did not notice any on hers.  

During our session we:
1.  Exchanged mutual unprotected oral sex without ejaculation.
2.  Exchanged mutual oral/anal contact.
3.  I performed protected anal penetrative sex on her without ejaculation.

Initially I was extremely anxious about the event, but have since reduced my level of concern for HIV infection as per your many comments on your forum. I initially wanted to have an HIV test, but have since decided to get your opinion.   Here are my concerns:

1.  You previously indicated that most escorts are HIV negative and I wondered if that also would pretain to the Transsexual escort community.

2.  I have seen little that relates to oral/anal contact and HIV transmission risk.  Your comments would be greatly appreciated.

[H. Hunter Handsfield, M.D.]

Thanks for the thanks. I'm glad you and others have found this new forum useful.

A comment about testing, which I have said before:  In general, because the chance of acquiring HIV from particular exposure always is fairly low, even for unprotected anal sex among men, testing after any particular exposure isn't the wisest approach.  It's better to just plan on regular testing, from every 3 months to once a year, depending on lifestyle and risks.

To your particular questions:  1) Generalizations always are dangerous.  My statement that most transgendered persons are HIV negative undoubtedly has many exceptions.  It depends less on transgender status than it does on traditional risks. For example, some male to female transsexuals seek out primarily heterosexual male partners prior to surgery (they are women in men's bodies, after all, and their sexual tastes tend to reflect that).  And not all transsexuals have multiple partners.  And escorts often are experts in sexual safety and pretty good at protecting themselves.  But I am unaware of any data on these things, and certainly not on HIV prevalence in transgendered commercial sex workers; just educated guesswork (although not just by me; most experts probably would mostly agree with me).

2) Oral exposure to HIV generally is low risk, and I doubt rimmers are likely to acquire HIV by the practice.  But  I am unaware of specific data on rimming.

So from a risk analytic perspective, I don't think you need HIV testing.  But if you have been sexually active and haven't been tested in a year, perhaps this is a good time to do it.  And my advice about the lack of medical/epidemiologic need for HIV testing (i.e., too low risk to worry about it) is always tempered by recognition that some people require it anyway for peace of mind.  If that applies to you, get tested.

Good luck--  HHH, MD

[monkeyflower]

As far as I know, rimming isn't a risk factor for HIV transmission. Oral itself is very low risk, so I'd think that as long as the condom remained intact for anal, you're fine :-)

[restlesssleeper]

Thanks for the input.  It never hurts to get some reassurance.  The first day or two was really stressful, but forums like this and links like the San Francisco City Clinic are a great help.

[restlesssleeper]

Doctor, I appreciate your input.  YOur response was what I was expecting, just wanted to hear it from you.  I figured that the transgendered were more likely to be "careful" since they have spent so much time and money to create the transformation.

THanks again for your efforts on this forum!