Anal Risk and HIV

[Brian123]

Dear Dr. K.

A week ago I had unprotected sex (receptive anal intercourse) with a man I had previously slept with 2 years ago.

I had not had sex in 2 years (the duration of time since I had last slept with him)  and was already tested for Hep B, HIV, Herpes, Syphilis, and Hep C last Fall (’05). All tests were negative.

Again this time he was the “top” and I was the receptive partner and he “came” on my chest, what is the likelihood of contracting any of the same diseases that I had been tested for?   He also has never received anal sex from another man.

He did claim that he had sex last August with another man (him being the anal provider) and the man tested negative to HIV in Oct. ’05. He claims he has only had sex (anal) with 5 men and that he has never had a STD.

Also, I wanted to purchase one of the Home Access kits for HIV. Are they a reliable test for HIV…and can I test by July to get an accurate test result?   I had only contacted the GMHC in NYC and they said that certain conditions had to be met in order for me to contract the virus: (1) the person had to have HIV, (2) you had to have an open cut/sore for the virus to enter the bloodstream, and (3) a sufficient quantity of semen/blood to enter the body. Since he “came” on my chest region, and he doesn’t pre-***, what is the chance of getting HIV?

Also, is it possible to get genital warts/herpes inside the rectum?

Would you please tell me what you think?
Thanks.

[H. Hunter Handsfield, M.D.]

It sounds like your overall risk of acquiring HIV or any STD was pretty low. Of course it depends mostly on whether your partner was infected, but it doesn't sound like he is particularly risky in his lifestyle.  The advice you were given by GMHC sounds pretty good to me--except that there is some small risk (although very low) even if there were no obvious cuts or abrasions.  I don't know what you mean when you say "he doesn't pre-***"; everybody has pre-ejaculate lubricating secretions, whether or not they recognize them.  But the bottom line (pun intended) is that the risk probably was low.

See many other discussions on this forum about "time to positive HIV test".  A July test result will be valid (based on your exposure a week ago) with Home Access or any other standard HIV antibody test.  In general, however, I recommend against getting an HIV test after individual high risk exposures, unless the risk is especially high (e.g., with a known-infected partner).  A smarter strategy is to just have routine HIV testing at roughly yearly intervals--or more often for people who frequently make unsafe choices.

Yes, warts and HPV infection are very common inside the rectum of gay men.

Now another bottom line (pun intended again):  You probably realize it was pretty dumb to have the exposure you describe without a condom.

I hope that helps.  Also, taking a guess that your opening greeting ("Dear Dr. K") means you also posted your question to my good friend Jeff Klausner, give him my greetings--and let both of us know if we disagree with one another.  And get (and then stay) safe.

HHH, MD

[Willl]

"I had only contacted the GMHC in NYC and they said that certain conditions had to be met in order for me to contract the virus: (1) the person had to have HIV, (2) you had to have an open cut/sore for the virus to enter the bloodstream, and (3) a sufficient quantity of semen/blood to enter the body. Since he “came” on my chest region, and he doesn’t pre-***, what is the chance of getting HIV?"

I don't agree with the second one. How can you be sure there was not pre-***?

[Brian123]

Apparently the "pre-***" would have to enter through the membranes inside the anal canal.....in sufficient quantity. But what I also forgot to ask is if ghonnorhea and chlamydia are transmitted by semenal fluids only and not by skin-to skin.

[Willl]

The virus is believed to be able to be absorbed across a mucous membrane without cuts or sores. Cuts and sores elevate the risk. Exposure to pre-*** would certainly be less risk than semen.

[Brian123]

Dr. HHH,
Thank you for such a quick response to an answer.
I would assume the person I had been with was telling all truths, and yes, reality has shown me that this was indeed a dumb risk factor. Having not had sex in 2 years and putting myself at risk this time only makes me more aware of the consequences.

Obviously the person I had sex with would have had to contract any/or all of these diseases in the 2 year time frame....a possibility, but then again...I am sure he would be a mess (physically).  No less, exposing someone else to a possible STD.

I am very glad I was able to ask the question above. Your time is greatly appreciated.

Brian

[Pretty Boy Floyd]

Brian,

Are you serious that the GMHC papers said those three things? That list sounds totally off, and GMHC is usually pretty good. I'm surprised. Don't have anal sex without a condom! And if you're gonna do it with a condom, make sure you're doing it right! Then again, don't stress yourself too much, what's done is done. We all make mistakes. That's what makes us human.

[Brian123]

For anyone of medical knowledge...a still unanswered question I have had (and I have researched the threads under 'HIV testing" and 'HIV testing time frames':

I had contacted Home Access (an FDA approved HIV testing kit)....only two threads were related to this topic....nonetheless...

Bonner/Will:
The Home Access test is indeed a 1st generation kit. However, are they just as likely to detect antibodies to the virus as much as a 2-4th generation test in 6 weeks-3 months?   Just out of curiosity, not out of impatience for testing.

I have seen that MD. HHH has answered "this type" of question in varied ways....but since the 1st generation is somewhat "outdated", is there any specific reason why Home Access Lab. would still be using this testing method?  

A possible suggestion:
"Would a separate topic on the STD forum for HIV testing/time frames be more ideal so that persons writing questions reguarding this topic would not reiterate the same question over and over again?"  I think MD HHH probably would appreciate it as well.

Thanks.
B.

[len247]

i had a similar situation. i had never had anal sex before and one night, i decided to do it.  I had been talking to a guy online for quite some time and he seemed nice.  We started having sex with a condom and since it was my first time, it was a little much for me.  we stopped and then started messin around again. it was then he entered me without a condom, without my permission. i realized it after a few strokes and made him stop immediately..  I started to freak out and was so scared.  we talked about HIV before and he said he was negative as of the end of march. plus, he said he doesnt precum, and he never bottoms.

Still, even just a few strokes is enough to have me worried, at one point petrified, even though i realize the chances of me contracting HIV are fairly low. I wont have anal sex again until i'm in a committed relationship, thats for sure.