Extremely worried

[Concerned1115]

Hi, i really need some help I have been extremely worried over the past few days. I am a male and I am 19 years old.
Some days back I went out with my friends and got a bit drunk. We then went to a brothel, where I engaged in the following activities.
Showering together, French Kissing; mutual masturbation, and finally i received oral sex (with a condom).

I am worried that I have received some serious STD or the other. I am still a virgin and feel really angry for having done that. What are my chances of contracting STDs and especially HIV?
thanks for your help

[H. Hunter Handsfield, M.D.]

You can hardly have a sexual experience safer than that.  There is zero chance of catching HIV or any other STD from it.

If you're going to be this anxious about that sort of exposure, you had better do some reading and self-education about the real risks of STD--or decide you're never going to have sex.  Bottom line, assuming you are heterosexual and only expect to have sex with women:  when you become sexually active, choose your partners wisely (don't hop in the sack with someone you just met and no injection drug users, for example); and use condoms for vaginal sex with other than permanent, mutually monogamous partners.  If you follow those guidelines, you really will have little to worry about with respect to your health.

Good luck--  HHH, MD

[JohnnyV]

By the way, even if you decide you aren't heterosexual and may have sex with men too, the exact same advice from the doctor applies, except replace "vaginal" with "anal."

J

[JohnnyV]

Oh, and if you have anal sex with women, use a condom.

[H. Hunter Handsfield, M.D.]

Actually, I intentionally referred only to vaginal sex in my reply.  Dedication to consistent condom use is not as effective in the long run for anal sex as for vaginal sex.  Condom failures probably are much more common in anal than vaginal sex.  Also, intent to use condoms often falls by the wayside in the heat of the moment.  Because the prevalence of HIV in particular and of other STDs in general are higher among gay men than straight men or women, the risks if the condom fails (whether by failed intent or breakage) are much higher.

In addition to general advice about partner selection and condoms, for gay men my advice is that it also is necessary to know every partner's HIV status (and also to know always share one's own HIV status), and to never have anal sex, either receptive or insertive, even with a condom, with someone of unknown or opposite HIV status.  While similar precautions might seem reasonable for hetersexual relationships and vaginal sex, in most settings they are not necessary to maintain a low risk.  But they are among gay men.  Of course, there are exceptions; some mutually committed gay men may decide to have anal sex even though only one partner has HIV.  But they do that in an open, understanding fashion.  My general advice is in the context of new or casual partnerships.

Looked at another way:  A gay man who has casual partners without sharing HIV status, but who is dedicated to universal condom use, has a fairly high risk of acquring HIV someday.  Most straight men and women do not.

Cheers---  HHH, MD

[JohnnyV]

Doc H,

As always, I am your humble servant when it comes to microbiology. I'll just pester you a little bit when it comes to statistics and the contemporary dating scene. My only claims to expertise here are that I've watched most episodes of "Sex and the City" and I am a reformed bad boy... and that I also work a lot with numbers and do my best to keep up on the data. The basic point makes sense to me, that it's good not to sleep around too much (though I think the same low level of sexual activity is to be advised to men, women, gays, and lesbians).

Just a few questions/point of discussion:

--I'm always one to tell gay/bi guys not to do anal sex (even with the rubber) unless there's a tremendous amount of trust involved. However, I think the high statistics of condom failure with anal sex might be skewed if researchers have more exposure to gay/bi men with drug or alcohol problems. If you're sober before and during anal sex, the rate of condom failure might still be higher than vaginal sex under the same conditions, but I think the difference is probably slight. Don't you think the point is more to have protected anal sex with a clear head, and not necessarily to avoid protected anal sex entirely?

--About sharing HIV status as a way to prevent transmission, there are a few huge social glitches that are worth considering as well. Below are two articles posted recently on Gay.com:

http://www.gay.com/news/article.html?2005/12/09/3

and

http://www.gay.com/news/article.html?2005/11/09/4

Both articles deal with court cases that ended with the incarceration of gay men for infecting their partners through anal sex. In the first one, in Australia, the entire court case hinged on a conflict between the two men's stories: the infectious partner claims he did tell the other man his status, while the infected partner swears he did not. The Australian court decided not to believe the infectious partner and sent him to jail.

In the second article, coming from Georgia, the infected man claimed that his infectious partner had a legal duty to disclose his HIV status, but the couple had not discussed HIV at all prior to having unprotected sex. In this case, also, the courts accepted the facts presented by the partner who was HIV negative at the beginning of the relationship.

What's been worrying me, in the aftermath of these two cases, is the fact that people can and do lie about whether they have HIV in the heat of the moment. Also, the fact that people may have been tested too long ago for the test to be accurate, or they may have been in a window period for their last test and didn't really _know_ they were infectious, etc.

Maybe it's especially urgent for gay men but I think heterosexuals also fall under the same exigencies... I don't think that people's claims to having or not having HIV prior to unprotected sex are reliable methods of preventing transmission. It's too haphazard, so I think people should use condoms for a long, long trial period until they know each other extremely well.

Also, just anecdotally, I've commented on this on the forum before, but sometimes those mega-trends don't always hold on the individual level. I am bisexual and have had over 250 partners in my life. My wife is straight and had 4 partners in her whole life. I never got a single STD except; my wife has had Herpes 2 and a few other things. I just take that as a wake-up call to everyone gay and straight; it's better to trust in your own cautionary measures and not in the "odds" whatever they may be.

Bonzai,
J

[gotherpeslifeisover]

HIV is a b!tch. It's one of those things that never cross your mind until you have a "scare", or until it's too late. I can't imagine living my life with that disease, but lately I've had no choice but to wonder to myself what I will do if I am indeed positive. Who do you tell? Who do you not tell? Do you tell your parents and family members, knowing that they will be devestated, or do u take the secret with you to the grave? How do you BEGIN to tell a possible future sex partnet that you have HIV? If I were positive I think I would just look for another positive partner and be done with it. One thing is for sure this is a horrible disease that people need to become more informed about, and I appreciate the docs and the people on this forum for helping to do just that.

[HHH,MD]

Public health institutions and experts are charged with preventing health threats on a global, population-oriented level. Of course there are stright men and women at equally high risk as many gay men; and of course there are sexually active gay men at zero risk. A man may be incarcerated in one case, or a person may suffer domestic abuse after revealing his/her chlamydial infection to a partner. That doesn't mean the advice is invalid for most people; a few people may die as a result of using seatbelts (trapped in burning car, etc). But the data are very strong that men who disclose and ask their partners' HIV status in general have lower HIV infection rates than men who do not do so. All generalizations have their exceptions, but I stand by the advice above.

I am unaware of any statistics on condom rupture. I just know that a) anal sex generally is a tigher fit and inherently more traumatic than vaginal sex; b) more gay men in my clinic than straight men and women say they have had problems with broken condoms; and c) other STD/HIV experts share my experience in speaking with their patients. So I have to believe condom failure is more frequent with anal than vaginal sex. But I cannot quantitate it and acknowledge the absence of data (and/or my unfamiliarity if data exist).

You are absolutely right about number of partners not translating directly to STD/HIV risk, a perceptive and sophisticated observation. All STD experts see persons who were randy to the extreme who never catch anything, and poor schmucks who have had only a few partners and acquired STDs all of them. This actually is the origin of my (and others') advice about partner selection as opposed to simply advice to limit one's numbers of partners. We would go a long way in HIV/STD prevention if we could identify and disseminate the "sixth sense" by which some people are more successful in safe partner selection. But until we do, the general advice I provided above remains valid.

Cheers-- HHH, MD