Scared and Confused - He find out he is positive

[tanner203]

Hi Dr:

i am a guy man who practices fairly safe sex; no anal without a condom (very rarely do it and only do it a relationship, I am a top), I always ask my partner's their status, always, and if I do practice oral sex, I do not allow my partner to ejaculate in my mouth.  I try to be very careful and have never had unprotected anal sex and to be honest I never will.  I met a guy, who I got to know for a few months and we dated, I asked him his status and he said he was tested and is negative.  We proceeded to date and have anal sex - I was the top - wore a condom everytime we had anal sex and there was never a condom breakage.  I also performed oral sex on him with no ejaculation or precum.  No one has ever ejaculated in my mouth.  To make a long story short, he tested again per my request and he found out he was positive.  I am totally freaking out, totally.  All those years (I am 30) of always following strict safe sex guidelines, always asking my partners their status (many times), and getting to know someone and date someone and this happens.  I ended the relationship but continue to support him emotionally as a friend.
1.  Since I always wore a condom for anal and the condom never broke - am I still at low risk?
2.  I performed orally on him and never took his ejaculated in my mouth - should I be freaking out about this?
3.  He tested neg for other STD's - does that lower my risk?
4.  What do you think the odds are that I will be ok with this?

Like I said, this was, no pun, a blow to my safe sex psyche.  I pride myself in always having safe sex, I just feel hopeless and am so afraid I may have gotten HIV from this.  

Thank you for your time, I think your great.

Tanner

[H. Hunter Handsfield, M.D.]

First, congratulations on your sexual safety.  If all gay men had similar attitudes and practices, HIV would disappear in gay communities.

But second, there are few certainties in biology, sexual safety--or, for that matter, life.  By having sex with other men in the modern world, you are at greater risk for HIV infection than the average straight man or woman, even non-condom users with multiple partners.  The odds you would acquire HIV from any particular exposure are very low; but by definition, you are selecting your partners from a pool of people with high rates of HIV.  The balance makes you at lower risk than many other gay men, but above that in the general population.

You don't say whether your newly infected partner believes you infected him.  That sounds unlikely--but if he says (and is being truthful) that he hasn't had sex with anyone else in the past 2-3 months, then obviously it is likely you are infected.  But it's probably more likely he has had other exposures; and for all you know, he was lying when he said he was HIV negative at the start of your relationship.  (I'm not accusing him.  It's just that you are in a position to judge these things, and I am not.)

But assuming he is infected and you were not the source, the bottom line (cute phrase not really intended, but not avoided either) is that you were: 1) at very low risk via anal sex with condoms; 2) at low but not zero risk by performing oral sex; and 3) at lower risk without STDs than if he had an STD (but don't put too much stock in this; many gay men have STDs not detected by routine exam, such as rectal chlamydial infection or undiagnosed herpes).  But these facts are balanced by the possibility that he was very newly exposed when your relationship started, i.e. might have had a high viral load.  Probably the highest risk of transmission occurs early in infection.

I more or less answered (4) above.  But you need to be tested to be sure.

I hope this information is mostly reassuring, even though not totally so.  Best wishes--  HHH, MD

[Confused_again]

Hey..If you're confident that you used a condom properly everytime, then you're virtually safe from an HIV infection..And the risk from oral sex is very minimal. In my opinion, this are what condoms for..to protect you. I believe you're fine, and thanks to your good judgment, you hopefully dodged a bullet. Get tested soon for a piece of mind and wait for Dr.HHH's advice. Good luck to you!

[tanner203]

Hey doctor, Thanks for the reply, I greatly appreciate it.  He was tested in January 2006 and negative and positive in September 2006 when I told him I needed him to test again.  we met in August.  As mentioned, I could not deal with the disease and we are no strictly friends.  I am concerned about you comment about high viral load.  If I had oral sex with him, is there a possibility that his high viral load would up my chances dramatically?   The anal sex was always with a condom and like I said we never had a condom break.  HE has NEVER topped me.

Thanks, your great.

[terrified_brian]

Tanner,

I'm in a similar situation, where I recently found out the guy was positive. Just like you I never have unprotected sex but have had a condom break a time or two.

Been about 3 weeks since my exposure and I'm set up to be tested at 6.

Good luck to you!! Your in my prayers whenever you decide to test

Brian

[H. Hunter Handsfield, M.D.]

There is no way to estimate your particular risk any more precisely than I have.  The odds are strongly against your having acquired HIV from him.  But you need to be tested to know for sure.

HHH, MD

[ilogik]

I thought if you used certain (petrolium?) based lubricants it would make it possbile for HIV virus to pass through a condom even if there is no breakege?

[H. Hunter Handsfield, M.D.]

Not true.  Oil-based lubricants, vaseline, etc weaken latex condoms and increase the chance of breakage.  But there is no evidence they let HIV (or anything else) pass through intact latex.

HHH, MD