Brief anal risk?

[rand1011]

Dear Doctors,

I'm a GWM who had an encounter with a male CSW last night.  Normally I don't do anything that would pose a risk, and I don't ever do any kind of anal sex (it's just not my thing).  During this encounter, however, the person I was with rubbed his butt against my penis and, at one point, I thought there was very brief insertion (my penis to him).  I'm not entirely sure about this; if there was insertion, it was partial/very little and extremely brief, as I pulled back the moment it happened and told the man I that I didn't do that.  I wasn't going to engage in anything with any risk with this person, so I didn't ask him about his status

Anyway, because I've never done anything remotely anal related (and don't plan to again), I have no idea what the risk is like.  Is there any risk here if there was brief insertion (my penis into him)?  And if there is, would PAP be a good idea?  It's only been 8 hours or so since my contact with him.

Thanks.

[Edward W Hook, MD]

As I said before, this is a judgement call.  That said, if it were me, I'd probably accept the reassurrances and not pursue PEP but that's me and not you.  Please be clear however, if you "talk to a doctor about PEP", you are seeking it

EWH

[rand1011]

Thank you very much for your help.  I was concerned that'd be your answer, so I called the person and followed up.  He told me that there wasn't penetration and said that he would have known if there was, that he was tested two months ago, and that he was negative.  Not to beat a dead horse, but do you think I should still consider talking with a doctor about PEP?  I'm thinking no, but I'm concerned he's recalling incorrectly (this seems stupid/paranoid on my part, I suppose, but I'm still worried about it) He could also be lying about his status, I guess---the lad still seems flippant on the phone.  He said I was overreacting, and he might well be right.

All in all, I'd appreciate some reassurance, presuming it's honest of course.  Sorry to be a bother, and thanks again.

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help but this will ultimately be a judgment call and the judgment should be determined based on whether or not insertion really occurred and to what extent.  To elaborate a bit, IF your partner had HIV (and a male CSW who does not use condoms is a rather high risk partner), the risk of insertive rectal sex is about 1% or 1 infection per 100 sex acts.  Variables such as the duration of sex and the depth of insertion have not been formally studied since they would be hard to measure in a scientifically acceptable fashion but, logically the risk of infection would be higher with more penetration and longer durations of exposure.

If you really think there was penetration, then PEP would be a reasonable thing to do.  If not, then certainly, PEP would not be appropriate.  If you are not certain it becomes a judgment call.  The judgment call might be more easily dealt with if you can contact your partner again and find out if he is HIV positive, if not when he was last tested, and whether or not, in his judgment, there was  penetration.

If you decide to pursue PEP, the sooner you start it, the more effective it will be.  Further, there is no benefit from PEP if it has been more than 72 hours since exposure.  

I hope these comments are helpful. EWH