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Avatar universal

Risky Behavior - HIV Risk

Hello, I am a 35 YO male, who was circumcised about 3 years ago; long story.    I've been exploring my sexuality this year and  having various risky anonymous sex.  I meet on 2 separate occasions with 2 men and received only oral sex without the condom.  

I have also met an African American female, in her 40s with her bisexual Caucasian husband, and they threw a party with multiple partner situation.   On that occasion, I received oral unprotected and also protected sex with only the female while she was on top.  When I ejaculated,  I became flaccid and her continued movement allowed the condom to slip off.  I got up and showered but may have been(???) uncovered for a short amount of time.  

She claims to have protected sex with men, both straight and bisexual men, and performs most of her oral sex without the condom.  It is evident that she has had a great deal of partners.  I only had sex with the woman.   I have some questions:

1) What is my risk for the oral with the 2 men being that it was anonymous?

2) What is my risk for the oral and covered sex with the women. Especially my risk for the condom slippage?  

3) Am I high risk and should I take PEP?

4) I know that symptom questions are not reliable indicators but as I read more about lymph nodes everyone asks about raised nodes.  Couldn't the swelling be described as a dull "pain" in the armpit and not as a lump per se?  

Your help is greatly appreciated.

Thank you
5 Responses
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the HIV forum.  Directly to your questions:

1) It is extremely rare to catch HIV by receiving oral sex.  Some experts believe it never happens; others calcuate the risk at 1 infection for every 20,000 exposures-- and that's only if the oral partner has HIV.  This part of your exposure should not be cause for worry.

2) Wome are very unlikely to have HIV, and when they do, transmission by vaginal sex averages once for every 2000 exposures -- without a condom, and only if the woman has HIV.

3) This exposure probably is not sufficiently high risk for PEP.  However, PEP might be a good idea if one of your partners was infected.  If in doubt, you should check with a personal health care provider.

4) Lymph node inflammation does not usually cause pain without swelling.  And lymph node inflammation due to HIV usually is body-wide, not limited to one area, such as a single armpit.

If you remain concerned, see a local physician or clinic.  But all things considered, I see little risk of HIV in this situation.

Best wishes--  HHH, MD
Avatar universal
Point of clarity please.  On question answer (3) you stated that PEP may be a good idea, but what if the status of some of the parties involved are not known.

Moreover, Is the fact of sharing bodily fluids in multiple partner situation more risky here and thus your suggestion that PEP may be a good option in this case.  Or is it simply the case that the persons involved here (the female, her husband, one other man, or I) are engaging in multiple partner sex.

Illustrative example, if one person gives oral and then immediate gives oral again to another is that consider closer in relationship to insertive sex.  To dovetail off that question, wouldn't the risk also increase if a female (I guess theoretically could be males also) have insertive sex and the next person is more at risk as the fluids are still there.  

Lastly, I know that you emphasis testing but a comment/question to your postscript remarks; do you consider that when my 6 week antibodies test is taken that I will more than likely be relieved of this stress I am feeling?   PEP is a choice according to the phone service I called and since it up to me to decide it can be difficult to parse all the information and make an informed choice especially when feeling stupidifed.  

Thank you advance for replying.  
239123 tn?1267647614
MEDICAL PROFESSIONAL
There are no standard guidelines for PEP, but for the reasons in my original reply most experts would not recommend it in the circumstances you describe.  "Unknown" partner status can enter into the decision, but among most heterosexuals in the US, fewer than 1 in 1,000 persons of unknown status are infected; and regardless of partners' infection status, transmission is rare without unprotected vaginal or anal sex.  For these and other reasons, PEP recommendations are highly variable, based on what is known about HIV transmission risks in the immediate geographic area.  Therefore, your local health department or an HIV/STD expert in your immediate area is a better source than I can be about whether PEP is warranted.

There is no single time when HIV test results become reliable.  The reliability of a negative test rises with time, but with standard antibody tests most newly infected people are positive within 3 weeks and almost all by 4-6 weeks.  So you don't really need to wait 6 weeks to have the first test.  Visit your local health department STD clinic and get their advice, personalized for your specific situation.
Avatar universal
I am writing a follow-up to my question.  Since then I have tried to educate myself as much as a layman could about risk and transmission of HIV and STDs.   I understand the natural of this forum and outside of clairvoyance to diagnose me; it is my responsibility to be tested.    My original post was an anxiety ridden (has much changed really?)  question and meant to try and receive an unbiased second opinion.  

Chronological events: All details above are correct but timeline is adjusted.

My exposure was on Aug 3rd,2010.  On August 4th called PEP hotline, which seemed very scripted, specialist stated that my exposure would be considered low(as you have stated) and advised against PEP but stated it was up to me.  But I was not completely assuaged of my fear and in writing to you, your answer #3 in first reply was indicative of some pause about the circumstances, although you maintain a low risk assessment overall.    

August  11(days 8) through August  25(day 23) : Uneasy feeling, general discomfort and pain in one armpit, then second armpit.  Occasional discomfort in tricep area and back of leg.   Never had a FEVER; daily reading taken as recently as today (97.8-99.1).   Since symptoms are body telling you about humoral response,  I tested.

Testing on August 19(day  16) and August 25(day 22): Both of the Home Access tests were negative.    In addition, female partner says she is tested regularly and “never has gotten anything”.   Really hard to believe that someone with many sex partners has never gotten even a throat STD.

August 27(day24): Visited SF City Clinic and saw a nice Dr.   Complained of penis irritation and exposure to possible HIV.  Physical exam and felt groin and urine sample had no WBC(what he was looking for.)   No other test performed.  Doctor proceeded to explain risk from one time exposure and that I should probably save my money on the next test.   I am sure that I told him the risks, MSM female partner and slipped condom.  He stated condom most likely protective in my circumstance and again indicated exposure risk; He was concerned more for my mental well being.    Indeed, I found little solace.

In my reading, anecdotally, I cannot find “stories “of one time condom failure(broken or slipped) that insertive partner  became infected and there are no caveats in the serodiscordant studies.  Even some of POZ forum moderators alluded to this and in their experiences. (Not to say it could not happen or has!).  
  
September 1(day 29):  Bilateral sternocleidomastoid soreness/pain (???)  from swollen deep nodes from the cervical chain? NOT AGAIN!  Pain progresses and worsens until night.  Next day mostly gone, very strange for neck pain.  

Q1) If testing at 6 weeks will I be able to move on?  3 months is very long time.

Q2) Although no WBC, would it be prudent to ask for standard Chlamydia, Gonorrhea, and Syphilis testing and work up?  Don't know if Dr. spun down and looked in microscope, but fairly quick so I am assuming dip test.

Q3) What to make of strange neck pain(drainage area of lymph system)?   I have had neck pain before and this episode was indeed strange.

Thank you in advance.
239123 tn?1267647614
MEDICAL PROFESSIONAL
1) With modern HIV tests, almost every newly infected person is positive by 6 weeks.  Givne your exposure, it will be negative and you can move on.  You don't need testing at 3 months in this situation.

2) The chance you have any of those STDs is low enough that testing isn't really necessary. But feel free if you want the additional reassurance.

3) Neck pain doesn't suggest either HIV or any other STD.  Undoubtedly it's a coincidence, unrelated to your sexual exposure.

That will have to be all for this thread.  Continue to follow up with the city clinic if you remain concerned or decide you would like to be tested; undoubtedly the doctor and other clinicians there know just as much about these things as I do and you can trust their advice.  
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