anal exposure

[jonny1986]

I need some advice on what steps I should take and when with regard to a recent encounter.

I am a gay male and I recently engaged in unprotected receptive sex with in which he did ejaculate in me. This was a major mistake on my part and something I never do. However, now that it's done I need advice and what steps I should take. I meet the other guy online, and while I did not know him personally, we have chatted numerous times. His profile lists him as negative and only practicing safe sex. I asked him before we meet, when we meet, and after if he was negative. He said yes each time, he was tested about 9 months ago, and that encounters were rare for him. He's a 40 year old, professional male who is not out. However, I cannot shake how uncomfortable I feel--this is something I never do. So, I was wondering at what dates should I get tested, and when should I feel in the clear both for myself and the possibility of exposing someone else?

[H. Hunter Handsfield, M.D.]

The duo test is offered by many but not all health care providers in the US (it's been adopted here less avidly than in most of Europe, for example).  I have no way of knowing whether your regular clinic offers it; you'll have to ask them.  If not, your local health department might have it, or might suggest other options.  And there's always the back-up approach of using an online STD/HIV testing service.

[jonny1986]

He's from out of town and here very often, so going together is out of the question. Where am I able to get that kind of test? Can I go to my regular free clinic or would I need somewhere more specific?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thanks for your question.

The best approach, if you're willing to try and your partner will go along, is for both of you to be tested.  Maybe you'll find he's also nervous about your status.  Even if not, he should be getting routine HIV tests from time to time, and this might be a nice opportunity, when it's on his mind as well as yours.  if you both have negative tests at this time, it would preclude the need for either of you to be tested again.  (Yes, there would be a theoretical risk one of you could be in the window period before a positive test.  But that's a really long shot and not one I would worry about.)

Assuming that doesn't happen, I would suggest you have a duo test (for both HIV antibody and p24 antigen).  That can be done as soon as 2 weeks after exposure, at which time it would pick up probably around 80-90% of new infections, which would be very reassuring even if not quite definitive.  You could then have a conclusive test at 4 weeks.

Of course there's also the issue of other STDs, for which the risk is higher than for HIV.  For that testing, you'll need to be professionally evaluated.  A rectal swab for gonorrhea/chlamydia testing can be collected any time more than 2-3 days after exposure. A syphilis blood test would be valid at 6 weeks after exposure.  Of course keep alert to possible symptoms, in this case anal lesions or irritation, discharge, etc and get examined promptly if anything shows up.  (The same advice about your partner applies as for HIV testing.  If he's willing, he could have urine and blood tests for STDs as well as HIV, with no need for either of you to wait for delayed testing.)

I hope this has been helpful.  Best wishes--  HHH, MD