hiv risk through anal frottage and oral sex with canker sore

[rmen818]

Hello Doctors,

First of all, I'd like to thank you for your time and generous feedback which we all find so empowering and useful.  I have posted once before over a year ago, and I took your advice and have been great-- I even went ahead and became an HIV-prevention counselor at my local clinic in the San Francisco Bay Area.  However, to no avail, when it comes to my own health, it's hard to be objective.

A few hours ago, I met up with someone-- to be honest, I'm not sure of his status, but we did speak about HIV and he was extremely adamant about safe sex and being negative. For an etching reason I trust his disclosure to me as being negative.  We kissed and I sucked him off. I have a canker sore in my mouth but he did not precum at all.  If he did, it was probably so minuscule that it wouldn't have mattered... (no taste, no nothing. and he even said he doesn't precum).  1) This was low-risk, correct? Or what would you say is the risk?

However, this leads me to my ultimate point.. the one that's causing me a little anxiety.  He fingered me and we started humping.  For a bulk of the time, he had his penis between my butt cheeks and the frot-ing became intense.  If there was any precum, I'm sure it would have landed inside my hole, but there was no direct penetration... Take frotting loosely though... we are human and are prone to human mistakes... so maybe at one point his penis did semi enter me... but I didn't feel penetration.

I was wondering what you think my risks are for the two exposures I listed above (1-oral with canker and 2-frottage).  Also, if he were to have cum on my chest and I had pimples, that wouldn't pose a transmission risk, right?  Do you recommend I get PEP? Or are these (now 3) exposures pretty unlikely for me to contract the virus?

Once again doctor, thank you so much for making this site available for us all.  It is truly an amazing resource and I appreciate the empowerment and the time you spend answering all of these questions.  

[Edward W Hook, MD]

Welcome back to the Forum.  I'll try to help.  You mention that your partner was adamant about safe sex and being negative.  If this is true, then it does seem most unlikely that he was infected. As you know, most people do tell the truth.  If you can contact him, a bit more detail about when his last test was or better yet, going together to get tested now with a rapid test could completely resolve your questions and concerns.  Validation of his statements to the effect of being negative would make this a virtually no risk encounter.  If this cannot be done, you have a decision to make (see my comment number 2 below). Going straight to your questions:

1.  Oral sex with or without a canker sore is a no risk exposure which does not warrant concern and certainly does not warrant PEP.

2.  Your second question is a bit harder for me to address, in part because of the way you describe it.  "Semi-entering" is probably a lot like be "a little bit pregnant"- either he did or did not.  If you did not, despite the proximity of his penis to your anus, there is no risk.  On the other hand, penetration is penetration and if there was penetration that raises the risk considerably, unless of course he was negative.  If there was penetration and if he had HIV (from the sounds of things, two rather big "ifs" the risk for infection is about 1 in 100 and worth of PEP.  If not, then I probably would not use PEP.

I hope my comments will help you to think through your choices.  The best course would be further communication with your partner. EWH

[Edward W Hook, MD]

Your anxiety is not a reason for PEP.  Based on what you say, I would not suggest it for my patients.  I'm sure you could get it if you want but as I sai, I woul not recommen it.

HIV RNA tests are widely available. Speak with your doctor or a local health department.  EWH

[rmen818]

Thank you for your response.  I did communicate with my partner and he said his last test was 4 months ago, negative.  He is always a "top" and always uses condoms for penetrative sex.  He assured me he's negative. When I asked if I should be worried, he said 'No'.  Albeit it seems that I was not exposed to anything, I can't help but to be anxious.  Should I talk to him again? Should I speak to someone at a PEP clinic? Where can I possibly take an HIV RNA test? I'm not sure where to look.

Thanks for all your help, doctor.

[Edward W Hook, MD]

There is no need for PEP related to frottage.  EWH

[rmen818]

Hello Dr,

Thank you for the reply.  It was just frottage.  When I say there may have been slight penetration, his penis never entirely entered me. The tip of his penis most probably entered the opening of my anus, but he didn't "thrust" it all in.  Does that make sense?  With that, how would it look like for HIV transmission.  Did you recommend using PEP for this type of exposure?