Doc Need Honest Advice

[nycBuspro]

47 yo Married Male. Non Iv drug and straight.   Last exposure was july 08  divorced 48 yo woman. We had condom protected vaginal and unprotected oral. We had about 3 encounters in one day. I was not drunk and did not notice condom failing.  She is not a csw. I asked her status prior to hooking up and she told me she had tested  in december and was fine.  I later find out that she prefers to go bareback and was into D/S.  I thought I was being safe ! But now I am worried. my 2nd  one time exposer was with a African American 19 year old collage student from NYC. She stated that she had sex the first time 2 weeks before we met.  I asked her if she had ever been tested and she stated No because she had never had sex before 2 weeks prior.  We also had Protected vaginal and unprotected oral. Both women preformed oral on me I did not preform oral on them.  Ther was alot of body fuids with masturbation and playing around.  But the only penile penatration was with condom and each time I used a new condom and never noticed one break. And again I was not drunk and no drugs.  Now here is my question I thought what  I was doing what is considered SAFE SEX.  Reading the internet has given me great anxiety.  I was tested last dec 2007 just prior to meeting the african american girl.  I always use a new condom. and always ask prior to sex thier status.  The older woman has reassured me several times after our meeting she was safe and had been tested.  The younger girl has told me she has never had unprotected sex. and I was her second guy.  
1. do I need testing
2. should I worry about passing anything on to my wife.
3. I need to know do i Really have anything to worry about. ?
Since My last encounter in July I have had no symptoms of anything besides the winter flu when the rest of the family has had it.  No rashes or fevers or anything, swollen glands nothing. l    You opinion would greatly help me relax and go back to a normal life.   Thanks for being there.

[Edward W Hook, MD]

Welcome to the forum.  You are asking good questions.  To re-phrase your question, you want to know about safe sex as it relates to specific exposures.

Condom protected sex is safe sex.  The risk of getting HIV from condom protected sex is on the order of 1 in a million exposures, IF your partner is infected (most are not).   Thus there is little need (little is a semi-quantitative term which one can interpret based on their own level of anxiety and concern- for most cases however, in my opinion testing.. is usually not needed).  Condom protected oral sex is even lower risk for HIV acquisition.

As for unprotected oral sex - the risk is tiny.  The quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.

Regarding mutual masturbation, there is no risk, despite the fact that it is usual for persons to get each others' secretions on one another in the course of mutual masturbation, there has never been a case of HIV transmission through mutual masturbation.  it is truly safe sex.

Finally, the comments above are related to individual sex acts with specific partners.  Thus, in your own case, there is nothing in your history or description to cause me to recommend testing to further sort things out related to the exposures you described.  On the other hand, you describe sex with two partners besides your wife.  Thus you qualify for periodic HIV/STD "screening (testing in the absence of symptoms) because you have had multiple partners over a period of less than a year.  As a matter of personal protection, we recommend annual testing for anyone who has had two or more sex partners in the past year (we consider this to be health maintenance- we also recommend you get your blood pressure and cholesterol checked regularly).

Hope this makes sense and is helpful.  EWH

[Edward W Hook, MD]

Correct.  EWH

[nycBuspro]

Dr., Thanks for your detailed and quick expert reply.   To sum up your reply,  I do not need testing becuase of the risks I described, medicaly speaking.  
And I understand the need for normal screening as a normal general health practice,
Is this is correct?

  I thank you.  You and the other doctors provide a great service that I truly appreciate and admire.   Thanks