transexual exposure

[abcd6378]

Hi Doctors

I have already aired my concerns on the commmunity forum but I would like a qualified opinion also as some of what I have been told is at odds with other information that is available.

I am from New Zealand and am a 30 year old male. Last Thursday, I met with a 24 year old transexual. Male to female (pre-operative). I asked her hiv status as soon as i arrived. She told me she was negative and showed me evidence from a negative test in March.

My exposures are threefold:

1) kissing

2) Oral without a condom. I was the insertive partner only.

3) Protected anal sex. I was the insertive partner only. I checked the condom afterwards for any sort of damage. It was intact.

I would like for you to analyse these risks and let me know how high my risks are given that transexuals probably have a higher likelihood of having hiv.

My last negative hiv test was in early August and this is the only risky behaviour I have participated in since.

I eagerly await your answer. Thank you so much for your time!

[Edward W Hook, MD]

You are overly anxious.  I have nothing more to say. Further posts will be deleted without comment.  EWH

[abcd6378]

I am now concerned again. Although she told me on the phone that she had a negative antibody test, she said she would scan and email the results to me but it's been 2 days and it still hasn't arrived. She says she has a conference and is tight for time but she will when she can but I'm suspicious she is hiding something from me....I just want this experience over with!!!

[Edward W Hook, MD]

Concerrns that your partner, who has not gotten HIV over the years, might have gotten it in the past 4 weeks and is infected but test negative are really not justified.  The event you describe is just too rare to worry about.  Know that you were not exposed and did not get HIV and work to move forward. Don't perseverate over something that is less likely to occur than your being hit by lightening while reading this.  EWH

[abcd6378]

Thanks Doc

I was still anxious so I asked her to have an hiv test for my peace of mind. The results came back today - negative for hiv as well as everything else. I really appreciated it actually becuase she was adamant she was clean and hadn't been with anyone since her last test. She just did it for my peace of mind.

I feel a lot less nervous now, although I realise that she could have contracted hiv in the 4 weeks or so before i was with her as that was within the window period for the  latest test.

Do you agree with my assessment??

[Edward W Hook, MD]

No.  No diference.  Both sorts have virtually no risk.  EWH

[abcd6378]

Sorry...but I am not talking about protected anal sex but about the oral sex. I was enquiring as to whether insertive oral is more risky than receptive oral.

In other words - was I at more risk because I was the insertive oral partner??

[Edward W Hook, MD]

Yourt question is irrelevant.  You used a condom.  Had you not and your partner had been infected, the risk of receptive rectal intercourse at about 1 infection per 100 exposures, on average, is estimated to be about twice as high as for insertive rectal sex (1 in 200, still very high).

Let's cease the "what if" questions.  EWH

[abcd6378]

Hi. Sorry but my question about insertive versus receptive was about oral sex and which one is the safer.

[Edward W Hook, MD]

No, it was still condom protected and therefore safe.  EWH

[abcd6378]

Thanks for your answer - you have made my day a great deal brighter. One other question though - does it make any difference whether you are the insertive or receptive partner during oral sex?(I was insertive). Does that make any difference.

This is my  last question and I am very greatful.

[Edward W Hook, MD]

Welcome to our Forum.  I will address your questions and then check the Community Forum to see what the folks there have said.  By and large, what is said on the MedHelp Community Forum is an accurate reflection of what we say here.

This was a no risk exposure for HIV.  Even if your partner did have HIV, which is unlikely on a statistical basis (you are correct, more transsexuals, on average, have HIV but the proportion remains low), a properly used condom which does not break makes sexual exposures no risk.  

That leaving kissing and receipt of oral sex.  Kissing is no risk, even deep kissing and even with gum or dental disease. 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.  

Thus, to summarize, I see this exposure as a no risk exposure.  Now let's see what was said on the HIV Community site.

We agree.

I hope these comments are helpful to you.  Nothing you  have said gives me reason for concern and I see no need for testing.  Take care.  EWH