precum anus and HIV

[Dvl]

Dr. H,

First I want to thank you for all the expert advice that you provide on this forum.  

I am a bi male who had a recent encounter with another bi male.
During this time, he put some of his precum on his finger to lubricate it and then inserted into my anus.  He moved it in and out for a few times lasting about 30 seconds.  He then put some more precum on his finger and did it a second time.  He then rubbed the head of his penis on the outside of my anus.  I did have an anal fissure at the time. I certainly regret not stopping him.

my questions are:
1. What is my HIV risk from this.  I questioned him afterwards and he denies having recent HIV testing but claims he has been STD free and has always used condoms for anal sex.  Assuming the worse case scenario(ie. he is HIV positive), what is the risk considering I had an anal fissure?

2. Should I be tested for any other STD's from this exposure.

3. I will certainly be getting an HIV test.  I am however leaving the country to go somewhere very isolated in six weeks to work.  Should the test be negative at 6 weeks time, can I be > 95% certain it is true and not need to repeat it?

4. Off topic, but having never had symptoms of herpes(oral or genital) and used condoms for vaginal and anal sex...should I be tested sometime just to know.

thank you.  

[TeddyB200]

*srry that's suppose to say oral to anal so meaning to eat someone anus out(excuse my poor choice of wrds I couldn't think of any other way to say it)

[TeddyB200]

If someone performs anal on another individuals anal that has HIV can they contract it?

[edc]

the testing guidline is 12 weeks test after exposure. does it means you need to at 84 days or within the 12 weeks(78-84days)?

i ask this because 78 days is the start of the 12 week. so testing at 78,79,80,81,82,83 is the same as 84 day?

thanks

[H. Hunter Handsfield, M.D.]

Thanks to ben_uk for the comment about hepatitis; I should have thought to say it.  Getting immunized against hepatitis A and B is a high priority for all gay/bi men.

HHH, MD

[Dvl]

thanks for your reply.
On previous strings, I have read that HIV infected sperm incontact with a mucosal service after unprotected sex gives a risk of 1-500 over 1/1000 of infection.  Is that true??

[JohnnyV]

Hi,

A few times on this forum, Dr. H has recommended that sexually active adults not schedule HIV tests around specific events. If you are having sex with men on a regular basis, you can get tested once a year and take care of everything in one swoop: HIV, Herpes, Hep, Syph, Gonnorhea, etc. Assuming that you do not have anal sex without condoms, everything else you do with men will have a tiny amount of risk, too much risk to be zero but not enough to be a serious concern. This goes for oral sex, getting fingered, rimming, etc. Individually, each of these encounters is low risk enough that it may be a waste of your time, and a source of too much stress, to focus on one event and then get multiple tests to address it. Yet at the same time, there are practical reasons for wanting to get another test in the future, after the 6-week test.

The only situation in which I would schedule 6-week and 3-month tests to assess a single event, would be if I am in a relationship with a woman and I have decided to stop having sex with other partners altogether, and I want to have unprotected vaginal sex with her. If I know that I'm really not going to have any more encounters with men (or other women), then it makes sense to worry about the 6/9/12 week course of testing, because it's a dramatic life change programme.

J

[edc]

about the hiv testing whats the procedure of hiv test in general? i mean right after extracting the blood does it need to be put in a cooler/ref/freezer when waiting to be tested or even in a normal temperature the blood can wait and the test still will be accurate w.o the cooler......?

thanks again

[Christie2004]

You are splitting hairs.  Do you really think there is some magic cut-off that 6 DAYS would affect the results that far out?  

The blood does not need to be refrigerated, either.

[BenG]

Hi there, until the doctor replies....

1. Testing at 6 weeks is very reliable for testing. 3 months is the advice given by many government health authorities, but with modern testing techniques, 6 weeks is sufficient. (Dr H has stated this).

2. My guess (as a laymen!) is that I would think the encounter you had would pose a risk of HIV transmission if he had it but I do not know how high the risk is - Dr H will let you know.

3. Another one of my thoughts...are you vaccinated against Hepatitis B? The latter is far more infectious than HIV (like 100 times-according to websites I have visited). I'm not saying you have it (and even if you did, 90-95% rid the virus themselves), but (based on advice from an STD expert I saw) if you have sex with men, you should definitely get vaccinated against Hep B as a precaution.

Hope this helps until Dr H replies.

Ben

[H. Hunter Handsfield, M.D.]

1) I am unaware of any data on the amount of HIV in pre-ejaculate fluid or the level of risk from the exposure you describe.  Clearly the risk is less than with, say, insertive anal intercourse, but it probably isn't zero either.  Presumably the presence of a fissure would raise the risk to a higher level than without a fissure.

2) I can't judge the STD risk, so I really can't advise with certainty about testing.  But since you're going in for an HIV test, I would say go ahead and also request testing for rectal gonorrhea and chlamydial infection.

3) Yes.  See other threads; use the search term "time to positive HIV test".

4) In the population as a whole, about 25% of people are infected with HSV-2, the main cause of genital or anal sex.  Among gay and bi men, it's closer to 50%.  I don't know how to judge the extent to which those odds apply to you; it depends on the consistency of condom use, number of same-sex and oppositve-sex partners, how and where you select partners, etc.  But when all is said and done, it's probably a good idea for you to be tested.

Good luck--  HHH, MD