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Unprotected Top/Symptoms
May 29, 2002

Dr. Kull,

Twelve days ago I had unprotected insertive anal sex with a bottom that I have since found out was HIV+. I was probally inside him for 5 minutes...I got off but I put it back in for 30 seconds in order for him to get off...I don't use any kind of drugs nor am I ever the bottom...

He also has said his viral load is undetectable...Could you provide your opinion as to my potential risks? & regarding potential symptoms if my body converts...it has been 12 days and so far I physically feel great, but am emotionally a wreck.

Thank you for the wonderful service you provide.

ScaredtoDeath

Response from Mr. Kull

Having unprotected insertive anal sex (being the "top") with an HIV infected person puts you at risk for infection. While one exposure does not guarantee infection, the fact that you know you were exposed suggests that you take important steps. First of all, if you continue to engage in sex with others before you know your status, it is extremely important that you use condoms. Secondly, talk to your doctor, or find one who you are comfortable talking with about HIV and sex. It's vital that you have a plan to determine your status and discuss treatment options if necessary.

That being said, there are certain things that are important to understand about your risk. We know that the bottom is at much greater risk for HIV infection than the top in anal sex. The specific data on HIV transmission from a bottom to a top during unprotected anal sex are somewhat controversial (see response to and links in Serodiscordant ). The bottom is at greater risk because the lining of the rectum is more likely to come into contact with more HIV infected fluids and is more vulnerable to infection than the urethra.

The actual degree of risk will vary in each situation depending on numerous variables (viral load, presence of blood, sexually transmitted infections, duration and frequency of exposures, and immunologic factors). Unprotected anal sex is risky to the top because the rectum is prone to microscopic tearing that could expose the top to blood, which is highly infectious.

None of this means that you should throw away condoms because you are a top. Tops do get infected with HIV, and taking a risk like that is probably not worth it. The odds are actually higher that you will be infected with another sexually transmitted infection if you have unprotected anal sex, as that prevalence of STIs among men who have sex with men is high.

RMK



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