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Help! What is My HIV/STD risk from unprotected anal/vaginal sex?
Mar 23, 2003

A week and a half ago I went out with someone I did not know and I had too much to drink. We were fooling around and I did not notice the exact moment he penetrated me vaginally from behind until it happened. I enjoyed this and right as I was climaxing, he pulled out and entered my rectum. I had another orgasm, he pulled out and I realized he was not wearing a condom and went into shock. At this moment, he came outside of my body, not inside. I later found out that this person has multiple sex partners and he obviously hasn't been wearing condoms with any of them. I have had itching, burning and irritation in my vagina since this incident and I have just purchased an over-the-counter yeast infection treatment, Monistat 3. I don't have any other symptoms like abdominal pain or fever, but I am wondering if this could be the start of an STD. If it does not clear up through the Monistat, I am going to go see a doctor. I am also going to get tested for HIV in 30 days, 90 days AND 6 months to alleviate my fears. However, realistically all I could have come in contact with is pre-cum. I've been reading everything I can on-line and the risk appears minimal but very real. Exactly how real is this risk and how much do I need to be worried? This is the first time I've had sex in over two years and I was just in a very low resitance mood to this guy who was very seductive and smooth. I am trying not to panic too much but just to be realistic and take these precautions. It's a very scary thing!

Response from Dr. Frascino

Hi,

You've outlined your risk exposure quite accurately - receptive, unprotected anal and vaginal intercourse with a partner of unknown status but without ejaculation. Yes, you made a mistake when you assumed Mr. Smooth and Seductive was responsible enough to use protection, because yes, it does take 2 to tango. But no doubt he's a jerk for not protecting you (and himself). Don't beat yourself up too much as we are all humans. We all make mistakes; and hopefully, we all learn from those mistakes. That he did not cum inside you does lower your risk, as does the fact you aren't sure he's even HIV-positive. The best "statistic" we have is that the risk per single episode of receptive vaginal and/or anal sex is 0.1-0.3 percent. Another factor in your favor is that although pre-cum has been documented to contain HIV, it is at a much lower concentration than semen. Can HIV-infected pre-cum theoretically transmit HIV? Yes, it can. Exactly how often (or how rarely) this happens is unknown. Certainly the risk would be considerably less than if you were the receptive partner with a full ejaculation.

Following a significant risk exposure, we have 2 options. One is PEP - post exposure prophylaxis. This involves taking 2 or 3 HIV medications prophylactically to hopefully abort any infection. This works best if started immediately after the exposure, and certainly no later than 72 hours. If you're beyond the 72-hour period or don't want to take HIV meds, the other option is to wait for a 90-day test. The 30-day test, that you mentioned is not considered conclusive.

Regarding other STD's, yes they are a possibility. Consider having your Ob-Gyn or general medicine doctor screen you for these, particularly if you continue to have symptoms.

Good luck with your tests. We'll all be rooting for you. If you see Mr. Smooth and Seductive again, why not snap the latex condom on his Mr. Happy in hopes of making sure he never forgets again!

Good luck.

Dr. Bob



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