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unproted anal sex with a HIV + guy
May 18, 2003

Hi Dr. Frascino,

I have had unprotected anal sex but stopped soon after, and I asked the guy to put on a condom. During sex he bit my nipples making them tender and ejaculated on to my chest. 3 weeks later I had a flu, didn't have fever but had sore throat and mouth ulcers for a couple of days, had red rashes appeared on my arm for a day then disappeared, had headache but not really aching rather it felt like my head was heavy and things were spinning around for a few days.... the guy told me that he was HIV + afterwards...I am worried now, are these the symptoms of HIV infection?

James

Response from Dr. Frascino

Hey James,

Your risk is brief unprotected receptive anal sex without ejaculation, but with someone who you later found out was HIV-positive. This does qualify as a risk exposure. The fact that it was brief and that he did not ejaculate inside you does lower your degree of risk somewhat. The noshing on nipples is not a risk. Your symptoms are vague and could be related to many conditions other than HIV.

So, what to do? There are always two options when a mistake happens. First, if there was "significant" degree of risk, you could take PEP (Post-Exposure Prophylaxis). This must be started as quickly as possible, and no later than 72 hours, to be optimally effective. It involves taking HIV medications for 4 weeks and getting periodic HIV tests. If its been greater than 72 hours, then your only option is HIV testing. This should be done at 3 months after the risk exposure.

Your chances of seroconverting? The only statistical estimate we have is 0.1 0.3% chance of seroconversion per episode for the receptive partner having unprotected sex with someone known to be HIV seropositive. Your odds would be statistically less, because there was no internal ejaculation. Consequently James, the odds are still very much in your favor for not having contracted HIV. Take the test at 3 months. If negative, yell WOO-HOO! Following this episode, Im sure you wont be making this type of mistake in the future!

We are all sending you good luck for your upcoming test.

Dr. Bob



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