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Very Worried in East Europe

Nov 17, 2003

Dear Dr. Frascino

I had unprotected sex, anal intercourse with a friend, he penetrated me. I have known him for many many years and when this happened 48 hours ago we were both very intoxicated. He says he didn't realize what he was doing?... I still don't understand. I assumed he was hiv negative as he hadn't told me anything and we had shared our hiv results several times over the last 15 years. Today he told me he is actually hiv positive and has been for the last two and a half years.

He did not ejaculate inside of me or at all. He says he virtually never has any "precum". He told me his viral load is very load and that it was undetectable the last time he checked his blood which was three months ago.

I am very worried that I might be infected. I know this is the example of unsafe sex. However, since this is so recent I wanted to ask if there is anything I can do? What are the chances that I got infected? And any help or information that you can provide to me or that could ease my worrying.

I am in a Eastern European country now and drugs are not easily obtained, however in 5 days I will be back in California.

Thank you very much.

Worried in East Europe.

Response from Dr. Frascino

Hello Worried in East Europe,

He penetrated you and didn't realize what he was doing? Well, that's a bit hard to believe. I mean there really aren't' too many other things that can be confused with anal sex, unless of course you guys were playing "naked twister" and he slipped and fell (in). OK, so your risk was unprotected receptive anal sex without ejaculation, with a guy who is HIV-positive. Yes, this definitely qualified for unsafe sex and places you at some risk for STD's, including HIV. On the up side, if your friend really does have a non-detectable viral load, that would decrease the risk of HIV transmission. Second, that he did not ejaculate inside you also decreases your risk. The risk of HIV transmission per episode of receptive anal sex with an HIV-positive partner is estimated to be 0.1 3 percent.

Your only option at this point is to consider PEP (post-exposure prophylaxis) with interval HIV testing. This may be difficult to arrange in East Europe. To have the best chance of working, PEP should be started as soon as possible, and no later than 72 hours after an exposure. If this is not an option for you, or you choose not to take PEP, than an HIV at three months will be necessary to definitely rule out HIV transmission.

This is also a lesson that I hope all our readers will take to heart. You can never really be sure that what a partner tells you is true, particularly in the heat of passion. Self-protection each time, every time, is the only way to be sure and safe.

Good luck. We are all sending you our best karma for a negative test.

Dr. Bob

Don't diagnose yourself at any stage
steam room= a + or - ?

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