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Multiple hiv+ exposures - part 2
Mar 15, 2006

Hi again Dr Bob, below is my question and answer from February. (feel free to cut and paste as necessary). My Mar 8th test came back negative too. What is now confusing me is that my ex-partner insists that it is impossible for him to orgasm inside anyone (!). He invited me to speak to his ex-wife (they had counselling years ago). I know for a fact that he wasn't a pre-cummer, his penis never leaked anything. (I will spare you what few details are left!). Does this actually matter though, can hiv be transmitted without any fluids being involved? I will retest again in another 3 months, but I am starting to feel optimism.

I must admit, I find your writings enjoyable, it's a gritty subject but your soothing words and occasional humorous observations are priceless. Thanks for that and the karma. Steve

Hi Dr Bob, thanks for educating me on hiv. (obviously I read the safe sex part too late!). I had regular unprotected anal penetrations from my ex partner over a 4 year period. He claimed he was neg, right until he collapsed (he had, by then, a tcell count of 24). He told me it was out of control diabetes (I'm gullible). Anyway, I was tested Dec 5 and was neg, I'm going to retest in March, which will be 14 weeks after my last exposure. I do remember you saying that the odds changed after repeated hiv + exposures. Should I delay the retest or just continue to retest every 3 months for a while? Regards Steve

Answer:

Hi Steve,

The estimated per-episode risk for acquiring HIV from unprotected receptive anal sex with an HIV-positive partner is 50 per 10,000 exposures. This estimated risk is per episode. You've had a very significant HIV exposure; consequently, we would recommend testing immediately, at three months and, if still negative, again at the six-month mark. Your initial negative test is encouraging, considering you were repeatedly exposed over a four-year period and your partner was not on antiretroviral drugs to lower his viral load. Let's hope your luck holds out for your three- and six-month tests. I'll send my best good-luck karma, OK? I'm here if you need me.

Good luck.

Dr. Bob

Response from Dr. Frascino

Hi Steve,

Well, there is a medical condition called retrograde ejaculation in which the ejaculate is pushed back into the bladder rather than out through the urethra. This can be caused by a variety of conditions, such as diabetes. Also failure to ejaculate has been reported with virtually all of the antiretrovirals, the heaviest evidence is in the protease inhibitor class. I don't know if this applies to your ex-partner not. But whether he does or not, you still need to continue your HIV testing protocol. Congratulations on your March negative test! Yes, I would definitely say optimism lots of it is warranted! I look forward to hearing form you in three months with hopefully additional good news!

Good karma continuing to flow!

Dr. Bob



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