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Semen on irritated anus and PEP
Sep 19, 2009

Hello Doctor,

I had sex recently with the guy I was dating (mid-twenties, unknown status). We were laying in bed, one of my leg over his body, with my ass quite close to his hand and cock, and he was jerking himself off. No penetration at all. I got some of his cum on my anus, as my leg was forming a kinda 90-degree angle over his belly. I did think of keeping my hole tight most of the time.

When I went to the shower seconds after he came, I realised the skin around my hole was irritated and (possibly) cut, as 1. he had been fingering me before he started jerking himself off and his nails could have tore me a bit down there, 2. i was suffering from haemorrhoids (there was blood on the paper when i went to the toilets a few hours later) 3. a bit of cum could have slipped into the rim of my hole / membrane while he came or while I changed position or while I went to the shower.

I gently washed my ass with warm water, no soap, just removed the cum with my hand, with no direct pressure as I feared it might have pushed it further inside my anus.

So my question would be, how would you describe my risk? And, although this may be described as low risk in terms of HIV transmission, was I a fool to think that it was safe to let him come near my ass?

I gave myself the benefit of the doubt and went to hospital about 20 hours later, lied about a slipping condom, to be given Post Exposure Prophylaxis (PEP). I guess that, as I am overboard paranoid, it was the right thing to do. The similar experience happened to me a few years ago and I'd rather have PEP than freak out again for having done nothing about it while I still could. Also, I asked to be referred to a psychologist to start working on the constant paranoia I've been experiencing for a year now.

Thank you for your patience, efforts and help. I would be very grateful for any advice you could give me. X

Response from Dr. Frascino

Hello,

Your HIV-acquisition risk is extremely low. I have no way of being able to evaluate your anal/rectal trauma due to your bedmate's untrimmed Streisand-like fingernails. Nor can I evaluate the hemorrhoid problem without the benefit of a physical examination. However, even taking these potential extenuating circumstances into account, I would still advise your HIV risk was very low. Generally speaking, PEP would not be recommended for this type of incident.

I'm glad to hear you'll be seeing a psychologist to help with your HIV paranoia.

As for advice, the most important thing I would say is that you should never lie to your doctors to try to trick your way into getting medications. Antiretroviral drugs have significant potential side effects and toxicities. It's possible to do yourself far more harm than good should you take these potent medications without proper justification and monitoring.

Dr. Bob



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