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Gonorrhea and hiv
Dec 10, 2009

Hi, Mr. Robert, i'm brazilian, so forgive my poor english. I had unprotected oral sex with a male prostitute on november, 6th. I made oral sex on him just for a few seconds - no cum for sure, and, i'm almost sure, no pre-cum, it was very quickly really. My mouth had no cuts or sores or bleeding gums. Then he sucked my penis till i ejaculated. I had no wound on my penis, and, as far as i noticed, there was no blood or cut on his mouth. Last week i found i had gonorrhea (there was no secretion, just a sting when urination). 1) I've read on this and other sites that the risk of hiv transmission via insertive oral sex is minimum (some say the risk is "theoretical"); 2) But i've also read that co-infection of hiv and gonorrhea increases the risk of hiv transmission - although you've said that the risk remains quite low. Is it possible to know how much this risk increases with the presence of both infections? The doctor advised me to make hiv test (elisa 1 and 2) within four weeks of exposure and to repeat the test within three months, he said the risk is low, less than 1%. Is it true, Dr. Robert? I've read here that CDC estimates the per-contact risk for unprotected receptive oral sex in 0,5/10.000 - so if co-infection hiv/gonorrhea increases this risk in, say, 10x, the average risk would be like 0,5/1.000, or something like that? And if i make a test within 30 days how much it would be reliable? I don't know if i can wait 90 days for testing!! I'm spending the minutes and seconds of my time making this calculations of the odds of being infected and destroyed my life.... Please help me, Dr. Robert, i'm married, have two beautiful little daughters, i'm drowned in guilt, fear and anxiety....my marriage, my life, my daughters, i put all these precious things in risk for some stupid thing...... Thank you very much and please let me know how can i donate for foundation

Response from Dr. Frascino

Hello Brazilian-Guy!

I absolutely agree your HIV-acquisition risk is extremely low, much less than 1%. It is far easier to contract gonorrhea than HIV from oral sex! Trying to calculate the increased estimated statistical risk of acquiring HIV is not at all helpful or accurate. The statistical estimates quoted by the CDC refer to relative risk in large epidemiological studies. It really can't be applied to a single discreet sexual encounter, other than to indicate the relative risk associated with the various sexual activities. For instance, unprotected oral sex is less risky than unprotected vaginal sex, which in turn is much less risky than unprotected anal receptive sex.

I absolutely agree your problem is guilt, fear and anxiety. This most likely is amplified because your walk on the wild side involved gay sex with a male prostitute. My advice is that you focus on this very real problem by:

Leveling with your wife. It's not only the best way to confront your guilt; it's also the right thing to do.

Talking with your doctor. You may well benefit from psychotherapy (counseling) and anti-anxiety mediations during the three-month window period. The counseling may also help you explore sexual orientation issues.

To sum up, let me reassure you once again: Your HIV-acquisition risk is extremely low. The odds remain very much in your favor that you did not contract HIV from this episode. However, you may well need some help with other issues: anxiety, guilt and sexual orientation concerns.

Donation information for The Robert James Frascino AIDS Foundation can be found on the foundation's Web site at (www.concertedeffort.org). Thank you for your desire to help others in desperate need. In return, I'm sending you my good-luck/good-health karma that your definitive three-month HIV test is negative.

Good luck. Be well.

Dr. Bob



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