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Risks associated with encounters and certain factors
Feb 3, 2010

Dear Dr. Frascino,

Hello! How are you doing? I am writing this e-mail because I am worried about my potential risk for HIV infection. I have two factors that I believe are playing against me, in addition to my exposures:

(A) I have very sensitive gums that seem to bleed relatively easily, especially when I brush my teeth. I am not certain as to whether my gums were actively bleeding during my sexual encounters.

(B) I live in a major US city that is often cited to have one of the highest percentage rates of HIV in gay men.

As for my sexual encounters, I had several in a short time span (for simplicity, I've decided to break them down day-by-day):

-- Day 1= Unprotected oral sex. I acted as the receptive partner. The insertive partner did not cum in my mouth, although there was pre-cum.

Day 2= Unprotected oral sex, fingering, and rimming. I was both the receptive and insertive partner. Insertive partner did not cum in my mouth, though there certainly was pre-cum. I stupidly brushed my teeth right before the encounter (about 10 minutes before).

Day 3= Unprotected oral sex, fingering, and anal 'rubbing' (anal-penile contact without penetration). I was both the receptive and insertive partner. Insertive partner did not cum in my mouth, though there was pre-cum.

Day 4= Unprotected oral, fingering, anal 'rubbing', rimming, and protected anal sex. I was both the receptive and insertive partner in oral sex, but I was only the receptive partner in anal sex. Insertive partner did not cum in my mouth, though there was pre-cum.

Day 5= Unprotected oral sex, fingering, anal 'rubbing', and rimming. I was the receptive and insertive partner in oral sex. Insertive partner did not cum in my mouth, though there was pre-cum.

Day 6= Unprotected oral sex. I was the receptive and insertive partner in oral sex. Insertive partner did not cum in my mouth, though there was pre-cum.

---

I am worried specifically because I have experienced fatigue (I fell asleep earlier than usual and was rather exhausted earlier than usual), signs of a potential fever (a rather warm head, followed by a slight feeling of dizziness that passed within a day), a minor headache (though that may have just been general pain pressing against the back of my head from some other condition), and a rash whenever I put gloves on (random red spots appear) or even on random occasions (though I have been told that I have dry skin). I know that oral sex carries a low risk, but upon accidentally (yet lightly) scratching one of my gums, I noticed active bleeding almost immediately today, which increases my worries of potential risk from open gums.

Would you recommend that I take an HIV-PCR test? It has been less than a month since these sexual encounters occurred.

Sincerely, Worried To Death

Response from Dr. Frascino

Hello Worried To Death,

Those were certainly six very horned-up days in a row, you sex machine you! Did you go on a gay cruise (with or perhaps without a ship)? Did you accidentally quadruple your Viagra dose? Did you just come out after years of denying your sexual orientation?

So after six days of nonstop sex, you're concerned that you are a bit tired and you fell sleep earlier than usual??? Dude, even James Bond or a young Mick Jagger would be wiped out after a six-day nookie-marathon, don't cha think?

Your "symptoms" are not suggestive of HIV. You are correct: Oral sex carries only a very low risk of HIV acquisition. Protected sex is protected, assuming the latex condom was used properly and did not fail (break). I would not recommend an HIV-PCR test, as these tests are generally not used for routine HIV screening, due to the rate of false positives, other technical considerations and cost. If you want to be HIV tested, the best test remains an HIV-antibody test at the three-month mark.

As for your sensitive gums, I strongly doubt they significantly altered your HIV risk. I would suggest you floss twice daily and see your dentist!

Be well. Stay well.

Dr. Bob



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