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Anal and oral with transexual
Apr 30, 2011

Dear Doctor,

Thank you for your website, I have been browsing it for answers. I am extremely worried since I had sex with a transexual escort (pre-op) five days ago. We both gave each other oral sex with condom and then we had anal (I was bottom). It was my first time with anal so I had a strong pain when he first started. He pulled out and then went again after 30 seconds. We had mutual oral for 5 minutes approx and then had anal sex for 3 minutes approx. When we had anal the transexual was wearing the condom he was wearing when I gave him oral (I don't think I bit or teared the condom then). I was drunk and wanted to get out of there as soon as we finished so I didn't check if the condom was broken or not. I am quite sure he used lube as I saw him take a bottle of lube (although it still hurt like hell at the begining). I don't think the transexual came at all. I haven't noticed any signs of bleeding from my anus after the episode, but I have felt discomfort in the area since. After the episode I took a shower, washed my anus with water and soap and brushed my teeth (stupid decision of brushing teeth, after I did some reading).

I am very worried since the night of the episode when I went to sleep I had a small fever and the day after that I felt a small cut in the back of my throath after the episode which disappeared in about 2 days. Also, I have experienced lower back pain and since yersterday I have a cold with a sore throath. I woke up today and the sore throath was pretty bad, although it seems to be getting better, but I have the symptoms of a flu (sneezing, coughing, runny nose and stuffiness, with a little bit of diziness).

I don't know if these symptoms mean anything at this stage but I am extremely worried. I also don't know if these symptoms are related to HIV or another STD or if they are just related to something else. I have been working a lot and sleeping very few hours and this incident and work has put me under stress and I am also feeling very tired.

I also called the escort to cofirm if we had used condoms and he said yes. I asked if I should be worried and he said that only if I have been having unprotected sex with other people (which I haven't), but of course, I don't really trust that. I am also specially worried since when I looked the transexual up online to find his number after the incident, I noticed some videos of him in porn websites (two videos with the same guy) where he was barebacking (bottom).

I will get checked in 3-4 days for all possible STDs. I understand I have to wait 6 weeks to get tested for HIV and I will do so then. However, I am extremely worried at the moment since I am married and I would like to know what chances there are of me getting infected of HIV or other STDs.

Also, would it be to late to get PEP? I understand it's 72 hours after the exposure, but I would like to know if there's anything that I could do.

Your response will be much appreciated since I am living a hell at the moment. Thank you and I will of course be making a donation to promote your very valuable work. Thank you Doctor.

Response from Dr. Frascino

Hi,

Your HIV-acquisition risk would be essentially nonexistent, assuming the latex condom was used properly and didn't break. Symptoms associated with HIV acute retroviral syndrome (ARS) generally manifest two to three weeks after primary infection. Symptoms are also notoriously unreliable in predicting who is and is not HIV infected. PEP would not be warranted for your degree of HIV-acquisition risk. PEP also would need to be started as soon as possible -- and no later than 72 hours -- after exposure.

Your problem is primarily guilt. I would suggest you seek psychotherapeutic counseling to help you confront your guilt and underlying sexual orientation issues. Ultimately you should level with your wife, as it's the right thing to do.

Thank you for your support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated. In return I'm sending my good-luck/good-health karma that you are now and will forever be HIV free.

Good luck.

Dr. Bob



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