Dear Dr. Bob,
Thank you for all of the great work that you do here -- it's a really informative and helpful resource.
I'm a 23yo gay male. At the end of 2010, I went out with friends, got very drunk, and met a guy at a club. He had the honesty and decency to tell me, on our way back to his place, that he's positive. Being drunk and idiotic, I shrugged this off without thinking about it. We made out, and he gave me a blow job. I started to rub my penis against his ass, and at one point, tried inserting my penis into his ass, unprotected. Fortunately (though perhaps embarrassingly), I was suffering from whiskey-dick and wasn't able to get it in much, though I believe the head of my penis may have penetrated a bit for a brief period of time. Afterwards, I started to finger him with up to four fingers, one of which had a papercut on it. Neither of us came, and I didn't notice any blood at any point. The next morning, when I sobered up, I worriedly and I suppose insensitively asked him if I had done anything risky with him, and he said I hadn't (though it would have probably been hard for him to tell me that he had). After later discussing my night with a close friend, we decided I didn't need to get PEP, and I didn't worry about it much, though of course, I made a resolution to drink less and to be a lot more sensible in my sex life.
Exactly one month after this encounter, however, I noticed I was feeling tired in addition to having a sore throat, canker sores, and a runny nose. It is flu season where I live, and I've always had a weak immune system, so coming under the weather and having canker sores are not uncommon for me. At the same time, the timing of these symptoms worries me. I have every intention of getting a test at the three-month mark, but the wait is driving me insane. I find myself having difficulties falling/staying asleep, which only adds to my fatigue during the day, which exacerbates my anxiety about being in the acute infection period.
I know you can't give me a definitive answer, but it would be great to have an honest opinion of my risk exposure until I do get tested. What do you think, doc? How worried should I be, and what steps, if any, should I take before the three-month mark?
Thank you very much again for your help, and I look forward to donating to your foundation.
For the level of potential HIV-acquisition risk described, I agree PEP was not warranted; however, HIV testing certainly is. Your overall risk is reasonably low, but not nonexistent. As for steps to take between now and your three-month HIV-antibody test, the only thing to do is learn from this lapse in judgment so that it never happens again. If you are having difficulties with anxiety, depression and/or insomnia, talk to your doctor. Psychotherapy (counseling) and/or anti-anxiety, antidepressant medications may help you get through the window period.
Thanks 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 karma that your definitive HIV-antibody test is negative.