Negative Male Positive Female

[sina84100]

Hi Everybody

Let me start by thanking the team here. I have read many of the posts and found you guys quick, clear, helpful and patient. I have a suggestion though. I think it would be great if you can publish some (even if minimal) information about your background in the field (e.g. are you PhDs? What did you study? Where have you worked? etc). I think this will decrease the cases where people get back at you asking the same question or say things like “I heard Mr. X’s opinion, can also Mr. Y say what he thinks”.
Now I’ll go over what happened to me two days ago. I went to a strip club and asked for a stripper I knew from a very recent visit. Afterwards, I offered her a ride and she accepted. We ended up at her place and after a little chat our sex session started. It involved open mouth kissing (20-30 mins), protected vaginal intercourse (15-20 mins), no ejaculation (which is gonna sound weird but it’s a whole different story). Then we took a break (a couple of hours), and had another session. It involved open mouth kissing (15-20 mins), unprotected fellatio (15 mins), unprotected cunilingus (10 mins), protected vaginal intercourse (15 mins), and unprotected fellatio again (20 mins) and ejaculation outside the body. I am not sure if the time intervals matter but I read in many posts that people mentioned the time of their contact was much shorter than this so I wanted to clear this out in case it changes anything. Also since I never ejaculated inside any of the two condoms (yes, I used separate condoms for the two session), I have no idea if the condoms were broken or had a hole. They were new and from a well-known brand.
I have several questions which I will ask below and give the details regarding each question before asking the question. From my understanding, you guys specialize in infection/transmission risk assessment. All my questions may not fit in this category but I still don’t have many references to check these up so I would be glad if you can answer them to the best of your knowledge or give me references.

1- After my encounter including two sessions, we had a chat, an enlightening one for me. This girl was an injection drug user for 5 years and a sex worker. She claimed that she doesn’t do that anymore (and she didn’t accept money from me), because she has a job now and doesn’t need extra money. She also mentioned she is on recovery from drugs. I am not sure how credible all these are especially because I know she lied to me about her age (I sneaked a peek at her ID) but then again many girls do that. Also during our sex, she was very insistent that I don’t use a condom especially the second time, which made me very nervous because I didn’t know her for a very long time. This makes me think that she is not used to using condoms and as a sex worker, she would be in high risk for HIV or other STIs.
I live in upstate NY and this girl was white and middle-aged (early 30s). Given all these data, how likely is it for her to be HIV positive? How about other disease? This is important for me because I want to know how risky my encounter was and also should I see her again or not (I know that Ann would say activities are risky not people, which is right because even in a completely clean region there can be 1 person with positive HIV, but I want to know the statistics if available).

2- From this point on, let’s assume that she WAS HIV positive (as a matter of fact, everything else positive). First question, I really can’t understand why she would insist for me to take the condom off. She even asked me to take it off at least for one moment, penetrate her, and then I can put it back on. Is there a psychological or mental condition where a person with STD tries to deliberately transmit the disease to another person? She seemed pretty honest when I asked about her drug addiction and generally, her life. I did ask her about STDs and she said she doesn’t have any and she gets checked regularly.

3- How risky was my encounter? My major concern is HIV but I am also worried about other STIs. What do you suggest me to do other than 6 weeks, 3 months and 6 months testing? I have read about PEPs. But they seem to be quite pricey and also have strong side effects. This encounter was about 36 hours ago so I still have a chance to get medication. Do you suggest that for this situation?

The upcoming two questions are about my future encounters.
4- In this question I am looking for some numbers, the risk of each of the activities I am going to mention. I am male and I don’t do MSM. I don’t have HIV or other disease so I am asking about the transmission risk from female positive to male negative in these cases. a) unprotected fellatio, b) protected fellatio, c) unprotected cunnilingus, d)protected cunnilingus, e) unprotected vaginal sex, f) protected vaginal sex, g) unprotected anal sex, h) protected anal sex. I know this is an HIV forum but in the cases above, are there other STIs for which the transmission rules and chances are significantly different from HIV? If yes, is there data on the transmission of those diseases?

5- Finally, I think this will be the pattern in my future sexual encounters: open mouth kissing, unprotected oral sex (both giving and receiving), protected vaginal sex, not frequent protected anal sex. What STIs should I be worried about? What should I do to make it safer?

Thanks for taking the time to read this long post. I know some of my questions overlap but I hope you will be patient with me (as I have seen you have always been) and reply to them.

[RapidRod]

 This forum is HIV specific and nothing that you have mentioned has put you at risk of contracting HIV.

[jkinatl2]

I am going to try and take a little time to answer you. Forgive me if I skip around a bit.

open mouth kissing (20-30 mins), protected vaginal intercourse (15-20 mins), no ejaculation (which is gonna sound weird but it’s a whole different story). Then we took a break (a couple of hours), and had another session. It involved open mouth kissing (15-20 mins), unprotected fellatio (15 mins), unprotected cunilingus (10 mins), protected vaginal intercourse (15 mins), and unprotected fellatio again (20 mins) and ejaculation outside the body.

Do you see the test I highlighted in bold? I did so because unprotected vaginal and anal intercourse are the only confirmed sexual risks for HIV. You had protected sex. You were never at risk for HIV.

None of the rest of your activities are risky for HIV. It would be ludicrous to suggest PEP (which is a month of the same sort of antivirals HIV positive people take every day) over an encounter that presented exactly no risk.


To the rest of your queries:

!) As stated before, there was no HIV risk. Other STDs can be caught through oral sex and things like herpes can be transmitted during kissing. While unlikely, it is prudent for every sexually active male who is not in a mutually exclusive sexual relationship to get a complete STD panel twice a year. Syphilis, for example, can have no discernible symptoms and shares the three-month testing window with HIV.

2) When doing risk assessment, we ALWAYS assume the partner in question is HIV positive. And unless specifically informed otherwise, we assume a high viral load as well.

3) Early 30s is not middle aged unless you met her in 1850. Early 50s might be, but even then, you'd be best off not judging.

As for your questions about future sexual encounters, you are correct. This is NOT a general STD forum. But you are right to worry, since treatment-resistant gonorrhea and chlamydia are becoming widespread. Usually those STDs present themselves in a burning and/or discharge within ten days of exposure. Starting treatment early is your best bet, as it is now usually multifaceted and treatment might take several weeks to complete.

5- Finally, I think this will be the pattern in my future sexual encounters: open mouth kissing, unprotected oral sex (both giving and receiving), protected vaginal sex, not frequent protected anal sex. What STIs should I be worried about? What should I do to make it safer?

What you can do to make it totally safe is to have sec with your hand. Even in marriage, there is an element of trust involved that your partner will not stray. In the meantime, and in a world where people actually exist and find happiness, you will have to determine your own boundaries and the level of risk you are willing to take.

I can say that if you adhere to the outline you provided above, you will avoid HIV and seriously minimize your chances of other STD infections.

About us.

There is an "about us" link at the top of the page. It needs serious updating, but I do believe that Ann and Andy have bios up there.

I know Ann and Andy were here doing risk assessment on this forum when I arrived about ten years ago.

We have all participated in HIV advocacy and outreach, but nonoe of us are physicians. Many of us, myself included, have worked closely with research scientists and have helped design and refine the LESSONS on these forums to represent the state of the art in HIV transmission theory. You really won't find a better researched and footnoted set of LESSONS anywhere else on the internet.

[sina84100]

Thank you RapidRod and jkinatl2. You answered pretty much all my questions regarding HIV transmission risk. About other STIs, I guess I'll have to wait to get tested. I did read your "How is HIV Transmitted?" and "Am I Infected? (A Guide to Testing for HIV)" lessons which was very helpful.