Risk from unexpected possible penetration

[redwsam]

Dear Dr.,
I’m back again. 15 days ago, I was involved with a guy that I was dating for a while. We engaged in usually safe activities of frottage and protected receptive anal sex. What makes me very concerned is that he was rubbing his penis (uncovered) around my anus during frottage. He then started to apply some pressure on my anus but suddenly I felt a push that was more forceful than normal. I stopped him immediately. This last for no more than 3-4 seconds. Personally, I don’t think that there was any penetration as I did not feel any pain, discomfort or friction. I’m scared that there might have been a very brief penetration of penis head (1/4in?) but since I’m not very experienced with anal sex, I can’t be sure.  I certainly did not have the same sensation that I had during protected penetration later that night. Also, upon asking (more than 3 times), he mentioned that he is negative and he did not penetrate me unprotected.
About 11 days after, I came up with a very mild throat discomfort which was gone by day 13. On day 10, 4-5 small light red spots (0.5cm in size) appeared on my chest. I applied alcohol to the area and few hours later, they started to fade. By the end of day 11, they were all practically gone. I also had a very small mouth ulcer (about 3-4mm) on my gum (day 12). My temperature was normal during this time (only went up to ~37.3C on day 12 for few hours). Now my questions:
1- How do you assess my risk realistically? What if there was a 3sec very small penetration (1/4in of penis head)? Have you seen any case of transmission like this?
2- Is full penetration (penis head past sphincter) required for HIV transmission or any minimal penetration is still considered very risky?
3- Are my symptoms (and lack of others, particularly fever) consistent with the ARS? Can they last for such a short time (~2 days max) and can the rash be so minimal (only 4-5)?
4- What do you recommend me to do before 6 weeks testing mark? I can’t sleep and eat well.

Thanks

[H. Hunter Handsfield, M.D.]

As sometimes happens, I failed to notice Dr. Hook was starting to reply to your question.  Since I put in the time, I'm posting my reponse as a follow-up comment, so you get two replies for the price of one.  As you will see, Dr. Hook and I are in complete agreement.

Welcome back to the forum.  However, I'm going to give you a bit of a lecture first.  Going back through 2009, I believe this is your 4th question on the forum.  All of them concerned zero to low risk exposures of the sort that most gay/bi men know carry little or no risk of HIV transmission.  I suggest you read up on and remember the real risks for sexual transmission of HIV:  if a bare penis (no condom) does not enter another person's rectum, vagina, or (rarely) mouth, HIV is not transmitted.  You should not need to be asking about the HIV risks every time you have a new sexual encounter.

As for not being experienced with anal sex and thus "not sure" about penetration, trust me on this:  if there were penetration sufficient to transmit HIV, you would know it.  Also, people rarely lie about their HIV status, so it is very unlikely your partner is infected.  To your specific questions:

1) Zero risk.

2) Full penetration probably is required.

3) To some extent almost any symptom can occur in ARS, because the symptoms are identical to innumerable other health problems that have nothing to do with HIV and generally are minor, like a garden variety cold.  That's why symptoms are rarely useful in judging whether or not someone has ARS.  But in any case, your symptoms you mention do not sound at all like ARS.

4) I recommend against HIV testing on account of this event.  What you do in the next 6 weeks therefore doesn't matter much.  Of course you are free to test if you wish, i.e. if you this reassurance doesn't completely settle your anxieties.  But I suggest you stop worrying about testing after individual exposures, unless you someday have unprotected sex with an anonymous or infected partner.

HHH, MD

[Edward W Hook, MD]

Welcome to our Forum.  I'll be please to try to help.  Let's start by addressing the possibility of penetration.  My guess is that it did not occur.  As you stated, you had direct experience with this partner as to what penetration feels like.  You did not have that experience, thus I find it quite unlikely that penetration occurred.  A second part of your question however has to do with what it the line between frottage and penetration.  This is, obviously, a bit more difficult question to address however I will comment that in the course of frottage it is not uncommon for partners to get each others' genital secretions on one another.  Thus I suspect what you experienced in the encounter you describe all fall within the category of frottage and, as such, is no risk.  I would not worry about transmission from this encounter.

2.  See above, I would not worry about "near/minimal"  penetration

3.  Your symptoms really do not line up well with the ARS in which symptoms are typically rather severe.  Further, the symptoms of ARS are totally non-specific.  When this has been studied in the US, less than 1% of persons seeking medical care for "ARS symptoms" are found to have HIV, the remainder having symptoms due to other processes. In contrast, over a given year, there is almost no one who has not had a viral illness, night sweats or both (sometimes on multiple occasions).  I suspect your sore throat and rash are coincidence, not ARS.  

4.  Do your best to relax.  I really see no reason for concern.  If you wish and it is possible, you can get a definitive answer by asking your partner to be tested at this time.  If he is negative a week after your encounter, he did not have HIV that could be transmitted to you.

I hope these comments are helpful.  EWH

[Edward W Hook, MD]

Yes, your DUO tests are definitve evidence that you did not get HIV.  A three month time is a waste time, money and energy- your results are definitive.  Take care.  EWH

[redwsam]

Dear Dr. Hook, I received my 6 weeks duo (ag/ab) test results today and it was negative. Does these 3 and 6 week negative duo tests mean that I can move on with my life now or is the 3 month test still necessary?

Finally, I would really like to thank you for your help and patience during these very very difficult times for me (and many other users on this forum). You are a great man and I wish you the best in the future.

[Edward W Hook, MD]

There are no good data on this as to precisely how good the DUO test is at 3 weeks.  A negative test however is strong evience against infection.  EWH

[redwsam]

I went ahead and did a combo test at 6 weeks yesterday, the results will be available in 2 weeks. I also got my results for 3 week test which was negative. As a last question (I won't bother you again), I know 4 weeks is almost definitive but how valid is a negative duo (ag/ab) result at 3 weeks? Thanks.

[Edward W Hook, MD]

There are rumors that the rapid tests give more false positives than the regular blood tests which take several days to provide results but more recent, carefull studies indicate that this is not the case.  Your risk for a false positve is low.  If you want to get the answer sooner, take the rapid test.  EWH

[redwsam]

Hello Doctor, since there is almost 5 weeks past this incident, I am going to get tested to obtain some peace of mind. I'm trying to decide between regular blood test or rapid test. My primary concern is the possibility of false positive which I've heard that is more common in rapid tests. Is this true? Does it make a difference that I never had a false positive ELISA before? Which one do you recommend? Thanks.

[mandeep7575]

Thanks for your post Redwsam. I had a very very similar concern that I posted about as well. Almost an identical situation... Except that i had pants and underwear on at the time and i thought that while i was in position that this person might have slipped it inside me. Im seeing now how crazy that sounds. Its nice to see your post though. I am just starting to explore my sexuality and am very nervous and scared.
Thanks

[Edward W Hook, MD]

Glad to help.  EWH

[redwsam]

Thank you Dr. Hook for your help. As I mentioned before, the rash was what made me very scared. Now with your comments (and also Dr. Handsfield's), I can see more clearly that there was no risk and I am much less worried.

[Edward W Hook, MD]

The typical rash of the ARS is far more extensive than jsut 4 spotsn  You need not worry.  EWH

[redwsam]

Thank you very much Doctors for you very reassuring responses. I guess I should consider myself unlucky that eventhough I always aim for a safe sex, accidents happen to me that I can never anticipate and this really fuels up my anxiety (and phobia). I wanted to see a couseler to address my anxiety issues but unfortunately, the earliest time is in one month so I am somehow stuck here now.

So from your posts, I can conclude that my risk is zero and I should not be worried. I am also not concerned with my throat discomfort as it was very mild. The only thing that is bothering me in the back of my mind is the rash. If I may ask another question to clarify your comments; is ARS rash usually more severe (more than 4 red spots) and generalized (not just upper chest), almost always accompanied by fever and last longer than 1.5-2 days? I suspect that this why you suggested that it is not consistent with ARS, correct?

Thank you a milion times.