Expert: Terry B - 3/28/2007

Question
QUESTION: 2 and a half weeks ago i had a cold sore on my lip. it was busy healing. i met a guy in a bar and we had PROTECTED anal sex, but i also had oral sex with him (performing) and he had some pre-cum. he came on the side of my face but i dont think anything came onto my lips. i was very paranoid after that and went to a sexual health clinic to get some PEP. the doctor told me they would not normally give pep for oral sex, but seeing that i personally think i might have a risk and that it is an unusal case, they gave me pep. i am not sure if this guy was hiv positive.

i've been on pep now for 16 days. i met a guy recently and we started a relationship. last night we got carried away and i performed unprotected insertive anal sex with him without ejaculation, i do however get pre-cum. i cant believe i made this mistake. he assured me he is hiv negative.

do u think there is any chance that if i might have been infected with hiv (not sure if i was exposed to the virus though), but taking the pep for a few weeks now, still be able to transmit it over to my new partner? i am really worried about this.

i would appreciate your advise
ANSWER: Dear Gary:

Peace.  There are a couple of questions in here and I will try to take them one at a time.  

First, no offense to whichever random person I might offend, but I suspect that few people who are interested in sex with someone (especially someone they have recently met) would be truthful about their HIV status in the midst of unprotected sex.  Even if you've been in this "relationship" for almost 16 days.  Assume your partner is positive unless you have incontrovertible evidence; trust but verify.

Secondly - by "PROTECTED" I assume you mean condom use.  Understand please, use of a condom all the time and every time is almost 100% effective; but this means an intact latex condom put on prior to ANY contact with the blood, vaginal secretions, or semen of the partner.  Accidents, condom breaks, and/or passion overcoming judgement and plans keep this less than 100% effective.  An open, weeping sore such as sometimes presents with Herpes (cold sore) produces fluids (blood products) which may contain HIV as well.  This means if you were exposed to semen (yes, precum is semen) on your open cold sore, you have an exposure; also, if you were infected, you could possibly transmit HIV to another by their contact with your blood and drainage from the sore.  

Regarding unprotected anal sex, a couple of things to keep in mind.  One, as noted, precum is semen - the advantage in withdrawing prior to ejaculating is reducing the amount of potentially infectious fluids.  Another concern is that anal sex sometimes stretches membranes and causes breaks; it has also been presented in scientific conferences that the action of the large intestine is to extract fluids and nutrients from contents; this action may actually allow HIV to be absorbed through the membrane wall.

Lastly, your question about Post-Exposure Prophylaxis (PEP):  If you are taking the medications as prescribed, and if the virus to which you may have been exposed is not resistant to any or all of the medications, the amount of virus present in your fluids might be low enough as to not place the person with whom you had intercourse at great risk.  I know of no research of studies where a number of persons on PEP had went out and had unprotected sex and then were tested for transmission; that is really what would be required to answer your question with a solid, evidenced-based trial.

Those are the facts as I can present them to you - add these to your fund of information about HIV and Sexually Transmitted Infections, and please do some self-examination about your health and your own risk behavior.  You need to develop some strategies to ensure you are upfront and aware of your own risk - based not on what you wish you could do  but upon what you have done - and ensure you are prepared to follow through with those plans.  As I read it, you have been in two increasingly dangerous (for disease transmission) situations within a little more than two weeks.  Please avail yourself of counseling that might be available at your local testing center - they should be able to answer your questions and help you develop effective risk reduction strategies for the future.

I hope this helps, and I wish you peace and increased safety and satisfaction in the future.

Terry

---------- FOLLOW-UP ----------

QUESTION: thanks for the reply.

one thing i want to ad is that the cold sore was not an open wound anymore. In the beginning of the evening it almsot looked healed, but the next day after having a shower etc, it started bleeding. i also did not perform oral sex on this person for a long period.  

Answer
Dear Gary:

Again, peace.  "Almost healed" is still "almost" - with friction, stretching, etc... as you learned in the shower it constitutes broken skin.  My concern is for your safety and that of your partners.  I hope all goes well for you.  Thank you for your prompt reply - almost like talking, eh?

The very best to you.

Terry