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STDs (Expert Forum)
Learning Tool: Please HELP
Answered by
University of Washington
Seattle - WA
This forum does not cover AIDS/HIV issues. This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomonas, Warts, Yeast Infection.
IMPORTANT
This forum is limited to questions about STDs other than HIV/AIDS. For questions about HIV prevention, or if you have general questions about safe sex (e.g., condoms, how to protect yourself from HIV and STDs), please visit the HIV Prevention and Safe Sex Forum
Some of the most common types of questions concern the risk of HIV or STD after a particular sexual exposure, and about symptoms that might or might not be due to HIV. If your question is along these lines, please visit the HIV Prevention and Safe Sex Forum.
This forum is limited to questions about STDs other than HIV/AIDS. For questions about HIV prevention, or if you have general questions about safe sex (e.g., condoms, how to protect yourself from HIV and STDs), please visit the HIV Prevention and Safe Sex Forum
Some of the most common types of questions concern the risk of HIV or STD after a particular sexual exposure, and about symptoms that might or might not be due to HIV. If your question is along these lines, please visit the HIV Prevention and Safe Sex Forum.
Learning Tool: Please HELP
by SeattleMan, Sep 30, 2005 12:00AM
Dear Doctor:
I’ve been checking out this Forum for a while, as well as The Body, Aegis.com, and Aidsmeds.com, and it seems to me that the same folks are writing in all these Forums (based on the questions). I just wanted to add some comments and get some input from you. I thought this posting could serve as “cheat-sheet” for worried wells.
1. Vaginal Sex and Condom: I don’t understand “why” a lot of guys can petrified after having one episode of vaginal sex with a prostitute with a CONDOM. Provided that the condom does not break or “slip off,” don’t we have enough science to back up the FACT that “no HIV transmission” will occur? It is a much different story is the condom breaks or “falls off,” because in those cases, protection is lost.
2. Circumcision: Why all the “fuss” about not being circumcised? So long as you are wearing a condom THAT DOES NOT BREAK or “fall off,” then it should not matter whether you are circumcised or not.
3. Oral Sex. This I will break down into two categories: receptive and insertive.
RECEPTIVE: People, stop trying to split hairs. Although the risk is quite low in RECEPTIVE oral sex, the fact remains that the risk cannot be ZERO. The person GIVING oral sex is potentially exposing his or her mouth to “potentially infectious fluids.”
INSERTIVE: Doctor, why are so many guys making a big deal out of this, especially uncircumcised guys (see above)????? Listen up, guys: when someone gives you fellatio, you are being exposed to SALIVA. Saliva will NOT infect you, even if you are NOT circumcised. Non-infectious fluid is NON-INFECTIOUS, period. What would it take to infect you? Blood from the person’s mouth, whether from the gums, a puncture, or whatever weird scenario your imagination can muster. Do you see why INSERTIVE oral is basically NO RISK? Unless you are STUPID enough to let someone give you a blow job with blood in his or her mouth, you will not get HIV. HOWEVER, you can get STDs. Thus, if all you’ve done is INSERTIVE, then stop stressing out over HIV. You do not have HIV.
4. Risk Assessment: It seems that everyone who uses a condom with vaginal sex or gets insertive oral sex always wants the Doctor to say ZERO RISK. All he can say is “under what conditions” is transmission possible. I’m sorry guys, but the doctor cannot say ZERO RISK for the following reasons: (a) People often lie about their exposures, b) the doctor was not there, and (c) People often time have sex when drunk, and they do not report their activities accurately. For example, people will often say vaginal sex was protected, even though they waited until before cuming to put on the condom. This is common, and people will still write in and claim that their contact was protected.
I hope this has served as good tool for worried-wells. And I look forward to the doctor’s comment. PLEASE feel free to CORRECT me or ADD, Doctor. I defer to you 100%, of course.
I’ve been checking out this Forum for a while, as well as The Body, Aegis.com, and Aidsmeds.com, and it seems to me that the same folks are writing in all these Forums (based on the questions). I just wanted to add some comments and get some input from you. I thought this posting could serve as “cheat-sheet” for worried wells.
1. Vaginal Sex and Condom: I don’t understand “why” a lot of guys can petrified after having one episode of vaginal sex with a prostitute with a CONDOM. Provided that the condom does not break or “slip off,” don’t we have enough science to back up the FACT that “no HIV transmission” will occur? It is a much different story is the condom breaks or “falls off,” because in those cases, protection is lost.
2. Circumcision: Why all the “fuss” about not being circumcised? So long as you are wearing a condom THAT DOES NOT BREAK or “fall off,” then it should not matter whether you are circumcised or not.
3. Oral Sex. This I will break down into two categories: receptive and insertive.
RECEPTIVE: People, stop trying to split hairs. Although the risk is quite low in RECEPTIVE oral sex, the fact remains that the risk cannot be ZERO. The person GIVING oral sex is potentially exposing his or her mouth to “potentially infectious fluids.”
INSERTIVE: Doctor, why are so many guys making a big deal out of this, especially uncircumcised guys (see above)????? Listen up, guys: when someone gives you fellatio, you are being exposed to SALIVA. Saliva will NOT infect you, even if you are NOT circumcised. Non-infectious fluid is NON-INFECTIOUS, period. What would it take to infect you? Blood from the person’s mouth, whether from the gums, a puncture, or whatever weird scenario your imagination can muster. Do you see why INSERTIVE oral is basically NO RISK? Unless you are STUPID enough to let someone give you a blow job with blood in his or her mouth, you will not get HIV. HOWEVER, you can get STDs. Thus, if all you’ve done is INSERTIVE, then stop stressing out over HIV. You do not have HIV.
4. Risk Assessment: It seems that everyone who uses a condom with vaginal sex or gets insertive oral sex always wants the Doctor to say ZERO RISK. All he can say is “under what conditions” is transmission possible. I’m sorry guys, but the doctor cannot say ZERO RISK for the following reasons: (a) People often lie about their exposures, b) the doctor was not there, and (c) People often time have sex when drunk, and they do not report their activities accurately. For example, people will often say vaginal sex was protected, even though they waited until before cuming to put on the condom. This is common, and people will still write in and claim that their contact was protected.
I hope this has served as good tool for worried-wells. And I look forward to the doctor’s comment. PLEASE feel free to CORRECT me or ADD, Doctor. I defer to you 100%, of course.
Doctor's Answer
by H. Hunter Handsfield, M.D., Oct 01, 2005 12:00AM
, Oct 01, 2005 12:00AM
I haven't analyzed your comments with enough care to declare full agreement and don't want to be held to the details, but in general they seem pretty accurate. I don't see any particular questions to me, except the rhetorical (?) one about human nature. You're reallly asking "Why do so many people feel they are at risk despite the facts indicating the risk is low?"
You could ask the same question about many social and medical issues of our time: Why do some parents refuse to believe the data on vaccine safety and therefore risk their kids' health and life by not getting routine childhood immunizations? Why do people fear criminals with guns more than the risks of having a gun in the home, even though the risk of death or injury is higher from having a gun in the house than from criminal activity?
Part of the answer (but by no means all of it) is fear of the unknown, which is why a reasoned statement of accurate information is a necessary first step--and that is the main purpose of this forum. People need to put sexual risks into perspective: the sexual revolution (which basically comes down to improved equality in sex across gender and sexual orientation) was, on balance, a positive sociological development. It brought with it an increased risk of certain adverse outcomes. But the fact remains that with a little planning, foresight, and common sense, sex can be safe as well as rewarding; and even when unsafe, usually does not result in a bad outcome.
In response to one of your comments below, in my responses that speculate about emotion, anxiety, and psychological explanations fo symptoms, I have always been very careful to distinguish between obviously physiologic symtpoms (stress won't cause a fever of 101 degrees for example) and those that might be psychogenic. And when someone says "flu-like", that can mean very different symptoms from one person to another.
Regards-- HHH, MD
You could ask the same question about many social and medical issues of our time: Why do some parents refuse to believe the data on vaccine safety and therefore risk their kids' health and life by not getting routine childhood immunizations? Why do people fear criminals with guns more than the risks of having a gun in the home, even though the risk of death or injury is higher from having a gun in the house than from criminal activity?
Part of the answer (but by no means all of it) is fear of the unknown, which is why a reasoned statement of accurate information is a necessary first step--and that is the main purpose of this forum. People need to put sexual risks into perspective: the sexual revolution (which basically comes down to improved equality in sex across gender and sexual orientation) was, on balance, a positive sociological development. It brought with it an increased risk of certain adverse outcomes. But the fact remains that with a little planning, foresight, and common sense, sex can be safe as well as rewarding; and even when unsafe, usually does not result in a bad outcome.
In response to one of your comments below, in my responses that speculate about emotion, anxiety, and psychological explanations fo symptoms, I have always been very careful to distinguish between obviously physiologic symtpoms (stress won't cause a fever of 101 degrees for example) and those that might be psychogenic. And when someone says "flu-like", that can mean very different symptoms from one person to another.
Regards-- HHH, MD
I don't know if you want any other forum members to respond to your post; it sounds like you have a grip on everything and don't really need us to confirm your facts.
The only point I'd make is to be patient with people who are worried about HIV. I have to admit, it's surprising how many times people can be given the same facts and still second-guess things. I've had a lot more risk than most people on the forum, so it strikes me as strange that others experience so much anxiety about no-risk or low-risk experiences. But at the same time, most people who post questions here are dealing with a lot more than just the biological questions about HIV. They are struggling with guilt, sexual taboos, desires they can't seem to suppress, and fear of losing the support of loved ones or the acceptance of their community.
Your cheat sheet is very helpful. But don't get discouraged if people aren't fully convinced by it and they revisit the same questions again. I see you've been looking at some other sites that have a different tone to them. If possible I would encourage people here to stick with the overall politeness and sobriety of medhelp. Aidsmeds is full of meanness and bitter invective. Thebody.com is good but Dr. Bob, while consummately knowledgeable, is often wry and sarcastic; and it's not uncommon for him to mock people. Other websites are more professional, but hide a moral agenda that gets in the way.
I can only speak for myself; often I post things here because I sincerely sympathize with other forum members, or I generally enjoy the exchanges between myself and others. That may mean I am an accomplice to those repetitive conversations that seem to annoy you. It's not ignorance, but a reflection of my own inclinations.
Thank you for the information you've posted, and I hope the doctor can add to it. As one of the forum regulars I appreciate it, but I'm still hesitating to adopt an aggressive attitude toward people whose questions seem frivolous or overblown.
Thank you,
J
In all my research the only thing that "stumps me," is the "whole thing of symptoms." Many folks have an exposure, and then they have symptoms yet continue to test negative.
Clearly, some symptoms are consistent with anxiety. HOWEVER, there are other symptoms that are not caused my anxiety such as:
(1) flu symptoms, (2) swollen lymph nodes, etc.
What gives?
So, are we saying that someone can have a REALLY high-risk situation, say "receptive anal" with an HIV+ person, then get swollen lymph nodes + the flu...three weeks later...yet that simply be a coincidence, and then test negative??
Feel free to correct anything that I said in my original poster, 'mano.
Of course. Why is that surprising? Just because you're exposed to a virus doesn't automatically mean you'll get it - and coincidences DO happen. Plus, as Dr. Handsfield has said before, what people perceive as swollen lymph nodes may not really be swollen (or are swollen for another reason). Certainly anxiety exacerbates perfectly normal bodily sensations, and causes you to interpret them differently. For instance, maybe you feel sorta tired and achy, like I did yesterday. I figured I've just been working too hard and hadn't gotten enough sleep lately, so I went to bed a little earlier than usual last night. Today I feel fine :-) However, if I were worried about HIV, I might have attributed my soreness to an infection, and started to be hypervigilant about any other possible symptoms. Then I'd decide that why yes, I do have a sore throat, and gosh, I do feel a little warm... and gee, is that a sore on my arm? etc. Before I knew it, I'd have convinced myself I had full-blown AIDS. See what I mean?