I am so worried about why am I so worried

[silviotoni]

Dear Doc,

By browsing through the archives I estimated my HIV risk as very very low. But why did I get a sore throat and very mild fever only 6 days after the encounter that lasted for 3 days. I deep kissed with a mucosal erosion (fresh cut) in my mouth for 1 hour, I received rimming, received oral sex twice, we mutually masturbated by exchanging hands several times and I had protected receptive anal twice. I am trying to stay calm thinking I took all possible precautions by choosing very very low HIV risk practices, but why can't I stay calm and think rationally since I am a well educated and otherwise rational person.

Apparently I did contract a virus,I guess a respiratory virus? Could this be ARS and HIV? I was exposed only to his saliva (during kising, rimming and receiving oral sex)and possibly to precum during masturbation.So what if he had blood in saliva,in quantities that are not visible or tastable, would that pose a risk given my mouth cut? I am so worried about why am I so worried when I think I know all the relevant facts? But this sore throat thing is killing me slowly.

Thank you very much.

[glad2bamom]

I'm a reader of this forum, and appreciate your advice.  I hope that some of the folks on here don't encourage you to quit responding to the questions.  I respect the fact that you don't get compensated much at all for your work on the forum, and furthermore, you venture over into other forums and answer questions for free.  
Thanks so much for all you do.

G'mom

[H. Hunter Handsfield, M.D.]

Thanks for the thanks.  It does help.  Thanks for your always-useful contributions to the forum.

HHH, MD

[monkeyflower]

Man, every time I read a thread like this, I figure you're finally going to renounce your sainthood and throw in the towel. I hope not. Not that it helps any, but I for one appreciate your advice and your perspective; I've learned so much from you and from this site. Thanks for all you do.

[Man_Apart]

I totally agree with u doctor H, the service u r doing here is great, and the $15 donation that people make to ask a question is really nothing compared to the time u spend reading and answering the questions and giving all that information and assessement, this is considered to me a volunteer work. And like u said, if someone doesnt like ur style, they are free not to come back here again!!
I am glad that u pointed out that u considered this a very low risk not because of the kissing but because of the other information given combined together, keep the good work doc and good bless u.

[silviotoni]

Thank you doctor. You are doing a great job. Since many of the people asking you questions are neurotic about their encounter, projectiong their guilt feelings into their fears, I am sure you understand that they judge every word of yours trying to reed throught you words whether their risk is somewhat different.

Deep inside we know what you meant. So the best thing would be just to ignore the prolonged disscusion with such forum members (sometimes myself included) because in their obsession with the matter they can certainly outpost you with thier questions.

I am actually amazed that you still found enough strenght and will to post a final comment to this thread.

Thank you very much. You are doing a great job, and I wonder for how long will you have patiance to continue doing so, since phsychotherapy is very demanding, and you have more important job to do in your primary experise area.

Thank you.
Silvio

[H. Hunter Handsfield, M.D.]

silvo:  "I deep kissed with a mucosal erosion (fresh cut) in my mouth for 1 hour, I received rimming, received oral sex twice, we mutually masturbated by exchanging hands several times and I had protected receptive anal twice."  That's a prolonged exposure - as opposed to the usual question on this forum, in which people mostly describe 5 min exposures, or pulling out immediately after they realized a condom broke.  I knew before your very first correction that your exposure was an hour or so, not 3 days.  Clearly your exposure carried higher risk than most by most other questioners on this forum--but still very low.

confused, do you really think I should have given silvio exactly the same advice as I would someone who describes 10 seconds of receiving a bj from heterosexual partner?  Get real.

I spend 1-2 hr per day on the STD and HIV forums, for compensation less than a tenth of the hourly equivalent of my salary.  It can take 15 minutes to read and understand some of the questions, and it is impossible to get through all of them each day without skimming repetative, rambling information.  If you don't like the advice or my style, why do you particiapte at all?  90% of the comments to MedHelp about my services are strongly supportive and appreciative.  Your comments, by contrast, are particularly ungenerous.

HHH, MD

[silviotoni]

Actually you are right. The sex was not prolonged and I received oral sex twice for several minutes. So if for practical purposes the risk of reveiving oral is zero, if for practical purposes risk of rimming is zero, if for practical purposes risk of kissing is zero, and if for practical purposes risk of mutual masturbation is zero and if for practical porposes risk of protective anal is zero, then I expected my overall risk to be practically zero. The only thing in which my mucosal erosion (after biting myself while chewing) could make a difference was not anal, rimming, receiving oral sex,mutual masturbation, but kissing.

So guys, lesson for all:don't engage in any activity if you want to be perfectly safe with anybody of unknown hiv status. If you engage in any activity other then unprotected anal sex, your risk would be characterised as low, very low, not zero according to the current inspiration for word choice of the expert answering teh question.

After all, it is not easy for the experts to assess the risks over the internet and if there is something suspiciuos to them in a particulat question they might use word low risk, or if somebody describes one instance of short exposure they may say practically zero.

[confused516]

You might as well ban this name.  Once again you decided to skim through the question.  There was nothing in the original question that said it was prolonged or that there was a lot of secretion axchange.  The anal sex was protected and you have always said that receiving oral sex is zero risk for practical purposes and you tell many people that testing is not needed if they only recieve oral sex.  That is why I asked if you were refering to the kissing, but instead of answering the question you get defensive.  All I ask is that if you are going to tell people that there risk is "zero for practical purposes" and "they dont need hiv testing" AND they can have sex with there wives without worrying about infecting them after an exposure such as recieving oral sex or deep kissing somone else than you should be consistent.  You shouldnt tell the next guy this is "low risk but not no risk". Also if people are paying you should at least take the time to read the question instead of skimming through wich you have admitted doing( you sometimes miss the question or details given)  You can ban this name I have others but I doubt i'll be coming back you are just to inconsistent.

[silviotoni]

Sorry Doc, I was fine with no follow-up questions but then was confused by additional comments. Of course that the risk is not zero.If it were I wouldn't be asking the question. The encounter wasn't that long thou, in my question I meant that the fever lasted 3 days, not sex:)

To man_apart. Your risk of kissing with chronic gingivitis is non-existant, since in reality there are more people with a sort of gingivitis rather then with perfect oral health, and the epidemiological data, based on this real people stil does't implicate kissing to be a mode of transmission.

[silviotoni]

but I only received oral sex ( i was the insertor). so why did dr.H  then said not zero risk when there are no documenetd cases of infection through receiving oral sex? may be it was kissing with the cut that made him said no zero risk.

[Man_Apart]

Trust me, when there is some confusion about sthg even if it was said before, he will reply. He is cool about that.

[confused516]

I agree but he always said for practical purposes it is Zero risk.  No documented cases ever. Even if it was .5 for every 20000 dont you think there would be at LEAST one documented case?  Alot of people only get a blow job.

[Man_Apart]

well check this out, i read on aidsmeds.com that there was studies conducted on magnetic couples (one hiv+ and one hiv -ve) in which the onley precaution taken was using condoms for anal or vaginal intersourse. (the study included gay men and heterosecual couples) they said that only 3 men seroconverted and became +ve and the only thing they did was giving oral sex to their +ve partners without condoms, the 3 cases were from the homosexual couple group not the heterosexual one, and there was no documented cases of one of the negative partners seroceonverting when they recieved the oral. check it out on aidsmeds.com

[silviotoni]

I doubt he would further comment on this, since it would be his 3 post to this question :)

[Man_Apart]

I believe he meant the (theoritical) risk of recieving oral and the rimming. I just read on one of his threads that for kissing to be a risk, the person has to be bleeding and the blood has to be coming in contact with the other person open sore/cut, I am sure of that coz my exposure was a kissing risk with gum problems (gingivitis and periodontits) and he said my risk is non existent!

[H. Hunter Handsfield, M.D.]

Dammit everybody, stop examining every thing I post for the least ****ing nuance in wording, assuming it means something different than I said before.  confused516, you do this all the time.  Once more and you will be blocked from the forum.

The question revealed rather prolonged sex, obviously with lots of secretion exchange, and with a possible mucosal lesion.  Anybody who certifies that as truly zero risk is wacko.  So is anybody who thinks it is high risk.

Sheesh.

HHH, MD

[Man_Apart]

oh my god, I just realized that i didnt mention to the doctor that i had chronic gingivitis and periodontal problems for more than a year, i didnt have bleeding gums though, not even when i brush and wasnt aware of any sores in my mouth, but i know my gums are always red.!! Now I am freaked out

[Man_Apart]

we will have to wait for the doctor to answer that!! but i think in one of the threads in the archives, he said something about fresh bleeding gums and visible blood, not just a little sore or a healed cut!

[silviotoni]

Yes I agree with man-apart. I think the doc was refering to receiving oral sex which risk is estimated to be 0.5 to 10000 exposures. I guess that kissing with a cut probably inscreases the risk somewhat but only if the other guy had blood in his saliva.

[Man_Apart]

I think he was refering to the oral sex and rimming as he always said they were very low risk , almost zero- but not zero risks- as there is a theoritical risk. I dont know if the cut in the mouth increases risk of kissing!

[confused516]

Why do you say "but not zero risk"?  He used a condom for the anal sex.  Is it because of the cut in his mouth?

[silviotoni]

Doc,
Your swiftness in responding is just amazing!
Guess what I have no follow-up questions !:)

I wish you all the best in your peronal and professional life.
Kindest regards and many thanks
Silviotoni

[H. Hunter Handsfield, M.D.]

It wouldn't make much difference even if there was visible blood.  Oral exposure to blood is not very high risk, unless in especially large amounts.

I doubt the azithromycin is why your sore throat went away.  Almost certainly it was a virus, and no virus is susceptible to any antibiotic; it would have cleared up anyway.  In any case, that's further evidence against HIV.

HHH, MD

[silviotoni]

Thank you Doc.

I took azitromycin and my sore throat was gone in a day or two.

You didn't comment on the other part of my question about blood not beeing present in saliva in visible quanitites.I guess if you can not see it or taste it than it is not relevant, right?

Thank you.
Silviotoni