Going nuts, need advice please

Again thank you for the input in advance.

I had protected intercourse with a pro about one week ago.  She did give me oral with a condom and we had brief intercourse again with a condom.
We changed condom twice because I was too nervous.  I don

[H. Hunter Handsfield, M.D.]

I continue to be amazed at people's inability to translate what they intellectually know, and what they see when they read other threads and my comments, to their own situations.  But here goes again.

You had totally safe sex and could not have acquired a urethral STD, or HIV.  No STD can cause immediate pain; it always takes at least 2 days for symptoms to start.  The only rational explanations for your immediate pain are 1) chemical irritation, especially if you used a condom whose lubricant contained the spermicide nonoxynol-9, 2) latex allergy, 3) some other physical injury, or 4) anxiety.  Of these, a chemical cause seems the best bet.  In any case, it cannot be due to an STD acquired during that exposure.  In you turn out to have chlamydia or gonorrhea, it will be from some encounter other than the one you describe.

I agree with other respondents' comments before mine (below), in particular about how important it is to not look to the internet for advice about symptoms.  Or if you do, to use only monitored professional sites, not commercial ones; to pay attention to context regarding symptoms; and to disregard unmonitored comments by nonprofessional participants.

HHH, MD

[abbr]

Thanks dude, I'm just going nuts cause I've had unusal bowel movements since then. Not diarrhea but been going more often than usual.  Maybe it's my hearburn.

Also I'm checking my tongue and I'm worrying myself thinking that I see white stuff on it.

The thing that's driving me nut is that it's only one week and I've read that it usually takes two weeks for symptoms to appear and to get a good test wait 4 weeks.

[abbr]

realized my nickname isn't displayed.


Jster

[marc4311]

even if u have white tongue that is not a symptom of ealy infection (thrush) would happen way later.

[abbr]

Again thanks, I swear you can't believe everything you read online!

[ode2med]

Reasearching on line is definately one way to drive yourself nuts.  With what I thought were symptoms gave me everything from SARS to HIV. Doc is gonna tell you only way to know for sure is to get tested.  But seeing that you have practically no risk he might advise against it, unless of course it will make you feel better.  But that's at the 6 week mark.  No need to worry my man, you're good!

[anxietyX5]

I have a question for anyone that knows the answer.how long does it take for other symptoms to appear other than flu like symptoms that appear between 2-4 weeks

[H. Hunter Handsfield, M.D.]

"I'm just going nuts cause I've had unusal bowel movements since then. Not diarrhea but been going more often than usual. Maybe it's my hearburn.  ...I'm checking my tongue and I'm worrying myself thinking that I see white stuff on it."


Those are not symptoms that suggest ARS, regardless of what you have 'learned' on the web.

The thing that's driving me nut is that it's only one week and I've read that it usually takes two weeks for symptoms to appear..."

That is reassuring, not something to drive you nuts.  Since ARS cannot start within a week, that's additional evidence against ARS as the cause.

"...and to get a good test wait 4 weeks."

From a medical or risk perspective, you don't need testing.  If you were my patient and your result were to be positive, my first response would be to look you in the eye and say "OK, let's talk about your real risks and where you got this.  Because it wasn't from the encounter you describe."  But feel free to be tested if having the negative result will help relieve your anxiety.

HHH, MD

HHH, MD

[abbr]

Thank you doctor and no that would be the only encounter that would be any cause of this issue.

I've been very careful before and one night of mistake is causing more stress than ever.

[VTStallion]

In your original response, you suggested to get information from professional monitored sites. I have been on thebody.com, aidsmeds.com, aegis.org, and, of course, this one. Are these sites reliable in your opinion? And do you have any other suggested sites?

[marc4311]

Im obviously not the doc but I can tell u that the cdc (when i called) and the Canadian national hiv/aids centre have both informed me that thebody.com is a very reliable source and to not do general online searches.

Supposedly most of the info u get online are for symptoms in the longterm effects like (thrush, weight loss and the mental problems, tingling all that because most people don't realize their exposure and or symptoms till way down the line...


I think the doc should stop answering questions about PROTECTED SEX and ORAL SEX....ur not gonna get hiv from those and there are people who are actually at risk from their exposures.  

thats my 2 cents

[VTStallion]

I knew that thebody.com was a reliable source. I was mainly wondering the good doctor's opinion on the other websites.

[marc4311]

Oh well i cant speak for him but i will tell u...... DONT search a bunch even if they are reliable! if u have to dude then stick to one because u may hear what sounds like conflicting stories but usually its because us non-doctors dont understandfully to begin with and ull drive urself EFFIN nuts dude

[abbr]

I really appreciate the doctor's effort on this site. I think that when one is presented with a life threatning illness,it is hard to remain calm and logical.

Include fear and lack of knowledge you get people like me freaking out.

Again as mentioned before, even though many posts are similar, the service provided here is priceless.  Many people do not fully understand STD's and are afraid to find out.

One thing for sure is that I learned my lesson.

Jster

[skerdstraght68]

I think of this site as a HIV eye for the straight guy.  I know this sounds horrible and it sucks but I do feel like aidsmeds or thebody focus heavy on the msm population where HIV is more rampant and equate the same fears to the straight popluation.  They do equate hetero vaginal sex as risky behavior equal to MSM  but is it really? I think the CDC over the years has used scare tactics at times to prove to americans that HIV is not a gay disease which it's not I agree, but their tactics has thrown the striaght community into a frenzie at times.  Look at aidsmeds or this site.  99% of everyone freaking out are straight yet almost everyone remains neg.  If I had to refer a straight guy/gal to one site it would be here only because logic is built into the equasion not just "Guidelines"  

I hate the word "Conclusive" because it undeminds the word "reliable"  Can anyone give me a conclusive answer to weather or not I will have a heart attack tonight?  Of course not, but in all reality the odds are extreemly low.

[JohnnyV]

Skeredstr8,

Here's an article you ought to read:

http://www.gay.com/news/article.html?date=2006/09/18/5&from=homepage

The line between gay and straight sex is blurred.

Anyway, it sounds as though you've looked around for a website that will provide comforting statistics, so that you can believe that your straightness entitles you to unsafe sex or a "pass" on protection that gay and bi men don't get. This certainly is a website that gives straight men, from time to time, a relaxing pat on the back. But you know what Thomas Jefferson said in the Declaration -- "a decent respect for the opinions of mankind...." You have found one website that makes you feel okay and a bunch that give contrary information.... You have to add them all up and come up with some kind of aggregate assessment of your risk.

The aggregate assessment should be that your sexual identity is not as relevant to your risk as your sexual behavior. If you are straight and you have lots of unprotected sex, you are at risk, period, punto, end of story. If you are straight and you want to know if you have HIV, you need to take a test, punto, end of story.

I like to use the example of the studies that show black men run a higher risk of heart attacks. If you're white, that doesn't mean you can run out and load up on bacon, roast beef, and malt liquor.

J

[skerdstraght68]

I understand your fustration for the "ignorant" hetero looking for HIV info they can easily lead to believe that thier one time vaginal sex was considered "high risk" when even you would agree that in the US that for this act, the  risk is far less than MSM.

[monkeyflower]

"The aggregate assessment should be that your sexual identity is not as relevant to your risk as your sexual behavior. If you are straight and you have lots of unprotected sex, you are at risk, period, punto, end of story. If you are straight and you want to know if you have HIV, you need to take a test, punto, end of story."

I completely agree. Your behavior is the determining factor, not your self-identification. A guy who calls himself straight and has sex with men is at just as much risk as a guy who identifies as gay. Probably more.

"I like to use the example of the studies that show black men run a higher risk of heart attacks. If you're white, that doesn't mean you can run out and load up on bacon, roast beef, and malt liquor."

That's true--if the straight guys were having sex with men. In this case, though, you're comparing apples to oranges. For your analogy to work, the straight guys would have to be having sex with men... but that's not the case here. With a few exceptions, the straight guys on this forum are freaked out about unbelievably safe encounters with women, NOT men. Like it or not, statistically speaking, the risks of contracting HIV through MSM are much higher. It's not an anti-gay bias by any means; it's just the facts.

[monkeyflower]

Too funny. Someone JUST posted this article on a sexuality listserv I belong to:

http://www.dfw.com/mld/dfw/news/nation/15554800.htm

Johnny: What I guess I'm trying to say is that your analogy works beautifully for those guys who identify as straight but are having sex with men. It's that behavior that matters, risk-wise. Straight guys having sex with women is a different story.

Of course that's not to say that repeated indiscriminate unprotected sex with lots of anonymous women isn't risky, because it can certainly be as risky as the same behavior with MSM. But I also think you have to take into account that since 99% of the posters here have about the safest exposures you can possibly imagine, the risks are obviously going to be much lower than some guy who had unprotected receptive anal in an anonymous hookup. :-)

[H. Hunter Handsfield, M.D.]

I haven't been following this discussion closely, just skimmed the past few comments, especially between monkeyflower and JohnnyV.  I'll just point out that HIV definintely is a bigger risk for gay men than for heterosexuals, for three reasons.  

1) Gay culture fosters more frequent partner change and larger numbers of sex partners, undoubtedly determined by a combination of social and biological factors.  Of course we're talking about trends and generalizations, not facts that apply to every individual in any group, gay or straight, male or female.

2) Anal sex is by far the most efficient sexual mechanism for HIV transmission, much more so than vaginal sex.  (And oral sex is so inefficient that AIDS would die out if it were the only sexual interaction.)  Biologically, the rectum did not evolve as a sexual organ, and both trauma (overt or microscopic) and the one-cell-layer thick lining enhance transmission efficiency in both directions.

3) Once an infection achieves a certain prevlance in a population, it tends to become self-sustaining.  Put simply, because of factors 1 and 2, a much higher proportion of gay men in most societies have HIV, so any new partnership carries a higher chance of sex between an infected and uninfected person than for most straight men and women.

The bottom line (no pun intended) is that even at similar measures of sexual safety (no. of partners, frequency of partner change, condom use), HIV is a higher risk for men who have sex with men than among exclusively heterosexual men and women.  But it also is true that every person, gay or straight, has the ability to protect him/herself against HIV with virtually 100% certainty--even if the challenge in doing so is more difficult for gay men.

HHH, MD

HHH, MD

[skerdstraght68]

If you are a guy who has sex with guys you are not straight.  You are Bi. Straight guys assume that Straight means, "I've never been with another guy before" Which it does.

[H. Hunter Handsfield, M.D.]

"Straight guys" might make that assumption, and that's the classical heterosexual perspective.  But it is wrong, and health/prevention experts (and many sexually active people) don't view things in such a simplistic way.  How would you classify the guy who isn't attracted to men but is coerced into sex in prison?  What about the teen confused about his sexual identity who has a single experience with oral sex in a dorm room?  There are whole cultures around the world that distinguish sexual practices from sexual orientation.

HHH, MD

[skerdstraght68]

So does that mean that when the CDC posts heterosexual cases a good chunk are from stright guys who decided to experiment?  It's highly misleading to "straights"  if that is the case.  Maybe they should list the acts rather than the persons sexual orientation.

[skerdstraght68]

Doc, just when you post to someone with a, "no need to test" statement, this article comes out asking everyone to test regularly. UGH.  I work at a newspaper and this just came across the wire.  After reading I thought, I dont think I can keep testing.  I just tested 3 times in 10 weeks.   Obviously when I read this I thought.  ****, I need to retest..  

U.S. health officials urge routine HIV testing for all Americans, ages 13-64, to curb spread

By MIKE STOBBE
AP Medical Writer
ATLANTA (AP)

[monkeyflower]

When I read that article earlier today, I just knew someone would freak out about it. Relax. They're just recommending making HIV testing a part of the routine bloodwork you have at every annual visit. It's like getting your cholesterol checked. That's all.

[skerdstraght68]

I cant even imagine a 13 year old dealing with it

[skerdstraght68]

I cant even imagine a 13 year old dealing with it

[monkeyflower]

Most people by far are nowhere near as afraid of testing as you apparently are. For instance, I guarantee I'm at much higher risk than you are in any given encounter, yet I only get routinely tested once a year. I worry no more about it than I do having my blood pressure checked (and fyi, I'm not overweight, no one in my family has HBP, AND I'm genetically salt-resistant, so I'm particularly unconcerned). Despite what you see on this board, I'm pretty sure most people feel equally relaxed about testing.

This sounds like a huge issue for you, one that significantly impacts the quality of your life. I think it would be good for you to see a therapist, if you're not already.

[HHH,MD]

SS68:  "Doc, just when you post to someone with a, 'no need to test' statement, this article comes out asking everyone to test regularly....  I just tested 3 times in 10 weeks. Obviously when I read this I thought. ****, I need to retest.."

You are overreacting and have totally misintreted the new guidelines and my advice in response to specific risky (or not so risky) situations.  The notion that everybody should be tested once to uncover infetions in people who are at risk but deny it, or who don't even know they are at risk (because they don't know their spouse/partner has HIV), is very different from whether testing is warranted after a particular exposure. I know something about this topic; see this link to the new CDC guidelines themselves (look at the authors).

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm.

HHH, MD

[skerdstraght68]

got a dead link...

[H. Hunter Handsfield, M.D.]

Try again.  The link still works fine.  Or just go to CDC home page (www.cdc.gov) and follow the obvious links to the new recommendations.

[skerdstraght68]

OK, I got it going.  I see your contribution.  Good stuff.  How does the CDC usually get it's information?  From M.D.'s or a self appointed group of investigators?  

[H. Hunter Handsfield, M.D.]

I'm not sure what you mean by "get information"?  Do you mean how do they develop recommendations?  Systematic and comprehensive review of the literature and other available data by CDC personnel, the consultation (repeatedly) with non-CDC experts and interest groups.  The recommendations document itself describes the rationale and the process, as well as the recommendations themselves, and lists the outside consultants and the groups they represented.  The same basic process is followed for all CDC guidelines, not just HIV/AIDS.  It is all based on science; policy is always influenced by political and social considerations, but science always is the first and dominant driver.

HHH, MD

[skerdstraght68]

The dumb obvious question in reguards to HIV is "window periods"  It's by far the biggest conflicting topic on HIV testing.  I have heard countless HIV professional and MDs state what you do about current HIV test.  The only ones that don't are the ones that follow the CDC "guidelines" not the science.  If MDs and professionals and even states for that matter state that the current window periods with current testing methods are shorter than what is currently enforced by the CDC, what's the reasoning for not following suit.  I've done probably more research on HIV transmission than most doctors and I have yet to come across ANYONE state that they EVER see negs turn pos after 6-8 weeks.  If this is the case, it seems logical for the CDC to at least investigate the matter and post it's findings.  If they posted stuff that said, "we have concluded an investigation and here were the results based on window periods," we/doctors would have something more solid to stand on.  It would even give those that follow guidlines something more than giving us the "13 week is only conclusive" which is based on what the CDC has told them.  This reply is probably predictable but it's the truth on how alot of us feel about the CDC.

[H. Hunter Handsfield, M.D.]

CDC has nothing to do with it.  Precise data on window period DO NOT EXIST.  All we have are the best estimates of experts, based on their understanding of the antibody levels and test characteristics.  To the extent information is available at all, the data don't come from CDC, but from test manufacturers.

Further, there will not be more precise data in the foreseeable future.  In order to nail down the window period with statistical certainty, you would need to study several hundred people with a known time of exposure and test them once a day (or at least every 2-3 days) for 3+ months. Probably this study will never be done in adults.  Most newly infected people do not know which date/exposure infected them, because almost nobody has only a single possible exposure.  (Few infected people have the single exposures described in most questions on this forum.)  And to be honest, such research is not a very high priority.  Few people in the public health, prevention, or HIV treatment fields see all that strong a need for more precise data--unlike many of the people on this forum.

As all my comments have implied, I am reasonably certain that if such a study could be done, it would show that almost all infected people would be positive within 6 weeks.  But you cannot fault CDC for sticking to the formal information as stated by the test manufacturers and certified by FDA--i.e., 3 months.

HHH, MD

[abbr]

Ok I went and go tested about 3 weeks from the encounter and it came back negative.

Is this long enough to wait for testing?

[shesix8976]

Hi, my fiance told me that he cheated on me and that a woman he met at a bar, a stranger gave him oral and he got gonorhrea....I have been told u can get gonorhrea from oral sex if she had it in her mouth. I am 7 months pregnant and we had sex 3 times after this unprotected, he didnt know he had the STD until after we had sex 3 times.  My concern is for me and my baby, i did get gonorhea and have been treated for it. Im REALLY concered about my fiance may have gotten HIV from this woman and given it to me, and what if he is lying to me and he did have sex with her without protection??? I tested 6days after exposure it came back neg, although i know it wasnt enough time to test. Nurse at health dept said that its low risk even if he did have unprotected sex with her. WE are getting tested again at 30days which the nurse said it would be conclusive. All I do is worry about this 24/7, please help. I have had slight headaches, leg cramps, and today 15 days after last possivle exposure my glands feel sore. I'm not sure if the cramps in legs and headache is from pregnancy or maybe headache from all the  stress...please help.