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HIV Prevention (Expert Forum)
Going nuts, need advice please
by abbr, Sep 18, 2006 12:00AM
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’t think the condom broke in any ways. She did however finish me with a hand job and lotion without a condom.
When I ejaculated I felt extreme burning. Now I have some constant burning on the fore skin/ outer layer of my penis (am I not circumcised).
I went to get checked for Chlamydia & Gonorrhea. It’s been over one week and I’m not really experiencing any symptoms except a slight sore throat.
I know you’ve heard this one a million times but I’m going crazy just worrying about it. And I really would appreciate your input on this.
What are the chances of being exposed in my encounter?
I’m still experiencing some slight burning, which is very similar to the yeast infection I got from my ex a while back.
I’m being super paranoid right now, just need a few words of assurance, thank you.
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’t think the condom broke in any ways. She did however finish me with a hand job and lotion without a condom.
When I ejaculated I felt extreme burning. Now I have some constant burning on the fore skin/ outer layer of my penis (am I not circumcised).
I went to get checked for Chlamydia & Gonorrhea. It’s been over one week and I’m not really experiencing any symptoms except a slight sore throat.
I know you’ve heard this one a million times but I’m going crazy just worrying about it. And I really would appreciate your input on this.
What are the chances of being exposed in my encounter?
I’m still experiencing some slight burning, which is very similar to the yeast infection I got from my ex a while back.
I’m being super paranoid right now, just need a few words of assurance, thank you.
Doctor's Answer
by H. Hunter Handsfield, M.D., Sep 18, 2006 12:00AM
, Sep 18, 2006 12:00AM
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
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
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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.
Jster
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
I've been very careful before and one night of mistake is causing more stress than ever.
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
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
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.
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
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.
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. :-)
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
HHH, MD
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) — Federal health officials Thursday recommended regular, routine testing for the AIDS virus for all Americans ages 13 to 64, saying an HIV test should be as common as a cholesterol check.
The U.S. Centers for Disease Control and Prevention guidelines are aimed at preventing the further spread of the disease and getting needed care for an estimated 250,000 Americans who don’t yet know they have it.
“We simply must improve early diagnosis,” said CDC Director Dr. Julie Gerberding.
Nearly half of new HIV infections are discovered when doctors are trying to diagnose a patient who has already grown sick with an HIV-related illness, CDC officials said.
“By identifying people earlier through a screening program, we’ll allow them to access life-extending therapy, and also through prevention services, learn how to avoid transmitting HIV infection to others,” said Dr. Timothy Mastro, acting director of the CDC’s division of HIV/AIDS prevention.
Although some groups raised concerns, the announcement was mostly embraced by health policy experts, doctors and patient advocates.
“I think it’s an incredible advance. I think it’s courageous on the part of the CDC,” said A. David Paltiel, a health policy expert at the Yale University School of Medicine.
The recommendations aren’t legally binding, but they influence what doctors do and what health insurance programs cover.
However, some doctors’ groups predict the recommendations will be challenging to implement, requiring more money and time for testing, counseling and revising consent procedures.
Some physicians also question whether there is enough evidence to expand testing beyond high-risk groups, said Dr. Larry Fields, the president of the American Academy of Family Physicians.
“Are doctors going to do it? Probably not,” Fields said.
But the recommendations were endorsed by the American Medical Association, which urged doctors to comply. The CDC said it’s difficult to predict how many doctors will.
Previously, the CDC recommended routine testing for those at high-risk for catching the virus, such as intravenous drug users and gay men, and for hospitals and certain other institutions serving areas where HIV is common. It also recommended testing for all pregnant women.
Under the new guidelines, patients would be tested for the AIDS virus as part of the standard tests they get when they go for urgent or emergency care, or even during a routine physical.
The CDC recommends everyone get tested at least once, but annual testing is urged only for people at high risk.
Consent for the test would be covered in a clinic or hospital’s standard care consent form. Patients would be allowed to decline the testing. The CDC’s guidelines say no one should be tested without their knowledge.
An American Civil Liberties Union official protested the CDC’s idea of dealing with HIV on standard consent forms, and the agency’s de-emphasis of pre-test counseling.
“By eliminating these safeguards, what they’re calling ’routine testing’ will in practice be mandatory testing,” said Rose Saxe, a staff attorney with the ACLU AIDS Project.
The cost of the new policy is not clear. A standard HIV test can cost between $2.50 and $8, public health experts say.
New rapid tests cost about $15. If an initial result is positive, confirmatory tests can cost another $50 or more. Treatment for HIV can cost more than $10,000 a year.
WellPoint, the Indianapolis company that owns 14 Blue Cross and Blue Shield plans across the country, has not yet taken a position on the CDC guidelines.
It also hasn’t estimated what it will cost to expand HIV testing for its 34 million members, but it traditionally covers tests recommended by the CDC, said WellPoint spokeswoman Shannon Troughton.
The recommendation, if fully implemented, could mean testing for to 100 to 200 million Americans, said Ron Spair, chief financial officer of Pennsylvania-based OraSure Technologies, one of three companies that sell rapid-result HIV tests in the United States.
The other companies are MedMira Inc. and Trinity Biotech. Standard HIV tests are done through both public health labs and private and commercial labs.
“This certainly expands the rapid HIV testing market,” Spair said.
Identifying more HIV patients will place an added burden on public health programs that pay for such care, some of which are facing potential cuts under a proposal before Congress. But more diagnoses may help win bolstered funding, said John Peebles, an assistant branch chief over HIV programs at the North Carolina Department of Health and Human Resources.
“If you don’t know what you need, you can’t make the argument for resources,” Peebles said.
The CDC has been working on the guidelines for about three years, and got input from more than 100 groups, including doctors’ associations and HIV patient support groups.
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.
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
HHH, MD
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
Is this long enough to wait for testing?