Seeking perspective

Dear Doctors,

I’m a 34 year old heterosexual male Caucasian professional, until recently have been based in Singapore.

Since June I’ve experienced significant health anxiety primarily focussed on an obsession with HIV, triggered by experiencing diffuse symptoms such as intermittent fever, aching etc after returning from vacation - some 6 weeks after my symptoms (and increasing anxiety) began (and a series of scans, blood test, HIV tests) I was ultimately diagnosed with deep vein thrombosis and a resulting pulmonary embolism in mid August which while extremely stressful at the time is being effectively treated and really causes me no ongoing concern.

However by that time my anxiety was extremely high and I had become and continue to be obsessed with HIV-this obsession went away when I was in the process of being diagnosed with DVT but then soon returned. I admit I have not always practiced safe sex and have had anxiety episodes in the past but normally have not been unduly obsessed with HIV to this degree – my GP doctor says I am at no higher risk than anyone else of HIV and that I cannot be tested after every sexual encounter. Since June I’ve had 11 tests including PCR - the last test 18 days ago as requirement of obtaining a working visa for a Middle Eastern country I’m currently assigned to – all negative.

I won’t go into all the symptoms as I’ve experienced some from head to toe, which despite my extreme concern at the time I may have been experiencing the ARS, given my history of negative test results evidently weren’t due to HIV and most likely accounted for by anxiety.

Like many posts on this forum I’ve displayed obsessive behaviour like constantly monitoring temperature, checking for swollen nodes, rash, searching internet for symptoms etc. My most persistent symptom is a sore/tight throat/neck feeling which comes and goes (over the last couple months) and understand is common for an anxiety disorder.

While recently I feel my anxiety is improving then the ‘what if?’ begins & the HIV fixation re-emerges. I’ve even begun to question objectively protected encounters which concerns me. At this stage I have two exposures/encounters than can’t be completely ruled out through my testing to date.

1. 26 days ago literally 5 seconds unprotected vaginal exposure with a female friend (non-CSW) during an otherwise fully protected encounter-have not experienced ARS symptoms that I am aware of.
2. 21 days ago – fully protected with a friend (non-CSW) and during noticed a small amount of blood on condom and saw a small amount on the skin on the base of my penis. Immediately stopped and washed up.

My questions;
1. Acknowledging my anxiety can you please assess the risk of the two exposures referenced above?  I’ve contemplated asking both ladies whom I’m still in contact to get tested but not sure this is fair to pull them into what is my anxious concerns. I’m now in a country where unlike Singapore rapid/anonymous testing is not available and to be honest I’m not sure more testing is the answer as I understand this can reinforce the anxiety/test/relief/anxiety cycle.

2. With respect to a heterosexual male are you able to provide some advice on what is a balanced perspective for HIV risk and required testing for safe sex practices to assist in avoiding irrational/obsessive concern? Singapore runs a fear rather than education oriented campaign giving the impression every second person has HIV to encourage safe sex and testing – not sure this is great for anxiety prone individuals like me.

I undoubtedly have an underlying anxiety disorder which I am actively trying to address through psychological counselling, medication etc – however would appreciate your advice in reference to above. Apologies for the long post.