Seeking perspective

Dear Drs I’m a 34 year old heterosexual male Caucasian professional based in Singapore.

Since June I’ve experienced significant health anxiety focussed on an obsession with HIV-after initially experiencing diffuse symptoms such as intermittent fever etc I was 6 weeks later diagnosed with deep vein thrombosis & resulting pulmonary embolism in mid Aug.

By that time I was extremely anxious & had become obsessed with HIV-I've not always practiced safe sex but my GP assures me I am at no higher risk than anyone else-since June I’ve had 11 negative tests including PCR the last 18 days ago as requirement of obtaining a work visa for a Middle Eastern country.

I’ve displayed obsessive checking behaviour like constantly monitoring temp/swollen nodes/rash/searching internet etc, most persistent symptom is a sore/tight throat/neck feeling which comes and goes which I understand is common for anxiety disorder.

When I feel my anxiety is improving the ‘what if?’ begins & the HIV fixation re-emerges. I’ve begun to question objectively protected encounters which concerns me. 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 during an otherwise fully protected encounter.
2. 21 days ago – fully protected with a friend & during noticed a small amount of blood on condom & saw a small amount of bood on the base of my penis-immediately stopped & washed up.

Questions;
1. Can you please assess the risk of the two exposures referenced above?  I’ve considered asking both ladies to get tested but not sure this is fair to pull them into what is my anxiety. I’m not sure more testing is the answer as I understand this can reinforce the anxiety/test/relief/anxiety cycle.

2. Please provide advice on what is a balanced perspective for HIV risk and required testing for safe sex practices to assist in avoiding irrational/obsessive concern? Thank you

[H. Hunter Handsfield, M.D.]

Intellectually you know you have been at little risk for HIV and that your test results are reliable.  My main "balanced perspective" is that you have correctly identified your only health problem related to HIV, i.e. your obsession with HIV despite your rational understanding that you have not been at significant risk and that your negative test results are reliable.  As you also understand, this is an emotional/mental health problem that is not amenable to rational analysis.  You have had plenty of that and the problem continues.  My additional words are not likely to help.  But here they are:  

1) Assuming "fully protected" means condoms were used for vaginal or anal sex, there was no risk for HIV and no need for testing.

2) My second "balanced perspective" is that you are at little or no risk for HIV.  All persons who are sexually active outside mutually committed monogamous relationships should have periodic testing for HIV and other STDs from time to time, like once every 1-2 years.  That is all the testing you need.  Testing is not recommended after individual exposures unless especially high risk, such as unprotected sex with a partner known to have HIV or at especially high risk, e.g. an injection drug user or commercial sex worker.

You need professional mental health care to deal with this problem, not a few reassuring words in addition to those you already have heard.  Therefore, I will not have further comments or replies on this thread.

Best wishes to you -- with compassion, not criticism-- HHH, MD