Update, need your expertise

[worried in toronto]

Hi Dr. H.

I wrote you months back regarding two instances of protected sex with women (i slept with them 3 times each). Since, i have asked them their status and they vehemently denied HIV infection. Both are educators and both were having affairs. I am very certain they are proponents of safer sex methods as they initiated the condom use with me (although i wouldn't have dared do anything without. Furthermore, i notified you about a nick by the straight razor at the barbers when he was clearing up my neck hair. I could hardly feel the nick but he used a styptic pen on it so i knew i must have been nicked at some point. So when i wrote i was worried about the sex with condoms, razor and pen. One of the condoms i used with the woman was really big and it slipped about 2cm, so i replaced it. Im assuming thats okay. I noticed a tiny rash on my face on the side of my nose near my eye and was instantly worried about seborrheic dermatitis and HIV. The doc in the dermatology forum didn't seem worried. I am getting ready to test and wondering what you think my odds are if you were a gambling man that i'll come out of this episode free of HIV. I had other std tests and they were negative.

One month after the barber incident i got what seemed a common cold and it was nasal congestion no fever or lymphadenopathy whatsoever seemed rather usual. Before that i had that same reddish type syndrome on my face but it went away (maybe acne or a form of seb derm from weather or stress?)


I did have a reddish mark/rash with no scaling or peeling just red on the left side of my penis on the part where the groin and scrotum,(maybe ezcema?) so on the scrotum  meet and it was there for a few months but promptly went away with hydrocortizone cream. I wonder if that means an immune deficiency. I am going to test soon. Have you ever seen in your career a guy like me get HIV from what i describe?

Thanks Dr. H. I really appreciate your words.
I won't bother you again with this worry.

[H. Hunter Handsfield, M.D.]

Monkeyflower has it right; I don't accept a long distance role as counselor to frightened people and actively discourage questioners--directly or indirectly--from using the forum in that way.  At times, that makes a response seem insensitive.  The other main purpose of the STD Forum indeed is to educate all users andl is just as important in my mind as satisfying the person who asks a question; ie my responsibility is to all users, not just the questioner.

I am fully aware that fear and anxiety often conflict with questioners' own intellectual understanding, and that factual knowledge itself won't resolve irrational fears.  However, accurate facts always are a starting point to achieve that goal.  Sometimes the "tough love" approach fails and upsets people. I try to strike the right balance but sometimes fail; the 4th or 5th questioner in a row with ridiculously low risk and sky-high anxiety probably is at greater risk than the first to get a response that I might (slightly) regret later.

Thanks for your comments--

HHH, MD

[monkeyflower]

Yeah, and my heart goes out to the people who are truly struggling with their anxiety and fears, however real or imagined. Our society is so sex negative, it's no wonder people deal with such extreme guilt and fear about their sexuality and the risks of being sexual. However, this isn't a support board. I think Dr. Handsfield is here to provide us with information about disease, not hold hands or reassure people who are at literally zero risk (or at any risk, actually).

Personally, I like this board because I learn lots and lots of new things. Many of the questions/replies have piqued my interest and led me to conduct further research on my own, all of it pertinent to each of my many varied roles. Okay, maybe not so much to my jobs as massage therapist or standardized patient, but certainly to my "real" jobs as sex educator, full-time grad student, and GA, lol. So, I feel a little frustrated when I read the eight millionth question about the HIV risk of the equivalent of touching a doorknob. Most of these folks need therapy, not medical information about actual risks, symptoms, treatment, etc.

I look forward to seeing the changes... as long as the changes don't mean Dr. Handsfield is leaving us. I thoroughly enjoy his responses and his rather unique point of view. It's a real breath of fresh air :-)

[wwarrior]

I 110% agree with binky2005.

[H. Hunter Handsfield, M.D.]

It's probably IgG, but still not a reliable test.  All tests for neutralizing antibody are nonspecific and do not accurately differentiate HSV-1 from HSV-2 (despite being called "type specific").

I'm holding you to your promise.

HHH, MD

[maryheather]

This is not in regard to this particular post~~this was just the first one in the list~~

I've been a member of MedHelp for a long time, but have only posted here maybe 2x.  I just have a comment/question for Dr. H. totally non-related to any STD or STD fear~~Every single question on this forum is practically the same....the same fears, the same illogical thought processes, etc.  How do you answer all these questions without going nuts?  Also, may I just say, if people are so concerned about their risk after the fact, why don't they just make smarter choices up front?  That's sounds judgmental, I know, I'm just blown away by the frequency of..."could this be HIV..etc" questions, when people obviously know the risk factors. Why continue with behavior that even makes them worry?  
Just an observation--I was young once, too.  However, some of these folks are repeat posters.  Oh well.  
Dr. H, you're great, and I find your responses informative, as well as amusing.  You have great patience, and insight.  Thanks.

[H. Hunter Handsfield, M.D.]

Thanks for that comment.  From an administrative perspective, suffice to say that I and the MedHelp International administration are well aware of the increasing proportion of repetative questions about ridiculously low risk HIV exposure events.  Solutions are under discussion, and changes will be coming to the STD Forum to deal with it.

As to the behavioral observations you make, you probably realize there is a giant difference between persons' intellectual knowledge about sexual risks (or smoking, or diet, or exercise habits) and actually implementing safe choice about sex (or the others).  If that disconnect didn't exist, public health officials and prevention experts would have little to do.  And keep in mind that the people who post questions on online forums are not representative of the general population.  Most sexually active people are (relatively) safe, and those who are not generally don't go have the frightened, illogical reactions that are greatly overrepresented here.

Thanks again.  Stay tuned for changes in the STD Forum.

HHH, MD

[binky2005]

I agree, Dr. HHH.  The only thing is--and perhaps its ultimately irrelevant to you--many people are uncomfortable and frightened about revealing the details of their sexual indiscretions to a doctor in person, so this board serves as a confessional of sorts for them, a place to tell their story honestly without moral judgment and with anonymity, and even if (from a dispassionate perspective) it's really nothing more than the same old story, everybody believes that this or that little nuance could make all the difference in the medical analysis and thus wants specific reassurance from you.

The other thing we should remember is that in learning about the risks of STDs (particularly HIV) today, many of the young people on this site are also forced to confront the prospect of their own mortality for the first time in their lives.  Not to mention the less serious but still terrifying prospects of lifelong social stigmatization or limitations on dating, marriage and child-rearing options that they believe (rightly or wrongly) may be imposed on them. That's heavy stuff for a 20 year old to deal with.

So while essentially the same HIV question is annoying and tedious and undermines the educational value of the site, there is an ebb and flow and overall the quality of the questions have been consistently very interesting and have been good fodder for education.  Also, one wonders what more can you really say about HSV-2, HPV, HIV or any other STD at this point. I assume 99% of what can be said has already been asked and answered by you in the archives.

[ToDoorNot]

Doctor, another thread hijack from me. I hope you will bear this time . This is the last time , I dont know where else to go and dont have credit card. Please please answer this. If a herpes test says that it is type specific neutralizing antibody test , is it assumed to be IgG? Pls answer this, one last time I am doing this. Never will I break rules here again. thanks

[worried in toronto]

I just saw the "shout". It wasn't that mean! I will adhere to that.

bill

[ToDoorNot]

Please understand my situation. I am stuck in Tokyo where they dont have only neutralizing antibody tests. My test came back negative for HSV1 and 2, can that be taken as reliable ,I mean the type specificity doesnt matter here.

[Willl]

You have been stuck in Tokyo for a while now. How do you plan on getting out?

[ToDoorNot]

Doc, I am continuosly refreshing this page for your answer, are neutralizing antibody tests reliable if the type doesnt matter? pls answer. Also, I am waiting for a IgG FA test result ( non type specific ) . Thanks a lot . Your answer will help me make future plans about what to do for further testing etc. Thanks

[H. Hunter Handsfield, M.D.]

You're lucky. The only reliable neutralizing antibody test result is a double negative, i.e. negative for both HSV-1 and -2.  If the test was done at least a few weeks after your last possible exposure, you are not infected with either virus.

That's it.  I will delete any further questions from you.  If you try, or if you jump another thread any time in the future, you will be blocked from further participation in the STD Forum.

HHH, MD

[ToDoorNot]

You are the best! I never expected that I could get a second opinion from the world's foremost STD expert . Thanks a lot doc. I took the first test 40 days from exposure. I have taken another test at 11 weeks and waiting for results. I hope that will make things clear for me , for ever. I will donate all the money i have spent till now on tests to this test. ( once i get back home in 2 weeks). Thnx doc, you dont know how much relief you are giving people with your patience and ofcourse expertise.

[worried in toronto]

I just saw the "shout". It wasn't that mean! I will adhere to that.

bill

[worried in toronto]

Thanks Doctor H.

Strange that my repeat post was on the same day as two other ones.

I will talk to the GP about this fear. Thanks for understanding.

[H. Hunter Handsfield, M.D.]

Sigh....   See the other threads posted today.....

You describe essentially a zero risk situation and symptoms that do not suggest HIV or any other immune deficiency.  But if uncertain about their cause, you should see a health professional; I do not attempt to make any diagnosis online.  No, I have never seen anybody in your situation get HIV; nobody in the world has seen somebody like that.  Please seek the advice of a mental health professional. Your irrational obsession with meaningless HIV risks is not normal.  I suggest it out of compassion, not criticism.

HHH, MD