You had a virtually zero risk exposure. No case of HIV has ever been documented to be acquired by performing cunnilingus, regardless of menstrual blood exposure, and you have been rather grossly over-tested. I would have recommended against PCR testing at all. The risks for the other STDs you mention also were too low to warrant the other tests you had. Having said that, you be sure you didn't acquire HIV during that exposure.
1) No test is 100% sensitive, and the PCR probably misses the rare case. But almost all infected persons would have a positive test before 4 weeks following exposure.
2) Canker sores rarely are a sign of HIV. In your case, given your test results, it CANNOT be due to HIV.
3) You need no further testing. However, because so many standard recommendations are for a final test 3 months after exposure, I won't try to talk you out of another HIV test at 13 weeks. But you need it only for the emotional reassurance of having a negative result, not because you have any realistic chance of being infected.
4) In theory the blood exposure might increase the risk, if your partner was infected (which she probably was not). But any increased risk probably is too low to measure or worry about.
Bottm line: Mellow out and relax. You're fine.
Oops, don't want anyone to get confused on the timeline we are talking about here. The sentence in section 3 that reads:
"I do not, repeat, do not, want to spend the next 2 months or so of my life like I've spent the last 7."
"...like I've spent the last 7 weeks."
Possible exposre was 47 days ago.
Sorry for confusion. Thanks!
Hello Doc and everyone
As the Dr and other websites clearly say that PCR testing is not recomended for diagnosis here is a example of my situations and other instances in thebody.com where there was false positive of pcr when some one was not infected
My case is 8 weeks back had a unprotected oral and protected vaginal sex.
after 4 weeks got tested with cdc with oraquick which was negative.
I could not hold on for next 8 weeks so went and got pcr testing from one of the website stdweb.com which was done by quest diagnostics.
I received a result of positive of 799 copies withref of 50 copies.
I started to freak out and totally depressed. I have had the 8 week ELISA antibody test from my doc which is negative. My Doc told me not to worry at all as if i was really infected and was going tru primary infection(ars) the viral load would have been in the range 10000 to more than million. and so mine is most likey a false positive. I have seen 2 instance like this on thebody.com which pcr was false positive and ELIS antibody test after 6 months also was negative.
So now i have increased my stress level and anxeity and always looking for ARS sysmptoms and have started to get headache and stiff neck.
The 8 th week antibdy test did provide me some relief but still not conclusive.
My advise to any one reading is unles ur doc (hiv speaclist) asks for pcr test because ur sick etc do not get it and increase ur stress level as i have done.
It may seem like a useful service, but I'm skeptical. Sometimes it is hard enough to avoid crossing the line into practicing medicine from afar when the issue is medical diagnosis or therapy. When advice and communication are themselves the mode of care, it could be even more difficult. A responsible mental health professional probably would shy away from taking the risk of being perceived as an a questioner's primary source of emotional health care.
Sorry, but you practice medicine from afar every day. It is the nature of the Internet that that is what you do. You have this site, where you answer questions about, at least according to the people asking them, life and death. All from afar. From very afar, in some cases.
Am I questioning your expertise? Not at all.
All I am saying is that in many cases you dismiss the questioner, and that is it. Where do they go from there? I have an answer to that question: no where. No matter how you wish to reassure the questioner, they still have doubts.
From what I have read here, I think what most people need here is a referral to a psychologist. I include myself in that category. Might be nice if you had one on staff to help out.
Wow, quick response, thanks for it. Like I said, probably just oral - she says no intercourse, I don't remember it, we were both pretty drunk. So, probably no intercourse (can't completely rule it out because I simply don't remember).
OK, fair enough, I went off the deep end. I'm not typically like this - I am fairly rational. Don't believe in ghosts, alien abductions and don't normally freak out about my health. Don't know why I am behaving this way. This is a new one for me.
All that stuff you told me helps, and I appreciate it. I probably will get the 13 week test, just for peace of mind. You think I'm good to go, OK, I can work on accepting that and moving on with my life. To be honest, you aren't the first person to tell me to let it go. As I said, not sure what's happened to my mental state. Like I fell into a hole and I can't get out. Feel good for a few days, then I'll get a headache, and uh oh! Feel OK for a week, then get an ulcer in my mouth, a twinge in my groin, whatever and I'm back to worrying again. No matter how innocuous any "symptom" is, it can send me into a few days of deep anxiety. I hate this need for constant reassurance - makes me feel like a child again, afraid of the dark.
The mind is a strange thing, isn't it? I'd always considered myself pretty stable until this came along. Now, not so sure :-). Probably would help to talk to a psychotherapist about it, I would imagine. Maybe I will.
Yo, read your post about your false positive PCR DNA (and that is most certainly what it is), and wanted to touch base with you. First of all, so sorry about your borrible experience. As you know, that totally sucks. I can only imagine my own reaction had it happened to me.
OK, first things first: my first PCR was recommended to me by a doctor, an HIV specialist in Washington, DC. I worked with the Dr.'s PA, an excellent and patient man. He, like Dr. H, said I did not need to be tested. But, when I asked him, he said if I wanted reassurance, he would run the DNA PCR test for me at 2 weeks. Luckily, it came back negative, at which time the PA told me to not get tested again. The PA did warn me about false positives, but did say that they could usually weed them out based on the supposed viral load.
I, of course, being the person I am, had to do more reasearch on DNA PCR. I went to a few Websites (mostly of commercial labs), and they all said 28 days for PCR was conclusive. So, I freaked and did it again. Again, negative.
Dude, I am heartbroken for you that you have to go through this. I know where your head is at, and I know how lonely it feels (well, I can imagine that at least). If you ever want to talk, give me your email and we can chat. I think, based on the viral load reported for you (under the threshold the PA told me would be false positive), that you're cool. Sometimes, man, you just need someone to talk to to get through the long nights, Let me know if I can be that person. If not, I wish you all the best.
And, one final post. I think I have a decent suggestion for an addition to this site: The Worried Well area, which is hosted by a psychiatrist. For those questions, such as mine (or, at least that's how I think you think of me - which is fine), this would be the place to go.
Worried well post first question, then, if deemed unlikely to have HIV, they get referred to worried well site, populated by people in the same boat, or, ideally, by people who have been there. Look, you give assurances, and maybe 50% of the people actually feel better long term from those assurances. Not a question of your compentence, of course, but it's a mind thing.
Your site could make a good bit of money from this. Unlimited follow up, unlike the STD and HIV forums, and you'd be doing a service for those who, against all odds, feel that they are still at risk. Contribution: $25. A good deal cheaper than an office visit with a psychotherapist. Think of the good you could do with the money.
Just a thought.
Jiminy, just read what I wrote and it sounds too much like a criticism of you, doctor. I do not mean that at all. I think you give a lot of yourself here. And I, for one, appreciate it.You are a Godsend. I only want to throw out ideas for revenue generation.
You won't dispute that there are plenty of guys and girls like me who, with an infentesimal risk of HIV, continue to obssess. You will further not dispute that "we" clog up the forums, keeping legitimate questioners from having their say. We repeatedly ask the same questions over and over. Further, you will not dispute that we, the so called worried well, take you away from your primary task, which is to diagnose HIV infection, and to prevent it in others. You tell me, Doctor, how is your time best spent?
As such, I propose a new section here: The Worried Well. You refer how you wish, but I believe it can be useful, with the right people on staff. Just a thought.
BTW, as I keep reading on this site, I realize just how smart you sre. It is amazing what you do here, it is amazing that you keep doing it, day after day. I wish we had awards for the most important people in our lives, Sir. If we did, you would win hands down, every year, every time.
Tx dude. you could write to me at ***@**** I appreciate it.
Here are some Stats...
The risk of HIV infection is greater for the partner who gives oral sex. Recent research presented at the 7th Conference on Retroviruses and Opportunistic Infections in February of 2000 concluded that 8 of 122 cases in an HIV-transmission study were possibly attributable to oral sex, which implies that although going down (giving oral sex) on a man is much lower in risk than other sexual behaviors, there's still a possibility for transmission. Of these 8 infected people, however, some reported having had recent dental work or having cuts in their mouths, meaning that HIV transmission by oral sex may be associated with cuts, lesions, or irritation of the tissues in the mouth.
For the cunnilingus (oral sex on a woman) recipient, the chance of HIV transmission is also low, although the entire vagina is a mucous membrane through which, theoretically, the virus can be transmitted. A woman receiving cunnilingus is more at risk of getting herpes or gonorrhea from her partner than HIV. A person going down on a woman should avoid it during her period, for menstrual blood can carry the HIV virus.
Your conclusions may be right, but perhaps for the wrong reasons. Be wary of unpublished results from scientific meetings. As far as I know, the study you cite has not been published in the scientific literature. The quality standards (peer review etc) are high for published research and virtually nonexistant for scientific meetings. Failure of a study to appear in published form 5+ years after meeting presentation suggests the information might be scientifically flawed.
Anatomically, the vaginal epithelium is not a mucous membrane. It is thicker than the mucous membranes of the rectum and mouth, and contains no mucus-secreting glands (the definition of a mucoous membrane). HIV transmission to women probably depends mostly on exposure of infected secretions to the cervical opening (where true mucous membrane exists), not the entire vaginal surface; or to genital ulcers (herpes etc) or other inflammatory conditions.
But your conclusion is valid and I appreciate the support in helping convince the many doubters. Fellatio is an uncommon mode of HIV acquisition. Although almost certainly higher for the receptive partner than the insertive one, even the former is extremely low. All things considered, fellatio is very safe sex.
To my awareness, the best published work on fellatio as a risk of transmission are 2 papers published in 2002: Page-Shafer et al (from San Francisco), AIDS 2002;16:2350-2; and Varghese et al (from CDC), Sexually Transmitted Diseases 2002;29:38-43. Both confirm the extremely low rates for fellatio, both giving and receiving.
Hi, thanks for responding. First, the proposed forum. I definitely see some type of danger from an undirected gathering of HIV anxious lost souls, all feeding into each other's anxiety. I think the point I was trying to make is that once the doc has answered the questions about testing, many people here are still anxious. They decide that they should get the 3 month test, and more than likely have a while to go before they can get the test. Who do they talk to at that point? Dr. H isn't a psychologist: his job is to lay out the relative risks, answer the testing questions, stick to MD type things.
But, we both know from reading the forums (and I know from personal experience), that while the words of the Doc may provide some temporary comfort, sometimes it's only temporary. In my own case, I try to use the answer to my question to ground me in reality when I feel myself drowning in a pool of anxiety. Sometimes it works, sometimes it doesn't. For me, the worst time is at night, when I am laying in bed, thinking (the brain never shuts off). I made a huge mistake in that I sought to empower myself with information about HIV, and all I wound up doing was driving myself crazy. I wish now that I had not the slightest clue about the symptoms of early HIV infection. I wish now I had not the slightest clue about that odd 1% of people (or less) who test positive outside of the official window period, etc. Sure, it's not rational to think this way: but that's the point of this discussion. There needs to be some emotional support to go along with the hard medical facts. Because, for most people in this predicament, this is purely an emotional, psychological issue. And, it needs to be addressed as such.
So, after my first suggestion, the Doc pointed out that it might be rather hard to find a psychologist to provide mental health counseling in this forum. After some thought, I agree with that assertion. Given that, what else can we do? And make no mistake, something needs to be done. Think about this: most of the "worried well" are experiencing extreme anxiety and stress. So extreme that they begin to actually suffer from ARS related symptoms: diarreah, night sweats, mouth ulcers (and this is the funny one: ulcers of the mouth, from what I have read, cannot be correlated to PHI, yet some Websites list them as a probable symptom, and bingo, the "Worried Well" suddenly start suffering from them), headache, muscle pain, perceived fever, etc. How extreme must one's mental state be to actually cause these psychosomatic symptoms? It almost defies credulity, yet it happens! The mind causes a physical manifestation of ARS related symptoms. Amazing.
The forum I propose would not be a substitute for professional counseling. It cannot take the place of a qualified professional. Instead, it would exist to provide peer support (much like a support group for any other mental illness or addiction issue - because there *is* an addiction component to this problem somewhere) to the "Worried Well" and otherwise who are sweating out the test window (I don't mean to keep harping on the WW. Invariably, there are some people experiencing anxiety who are indeed HIV positive). The purpose of the forum would NOT be to discuss symptoms, effective window periods, or any other topics best left to an individual's doctor or Dr. H. It would instead be made up of men and women providing support to each other for those 3 odd months when waiting out the window period. I know from personal experience that sometimes all one needs to get back on the right track is a sympathetic ear, someone to talk to when the walls start closing in. And this forum would be the place to go to get that.
Structural questions would have to be addressed (would it need a moderator - my thought is yes). And care would have to be taken to limit the discourse to the emotional component of the HIV test - not the technical merits of said tests, or the window period, or other areas.
Look, we all know that there is an emotional component to this issue. Much is done to address the emotional needs of those who do test positive. And I am surprised that more is not done to help those who are sweating out the long 3 months until they can be tested. Based on my own experience, I feel that this community is underserved. This is a serious mental health issue, and should be treated as such. And a forum such as the one I propose would be a step towards doing that.
Wow, this is a long post, and for that I apologize. I tend to wax passionate on this issue. As for your own questions, I don't mind answering them here:
1. I do suffer from OCD. Undiagnosed, but this episode of my life has made me realize that I have been suffering with this cursed affliction since my early teen years. I am surprised now that I have not addressed it yet. But, in my own defense, it was nothing more than a minor annoyance, or so I thought, before now. OK, so I have to turn the light on and off exactly 11 times or I get horrible anxiety and believe that something really bad is going to happen. Fine. It seemed like a natural thing when I was younger - I never gave it a second thought: I just turned the light on and off 11 times before I went to bed. As I grew older, I began to realize how ridiculous my various rituals really were. But, as I said, I had lived with them for so long before then I figured what the heck. It can be frustrating at times, but on balance, my life was OK otherwise. What I didn't realize before this event was just how, over the years, pervasive and problematic my OCD had become. I think at this point, I'd like to be free of this behavior. I firmly believe that most of my worry is related to OCD: I've talked to 1 GP, 2 online STD specialists (Dr. H here and Dr. Francisco at TheBody.com), had a real life appointment with the PA of an HIV specialist and spoken to more than one HIV counselor, and they've all told me the same thing: you're cool, you're fine, you are OK. You don't need to be tested, or you don't need to be tested again, or, OK, I can see what a mess you are, so get tested again at 3 months just to save your sanity. And what is the result? Great! Major Relief! Whew! And then, 2 or 3 days later, the worry starts to creep back in, the sickening anxiety that keeps you up until 3 or 4 AM every night - then the endless surfing for information about ARS, HIV, HIV Testing, AIDS, the testing window, the average time to onset of full blown AIDS. Arg! I hate this cycle! Why am I like this? As I said, I think it's OCD. I envy those who get an HIV test at 6 weeks and forget all about it. I envy those who can go out and lead a normal life, which includes a normal sex life, and never break a sweat. Oh, to be them for one day!
In my own case, I feel I am a good candidate for psychotherapy. Not only that, it is long past time that I actually got it. The forum that I propose, not to put too fine a point on it, would only be a supplement to professional counseling for me. I could not get the help I need on an Internet forum. I could get occassional support, though, and I could give it (which I found to have a much more positive impact on my mental state than anything else).
2. Anxiety: Yes, I suffer from general anxiety (not tied to any one event, in many cases, unless I become fixated, as is the case now). I think it is tied into OCD.
3. Sex and Guilt: Yes, yes, yes. This is a complex and personal issue, but I can say this: I have never been completely comfortable with sex. I like it, sure. In fact, I really like it. But a lot of things, at least for me, are tied up in it as well, not all of them pleasant. I am sure that, for many people, having cheated on an SO or wife/husband does play a significant part in suffering extreme emotional distress at the thought of having acquired HIV (and by extreme, I mean an unhealthy fixation and fear that one has become infected despite the best possible evidence to the contrary - to include tests, reassurances from trained medical personnel, etc.) Gee, this describes me!
Ahg, my fingers hurt from typing. Or, is that joint pain? OK, that last bit was a joke, but you get my drift.
Take care, MF. Hope to hear from you again.
OK, this is a bit after the fact, just want to say something else in regards to the Worried Well section I proposed. The doc is probably right when he says that a psychotherapist is probably NOT going to want to devote his or her practice to treating patients in this type of forum. Having said that, let me relate something to anyone who might still be reading this thread.
First, know this: despite the assurances of the Doc, I still wake up in a cold sweat some days thinking about this. I am still hyper aware of my body. This morning, for instance, felt another bump in my mouth and spent an hour cruising the Internet for ARS related information. For the past two nights, felt a bit warm, so started checking my temperature. Rational? Hardly. I know that, but can't seem to get to the point where I am thinking rationally.
If you read through this thread, you will notice that one of the posters and I invited each other to start up a discussion via email. In that discussion, we spent a lot of time reassuring each other that we were fine (in all honesty, the other poster had more reason to be worried than I, though his worries, I believe, will ultimately be proven baseless). Regardless, what we have in common is this: the grueling wait for the end of the window period so that we can get a conclusive test.
In any event, I felt better for having that discussion with the other poster. In fact, I felt great for some period of time. I felt like I was doing something productive. As such, I strike my last suggestion, and instead offer this one in its place: the "Sweating It Out" forum, devoted to and populated by fellow posters who are suffering from, in many cases, the almost debilitating symptoms of "HIV Testing Windowitis".
It would not require any additional time spent answering questions by medical staff here, as it really is a support group run by those of us waiting for the final test. I think it would do some good, and I know it would be one of the few places on the Internet devoted to this topic. I truly believe it would provide a great service to the nervous masses. And I also think it would be a big hit. Could be a forum, or an IRC. Could charge a 1 time fee, or none at all (charity!).
Curious what you think, Doc. And, of course, curious what others think too.
Thanks for listening. Hope you all are doing well.
On one hand, I think that's a good idea. Support is a wonderful thing. I see a pretty big potential problem, though, in that a bunch of anxious folks concentrated in one location, with one particular concern, might only feed each other's anxiety. That would be unfortunate indeed. What do you think?
On a vaguely related note, I'm fascinated by this STD anxiety. I've never really been exposed to it before, and while I have to admit I don't understand it, I really want to. Would you be willing to share your thoughts about why you might feel this way? I would be particularly interested in whether you experience anxiety otherwise (health or generally), how you experience health issues (do you tend to tough out pain/illnesses, or do you retreat to bed with every head cold, that kind of thing, lol), and how you view your sexuality. And anything else you can think of that might pertain to your worries, like whether you had outside encounters in an otherwise monogamous relationship. I have no doubt that displaced guilt is a(the?) huge factor for most of the worried well, but there are also some who are unattached who are equally worried.
I wouldn't be doing anything with this info, aside from just developing some personal understanding; while I may want to develop this into a dissertation topic someday, I wouldn't use any of this data. I don't think this is the right forum for this discussion, though, so if anyone is interested you can email me at ***@****. Thanks!
I remain skeptical about the proposed forum, but I could be wrong. You both have obviously put some thought into it. Consider proposing the idea to MedHelp International. It will get more attention as an email, perhaps using some of the text in your comment above, than by simply referring them to this discussion. Perhaps you'll find it has already been addressed (and they couldn't find a willing mental health professional); or perhaps they will be receptive to the idea.
Well, as I said in my reply, I too doubt any competent therapist is going to want to provide therapy in a forum such as this. Further, the more I think about it, the more I doubt that the forum would not devolve into a million lonely voices, all crying out for relief. Still, I think it may be worth a try. As I am sure you can see, there is a market for it, as well as a need. Maybe it would help.
I will propose the idea to MedHelp International, as you suggest. We'll see how it goes.
I really don't know. I have a couple of friends who are therapists, and if I remember I'll ask them what they think about the support group idea. I'm pretty sure there are more reasons for it than against: support groups tend to normalize ideas/behaviors, they get people talking about things they'd otherwise suppress, they allow people to be altruistic and help others... However, I also know that it's incredibly easy for things to spiral out of control if you get trolls, or people who are excessively anxious and misinformed. Luckily, if that happens long enough after the group/format is established, I think the regulars can help keep that kind of thing in check. I still think it would be much, much better, though, if there were at least one or two moderators to keep an eye on the "alarming" posts. They wouldn't necessarily need to be professionals, either, just people who are relatively objective.
Of course, I also think you might find a therapist who is willing to moderate such a board. It's been done before. WebMD has a sex board staffed by an awesome sex therapist, and there are anxiety and depression boards staffed by other therapists. While none of them provide online therapy per se, they do offer information, guidance and support. Interestingly enough, I NEVER see these kinds of STD anxiety questions on the Sex Matters board, maybe because people with this kind of anxiety believe it's more of a physical issue than psychological. On the other hand, I don't frequent the anxiety or depression boards, so I don't know what's being asked there. Anyway, either way it's worth approaching MedHelp. You never know.
And xhost, you are quite articulate and expressive, and I really appreciate your input. I actually think I understand how you feel. Interestingly enough, I also have experienced somewhat similar anxiety, I think; my husband has had some serious health issues, and I've been known to suddenly awaken at 3am and be unable to go back to sleep for worrying. So although our anxiety takes two different tracks, I think I can relate to your feelings. Thank you for sharing that.
Yep, I agree with everything you say. If no one minds, still fleshing this out a bit, so I'd like to post my thoughts here as a sort of dry run for the email I plan to send to Medhelp International. Here goes:
1. Yes, it would need to be moderated. Thinking about the user population that such a room is likely to attract, it is going to be a nervous group milling about. It would take 1 or 2 malicious posts to push some people over the edge. All support would need to be *emotional*, not medical. Need a referral to a testing site? Well, check these links. Need help getting through another endless night? Hey, we can do that. Need to know what the 15th symptom was on that list of ARS symptoms you found on Joe Gumba's HIV info and car repair site that you browsed by at 2 AM 2 weeks ago? Sorry, can't help you there.
I think, to keep the forum self-sustaining, we would need to charge just a bit as an initial "cover" charge, if you will. I was thinking 25 - 30 dollars. One-time payment, post as much as you like, with maybe a limit on posts per day, just so one or two people don't drown out the rest of the room. Post limit would be generous.
Thing is, as I said before, sometimes you just need someone to talk to. The average HIV worry wart is John Q. Smith, did something he or she considers stupid, maybe cheated on the wife or husband, and now they are staring at 3 months of worrying. And typically worrying all alone! Who do these people have to talk to? Probably not the wife or husband or a co-worker or their priest. There is a large degree of shame associated with this. So, they keep it all inside. This is, pardon my french, a damned shame, and it doesn't have to be this way. As far as I can tell, old John doesn't have much in the way of support now.
2. Yes, yes, yes: the whole idea is peer support. A therapist, if one wished to take on this type of challenge, would be most useful in stepping in and recommending professional help when needed (perhaps with advice on where and how to get it). I looked for just such a forum, or chat room or what have you, and never found it. It would have done me a world of good, and possibly still would, had such a resource been available to me. Of course, the disclaimer would have to say loud and clear that:
I. If you are contemplating hurting yourself, get professional help immediately. Perhaps then list a website that lists, in turn, numbers for mental health hotlines.
II. This site is not manned by professional therapists. It is "staffed" by peers, many of whom are in the process of "sweating it out", or have done so in the past.
3. I have been kicking around a concept that may prove helpful: testing buddy. Hook up with someone in the forum and decide that you will be testing buddies. The buddies provide each other with emotional support through the testing process. I think it would help many through the dark days leading up to the test. Could have a section devoted entirely to posts from people seeking such "testing buddies".
Wow, every time I get on this subject, I get quite verbose. Sorry about that. And, thank you for your kind words. If nothing else, I am long winded.
If you'd like, I will post a copy of my email to MedHelp International here before I send it. If anyone is actually reading this thread, perhaps I could get comments or suggestions for improvements. I would also be curious to know what other people out there think of this idea. And, of course, if anyone would like a testing buddy, I would be more than happy to oblige.
Everyone take care and be well.