Risk Assessment

[GruppeB]

Reading over the forum I realize many of my questions have been answered but I appreciate your personal/professional opinion.

I am a 26 year old heterosexual white male
I always use protection but have had five condoms breaks with different women, each time I pulled out, almost- if not immediately.  Each of these times I was assured by the woman that their HIV status was negative.  I have been tested for chlamydia and gonorrhea and came back negative. I realize how stupid it was of me not to get HIV tested and am getting an at home test today.

Over the years I have had underarm lymph node pain off and on (infrequently).  Also worth noting before I became sexually active (18 years old) I had what my neurologist describes as a meningeal infection.  Facial numbness, severe muscle spasms, bone pain, sleep disruption.  Not sure if this is relevant but thought I would add it to give you a fuller picture of my health. The muscle spasms persist to this day and my neurologist said it was likely Lyme but never had me tested, citing the unreliability of the test.

So my question is what is my overall risk? Should I be treating the underarm lymph node pain as such a harbinger of doom?  Any and all words of advice are appreciated and please let me know if I have left out any pertinent information.

Thank you.

[GruppeB]

I should mention the lymph nodes remain fairly swollen.

But more importantly you hit the nail on the head about my fear of getting tested.  I know its fairly irrational in when I logically think about it but it has become a psychological problem of avoidance/denial.  Whether I convince myself its a non issue or that I am doomed.

Thank you for your advice I will be getting tested and hopefully some psychological help.

[Edward W Hook, MD]

Regarding your swollen lymph node. There are many other illnesses which can cause lymph node swelling.  Swollen lymph nodes are a non-specific response to any number of stimuli including infections due to bacteria and viruses, allergic reactions and autoimmune disease.  Of all persons with swollen lymph nodes only a tiny proportion of them have HIV.  Please do not worry about this.  EWH

[Edward W Hook, MD]

Welcome to the Forum.  I think there are two issues in play here. the first is whether or not you are at high risk for HIV (the answer is no), and the second, related issue is your fear of testing.  Let's address them each.

First your risk of HIV.  it is low. Presuming your partners were located here in the U.S. we can mathematically calculate your risk of infecting from the fact that less than 1 in 10,000 women in the U.S. have HIV and the fact that the risk of transmission of infection for any single sexual episode is less than 1 infection per 1000 sex acts.  Thus, based on these two numbers, your average risk of having been infected in the course of five condom breaks is less than 1 in 2 million.  If anything, I would guess your risk is lower than average.  To put this in perspective you are between 10 and 100 times more likely to be struck by lightning than to have gotten HIV form the exposures you describe.

The second issue is your fear of testing.  You need to get tested to put this behind you and, as you have already been told, the easiest way to do this is to have your doctor do it or, if that worries you, to go to your health department where confidential testing is probably done on a regular basis.  Testing does not give a person HIV but it does give them the power to know what is going on and whether or not they have the infection.  Most tests are negative and if you were so unfortunate as to have HIV, the test would allow you to seek treatment sooner.  There is no reason to delay or avoid HIV testing.

Finally, the symptoms and lymph node discomfort you mention do not raise any concerns for me about HIV.

I hope these comments are helpful. EWH