Worried about HIV exposure

[charlie18506]

Hi. I am so disgusted and angry with myself I can barely write this. Last night after taking too many adderall and drinking too much, I cheated on my fiance. I had a blackout and ended up in a tranny bar. I got a pre-op transexual prostitute and gave her unprotected oral and while I was only semi-erect gave her brief unprotected insertive anal. I did not ejaculate and I am circumcised. Still I'm worried about being exposed to HIV. I desperately want to get tested, but this only happened yesterday, so it's too early. I feel suicidal. I love my fiance so much, but a demon takes over me when I get intoxicated. Today I threw away all my adderall and I haven't slept all night. I hate myself so much right now. Please give me some reassuring words. Or at least some advice.

[Edward W Hook, MD]

Welcome to the Forum.  I'll be pleased to provide some statistics.  I cannot assure you that there was no risk form this exposure- there was although the risk is low- certainly less than 1%.  Most transexuals do not have HIV and the risk associate with insertive anal intercourse if your partner was infected is about 1in 200 (there is no meaningful risk related to your receipt of oral sex during this encounter).  If you make a high estimate of the likelihood that your partner was infected, say 10% likelihood, then your mathematical risk for infection is about 1 in 2000.

The best way to address your concern is to find your partner and determine if she has HIV.  If she has not tested recently and is willing to do so, an HIV test at this time will provide the information you seek.  Alternatively, you will have to wait for about 4 weeks at which time you can seek testing with a combined HIV p24 antigen/HIV antibody test.  At four weeks these tests will provide definitive information as to whether you acquired HIV or not.

I should add that this is not a situation for which PEP is recommended.

I hope my comments are helpful.  The odds are strongly  in your favor.  EWH

[Edward W Hook, MD]

Glad to help. Take care. EWH

[charlie18506]

Thank you, Dr Hook. Unless my fortunes take a sudden dramatic reversal, I think I'm done here (I will test again in 2 weeks just to be 100%). Thank you so much for your advice. But hopefully you'll never see me here again. I'm done being reckless.

[Edward W Hook, MD]

The rapid test you had would have detected over 90% of recent infections, making it very unlikely that you were infected.  EWH

[charlie18506]

Hi Dr Hook. Today (30 days after exposure) I went to a clinic to get tested. I was frustrated because they didn't have an anti-gen test, so I couldn't do the DUO. They suggested a rapid finger-prick test, but because it's not 6-8 weeks they said it wouldn't be 100% conclusive. I asked what the odds are then, but they were very conservative and cagey about that which annoyed me. Eventually they said if the test was negative, I could rest easy and not worry too much about being exposed. The ten minutes I waited for the test were the longest of my life, but I'm sure you already know the answer; negative. They said I should test again in two weeks to be sure, but I'm hugely relieved. What would the percentage of accuracy be for a rapid prick-test at 30 days?

I can't thank you enough, Dr Hook. Your rational comments have helped me mantain my composure during this month. And now I see the light at the end of the tunnel. I also retested for all STIs and had a blood-draw for syphilis testing (she thought my first doctor was very unethical for testing me the morning after my incident and said the only thing he took from me was my money). She recommended against a Herpes test since she said it's highly uncommon to have no symptoms, so I didn't do that. STI and syphillis results will be in 5-7 days and I should retest with another rapid in 2 weeks, but for the first time in a month I can relax.

Anyway, my main question is if you could give me some odds for how accurate the rapid prick-test would be at 30 days? I'm not that worried, but I'd be interested in your thoughts about this. Thanks again, Dr Hook.

[Edward W Hook, MD]

Sorry to hear that this continues to worry you.  My advice would be to make sure your doctor is doing a combined HIV p 24 antigen/HIV antibody (DUO) test rather than leave it to chance.  You clearly do not want to be in a position of doubt.  when you do, I anticipate that your tests will be negative.  At that time there really is no reason for further concern and no reason to worry about unprotected contact with your GF.  

BTW, congratulations on your seeking counseling from on your alcohol and adderall issues.  EWH

[charlie18506]

Hi Dr Hook. Tomorrow will be the 28 day mark and I will go to get tested for HIV (I ended up not doing the RNA test). Should I specify that I want the DUO test or can I just tell the doctor it's been a month and leave it up to him? I'm so worried. I know you said my chances are less than 1%, but I worry about viral loads and other unknowns and it's driving me crazy with fear and anxiety. Almost every minute of every day since this has happened I've agonized over this. It ruined a highly anticipated trip overseas and my girlfriend is starting to wonder why I'm shying away from her so much. If I get through this I'll never subject myself to this kind of risk again. I'm so determined never to repeat this I've started seeing a rehab counsellor for my adderall addiction and drinking. I haven't drank or taken any adderall since this happened.

On the plus side, it's been 4 weeks and I had no noticeable ARS symptoms. I know some cases are asymptomatic, but would the absence of meaningful symptoms further lower my odds?

Last one; if I test negative on the DUO (and a second STI test) can I resume having sex with my girlfriend without worry that I'll pass something on? I assume your answer will be yes, but I just want a final affirmation that's okay.

Sorry to bother you. I hope I didn't blather on too much. I won't post again until I get my result. Thanks in advance.

[Edward W Hook, MD]

1.  Your urine test was, in theory about a day early.  Your negative test makes it unlikely that you were infected but if your wish to be completely sure, a repeat test, now that more than 2-3 days has passed, is recommended.   If your STD test were positve, it would be slightly, but only slightly, more likely that you could have acquired HIV, if you had been exposed.  

2.  RNA tests are not recommended for routine HIV diagnosis, in part becasue a false positive test result is more likely than for antibody tests and in part because of expense.  On the other hand, the combination of a negative RNA test plus a negative HIV antibody test at 24 days is about equialent to the preferred DUO (combined HIV p24 antigen/HIV antibody) test.

EWH

[charlie18506]

Dr Hook, I have two follow-up questions. The day after the exposure I had a urine analysis for most other STDs beside HIV and they all came up negative.  The doctor assured me that was enough time (1 day after exposure) to test for those particular STDs. Do you concur or should I test again? I have no symptoms for any STDs almost 2 weeks after exposure. Also, I know correlation does not equal causation, but if I test negative for all other STDs do you think that's a good sign that I'd be negative for HIV as well?

Second question, I'm still wracked with anxiety, but I heard about RNA testing being able to detect HIV after 9-11 days. You did not recommend that, so can I take that to mean you disagree with RNA testing? I heard it's sometimes inaccurate, but I'm also eager to put this ugly chapter behind me.

[Edward W Hook, MD]

Thanks for the thanks.  I would check with local public health authorities.  They may be able to refer you to an appropriate local resource.  EWH

[charlie18506]

Thank you, Doctor.

Your words have helped me more than you know, but I'm still wracked with anxiety and can't sleep. I keep running the 1:2000 statistic in my head and it's reassuring, but then when I think about what I did I get cold sweats and start panicking. I don't wish to bother you with my clearly non-medical anxiety, so is there any forum or place I can go to talk to someone about this and get help? I'm a serious self-loathing manic-depressive who acts reckless and has psychotic episodes after drugs and alcohol and I'm worried it's going to kill me, maybe not this time, but eventually. Thanks in advance, I won't comment again. You and Dr HHH are doing a great service.

[Edward W Hook, MD]

Just for clarification, my comment was that most transsexual do not have HIV, not that their rates are lower than others.  Rates vary from group to group and from region to region.  Transsexuals do have a higher HIV rate, on average, than the general population but that rate is still typically less (and often far less) than 10%.

HIV is less common in Korea than in many other parts of the world.  

Take care.  EWH

[charlie18506]

I swear this will be my last update. I don't want to be one of those posters whose anxiety gets to the point of annoyance for others. I called the establishment today and the mama-san said the "girls" were clean and had no diseases. But I don't know if I can trust her. She's the same person that rolled me for a lot of money the night before. Anyway, my anxiety is less than earlier.

[charlie18506]

I went to the clinic today. Dr gave me zithromax to get rid of any potential bacterial diseases and agreed PEP would be overreacting. This is in Korea and he said this country had less of an issue with HIV than other countries and while many prostitutes get regularly screened, some establishments skirt the rules. He said risk was minimal, but real. One question though; why are transexuals less likely to have HIV?

I hope I'm not bothering you. I have no one to talk to about this. My girlfriend would break up with me and everyone else would just think I'm a scumbag (and I'd agree). I hate myself more than I've ever hated myself in my life. This is the worst thing I've ever done and I think the guilt and anxiety is driving me crazy.

[charlie18506]

Thank you so much, Dr Hook. You're a true gem and I feel somewhat relieved. I was thinking of asking about PEP, but I'll follow your recommendation. Regardless, I am going to a clinic today to ask advice anyway. I might not have anything, but the guilt is another matter. It will take a long time for me to forgive myself.