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Avatar universal

Worried about HIV

Doctor, I am quite a bit of a worrier and I have some questions and a situation that I hope you can answer for me and assess my risk or if I need testing. I have been in a monogamous relationship for awhile now and I am always worried about STDs and HIV and such and I'm trying to work on my anxiety regarding this because it is consuming my mind. To get to my questions, my boyfriend recently travelled to Rwanda for 4 weeks on a human rights delegation and worked with a group of young HIV positives to raise awareness of safe sex and support for those infected and affected by HIV/AIDS. He just returned and Ive been spending some time with him but have been unable to bring myself to have sex with him due to my fears and I cannot talk to him about it because I know he would be upset if I asked. He said he definitely did not have sex of any kind but that his living conditipns were dirty and I know he worked with people with HIV so it has made me nervous. What made me more nervous is 2 days after he got home he had severe diarrhea about 15 times in one night all liquid, a fever of 100.5  and sweats in the middle of the night and body aches. We went to the doctor and they said he was severely dehydrated and had a trace of blood in his urine so they sent him to the ER. Once he had an IV the aches stopped but the fever went on for another few hours. The doctor said all his blood work came back fine and his white blood cell count was normal and they took a stool sample but still no results back on that yet. They sent him home with tiandazole? And cipro in case its a bacterial or parasitic infection and gave him Immodium. He no longer has a fever today which is 24 hrs later but still has liquid diarrhea every hour or so...Im worried could this be ARS? The doctor said the trace of blood in his urine was so small it was nothing to worry about but now I am scared because
12 Responses
239123 tn?1267651214
MEDICAL PROFESSIONAL
Welcome to the forum.

You are overreacting (which you probably know).  I think you should trust your partner.  If he did not have sex during his travels, he could not have caught HIV.  Period, full stop, no need for discussion.  It doesn't matter who he touched, hugged, kissed, or worked with.  Not one traveler to Rwanda or elsewhere in Africa ever caught HIV while there, except by sex or overt blood exposure, e.g. by transfusion.  Peronally, I do regular research in Zimbabwe, where the HIV rates are as high as in Rwanda, and I never even thought of not having unprotected sex with my wife when I returned, and she certainly never raised the issue either.

As for his symptoms, diarrhea is not the main symptom of ARS.  And of course non-sexually transmitted intestinal infections are very common in travelers to Africa; undoubtedly this is what your partner has had, and that is what he is being treated for.  And fever due to ARS never goes away in only 2-3 days; it takes a week or more.

Finally, your comments below suggest you have misunderstandings about HIV transmission.  Without unprotected vaginal or anal sex, you are simply not at risk of catching HIV by sexual exposure.  Having pimples or other skin lesions makes no difference.

My advice is that you 'fess up to your partner, i.e. tell him your anxieties about HIV.  And share this discussion with him.  Then go ahead and have sex at a time and place of your mutual choosing -- with no worries about HIV.  You really have nothing to worry about.

Regards--  HHH, MD
Avatar universal
I am scared because he licked and sucked on my nipples a little bit and bit them a little but no blood waa drawn but what if he had blood or a cut im his mouth or I had a small cut on my nipple? Could i get HIV from this time? We also kissed closed mouthed only because I was worried because I always have canker sores in my mouth. Also, he did rub his penis when he had precum and then kindve rubbed my butt towards the top of the crack no insertion. I dont think he had precum on his hand but I cant be sure. I watched him masturbate this morning because he was feeling better other than the diarrhea. I did not touch him at all but I noticed when he ejaculated his semen was a brownish yellow color with some of the normal white color which I have never seen before in all the time Ive been with him. He swears he wasnt with anyone else in Rwanda and he tested negative for HIV before he went there. Its just weird to me that he wasnt sick at all while there but comes back and gets a fever and bad diarrhea and the diarrhea still continues after a day and a half. Could this be ARS? He said he had no risks I just worry he couldve touched HIV blood somehow and got it even though he says he didnt. Could any of the things we did (kissing with chapped lips, sucking nipples, rubbing his finger on my butt after touching himself, or kissing my neck when I had a pimple) have transmitted HIV? Should I be tested? Idk what to do because I cant keep avoiding all types of sex with him because I know he wont understand my anxiety.
239123 tn?1267651214
MEDICAL PROFESSIONAL
See above.  FYI, the reason for the 2,000 character limit is to prevent exactly this, i.e. to require initial questions to fit into the original window.  On many MedHelp forums, the moderators set their browsers so they never even see follow-up comments.  In any case, the issues you raise here do not change my opinion or advice.
Avatar universal
Doctor,
Thank you so much for your prompt and helpful response. I truly appreciate it. I know that my fears are probablt unwarranted and due to my anxiety over things such as this, but I needed to ask am expert because whenever I read things online it confuses me. For example, the CDC website said there was a case of a person who got HIV from deep kissing an infected partner. Things such as this and then my boyfriends sudden fever/continued diarrhea after returning simply heightened my anxiety. I don't really feel as though I can tell him my anxieties without him thinking I am ignorant or offensive. Just a couple more questions and this will be my last post:
1) I truly believe he did not have sex on his travels because we have been together for 4 years and are always very honest and would not lie about situations like that, but there truly is no other way he could have gotten HIV other than through sex or needles?
2) is it possible that the fever for ars could stop and start again with just diarrhea as the only symptom? Just general question.
3) Is his discolored semen cause for concern or normal? In 4 years ive never seen his semen with a yellowish brown tint but maybe this is due to the malarone, tinidazole and cipro?
4) is him kissing me with chapped lips or him sucking/licking/biting my nipples with no broken skin a risk a way that HIV can be transmitted? Or him touching himself and then me? And should I get tested or all of this was absolutely not a risk for HIV? I just need that final reassurance because I would like to start having unprotected sex with him again with no worries because I truly dont want to hurt his feelings due to my fears/any misunderstandings I may have about HIV and he is going back to Africa next year and wants me to travel with him so Id like to be able to do that with no fears.



Also, is there an organization or foundation that you and Dr Hook are associated with that I could donate to? Ive read both of your posts and truly appreciate what you both do here so I was wondering if there is any you are affiliated with or recommend donations to. Thank you for your time.
239123 tn?1267651214
MEDICAL PROFESSIONAL
Attributing any particular HIV infection to a specific exposure is often difficult.  I don't know the details of the case CDC cites.  However, nobody should get uptight about a single case of anything.  A couple hundred people die of lightning strikes each year in the US, and once every few year someone probably gets killed by a meteorite.  But nobody goes around worrying about it or taking any but the most rudimentary precautions.  Just as I would not stand outside in a thunderstorm pointing a metal rod at the sky, I would probably avoid open mouthed kissing with a person known to have HIV.  At the same time, I wouldn't give a second thought to kissing a partner with no obvious risk --- which is how I would characterize your partner.

1) Are there other ways to catch HIV?  Sure.  If someone with HIV deliberately contaminated a hollow-bore needle and stuck it in your partner is one.  But for practical purposes, no, there is no other way.

2) Possible?  I suppose so.  Likely?  Absolutely not.

3) Discolored semen isn't all that abnormal; riding a bike can do it (becaue of minor trauma to the prostate, resulting in small amounts of blood).  It certainly doesn't imply HIV.

4) Again, can I prove there is zero risk of HIV transmission from kissing in the settings you mention?  No.  Do I believe it has ever happened?  Also no.

You must not focus on possibilities for any health risk, only on probabilities.  If you emphasize what MAY kill you, you would never go out in a car or take a commercial flight.  According to the National Safety Council, if you live in the US, there is 1 chance in 1,756 that you will be dead of an accident (auto, drowning, a fall, etc, etc) within 12 months.  That risk is thousands of times higher than the chance you'll catch HIV someday.

So keep a perspective and stop worrying about virtually zero risk events you can't prevent anyway.  Try to stop worrying about HIV in your situation; it simply isn't goint to happen.  And don't forget your seatbelt.
Avatar universal
Thanks doctor, so no need for testing or concern from sucking nipples and the other things I mentioned? Would you say its safe to say I had little or no risk for HIV and can now have unprotected sex with my boyfriend?
239123 tn?1267651214
MEDICAL PROFESSIONAL
Definitely no need for testing and it is safe to have unprotected sex with your partner.

Thanks for your offer of a charitable donation in support of STD/HIV prevention.  I recommend the American Social Health Association (www.ashastd.org).  Full disclosure:  I am a member of ASHA's Board of Directors, and Dr. Hook is a past president of the Bard.
Avatar universal
Hi doctor,
One last question. My boyfriend has no other symptoms but diarrhea which is all liquid since this past Wednesday night so 4 days now, he only had a mild fever the first day. However, he has been on cipro and tinidazole from the emergency room since Thursday night if it was a bacterial or parasitic infection from him travelling to Rwanda and he still has all liquid diarrhea for 4 days now atleast a couple times a day. If it was a bacterial or parasitic infection wouldnt the medication have helped by now? And is this common for intestinal infections for travelling abroad or does this change any of your advice? I will not post anymore I just wanted to ask because he is worried that the diarrhea hasnt gone away yet. Thank you.
239123 tn?1267651214
MEDICAL PROFESSIONAL
All this is consistent with travelers diarrhea, and not for HIV.  However, it sounds like he has a fairly severe case, and he should be under a doctor's care.  Please make sure that he is being closely evaluated.  But disregard HIV, which does not cause this sort of problem.
Avatar universal
Thanks so much doctor. He has an appointment with his primary care doctor on Tuesday and has been trying to keep hydrated as much as possible but has lost like 8 lbs probably due to dehydration and not eating. I'm guessing since the medications didnt work that it may not be a parasite or bacterial infection? And HIV is definitely not a concern for this type of severe diarrhea? Thanks so much again, I just want to make sure he gets better and doesnt have to take another trip to the ER because hes been worried about it not getting better yet.
239123 tn?1267651214
MEDICAL PROFESSIONAL
I'm not going to repeat what I already said.  Suck it up and move on, and stop asking about HIV.  It's not an issue here.
Avatar universal
Ok, sorry about the repeated question. Thanks for all you do here and your patience.
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