family man under dire stress

[mrfinster]

OK, here's the story.

I am a 38-year old hetero male, and stupidly visited a prostitute in NYC (Japanese girl) on 10/3. I only had vaginal sex (protected). But before putting on the condom, my penis tip rubbed against her anus and vagina, then she rolled on a condom, which i PRESUME to be LATEX.  She then applied lube, which I PRESUME to be waterbased. (It wasn't vaseline, i know).  Intercourse lasted 45 secs. i withdrew with the condom intact. I wiped the fluids off myself with a tissue she provided.

The next day i had penis pain and burning diffuse pain in my right groin. No burning on urination. This sole symptom lasted about 2-3 weeks.  At 5 weeks, I had a brief low fever for a night, with aches, followed by a couple weeks of just feeling lousy and almost chilled (no fever). At 8 weeks, i had what i believe to be a stomach flu, which was 1 night of intense vomiting, followed by 2 weeks or so of feeling lousy and not eating. ANd a dry cough too.  I noticed pain in my upper abdomen, which i felt might be my spleen and liver. (i had mono as a teen, so i remembered that kind of pain) (My wife and kids got that flu a week later) At that time I noticed some glands in my neck, armpit and groin began to ache, not particularly swell, but tender to the touch. These nodes have lasted to date, but have been tapering off in severity of pain.  At this time (13 weeks), i still have some minimal node pain in my neck, armpits, even behind my knees & around my lower right groin (that same diffuse, burning pain), which actually hurts more when I sit, and not at all when i stand.  I also have a node in the middle of my back right near my spine just below shoulder blade level that is sore and bothers me.  

I am a nervous wreck, and fear for myself, my wife and my kids.  

PLEASE HELP!

1) what are your thoughts about the risks during the sex act?  the rubbing issue? (could the virus get into my meatus? and/or get trapped on my penis when she rolled the condom on?) the latex(?) issue? (do SW's ever use lambskin?) the lube(?) issue?  (was it long enough to create permeability in the latex?)

2) what are your thoughts about the nature of my symptoms?  are they ARS-like?  The nodes are most disconcerting, given they are generalized.  no major swelling, but noticable and tender!  what about the timing and onset of them all?

I called several hotlines and all said testing wasnt warranted?  do you concur?

I know my stress can excaserbate and/or manifest symptoms, but I believe you cant dream up lymph symptoms, right?

Please give me some guidance as I am truly depressed and cannot function properly given my fear and guilt!

Thank YOU SO MUch.

[mrfinster]

i was going to post this in the STD Forum, but I thought i needed to continue the thread where it began.  My questions were unrelated to the hiv, but rather new concerns over other std's, for which --- i thought -- i had valid questions.  If i had in fact posted it there, would you have reacted in the same manner?  You sound truly contentious. I dont understand that.  If the questions had simple answers that addressed my concerns, why treat it as if i were a criminal.  I am disappointed with your reaction, as a doctor and a human being.

[H. Hunter Handsfield, M.D.]

Duplicate posts on the same topic are not permitted, especially in a zero risk situation.  I deleted your new attempt.  Your level of anxiety suggests you need professional counseling.  If you want advice from other participants in this forum, take it over to the HIV support forum.  I won't have any further responses.  This thread is over.

HHH, MD

[mrfinster]

thanks.

I just got the guts to get an Oraquick hiv test and it was negative.  the worst 20 minute wait of my life.

i am human, yes.  but i still feel like a stupid animal.

fyi, i'm still struggling with various symptoms that keep haunting my thoughts. the hiv was fortunately negative, but i am now concerned about hep and htlv. i feel like i'm in a death spiral...

i guess i deserve it for my infidelity..

[Curious_Milo]

Hello,

I had to respond to your post because I know exactly how you feel... believe me. I myself am married, with two children. I have also made this same mistake, and have worried almost to the point of insanity.

Try to keep the fact that you were wearing a condom centrally fixed in your mind, while realizing that nobody has ever been infected through an intact latex condom. I have no doubt that the condom was latex. For her, sex work is what puts bread on the table, and why would she want to risk that, and her life, with a non-latex condom? Not to mention that natural skin condoms are much more expensive and harder to find... No, it was latex I'm sure. Try to keep these ideas in your mind, as I have.  Hopefully, this will help bring you some peace.  

Humans are animals, and we make mistakes too you know.

[mrfinster]

Thanks, doc.  You words are reassuring.  Of course, the guilt & anxiety are always tricky variables when assessing these situations, and something I will have to cope with on my own terms. I probably wont get a test given this was my only "risky" encounter and indeed occurred as I described.

It's just hard to intellectualize the pain and tenderness in my nodes, or at least the areas where my nodes are located... swelling aside. I guess that stomach flu was viral & had a 4 week long lingering effect?  could that be true?

All the best in 2007.

[H. Hunter Handsfield, M.D.]

General comments before I go to your questions.  1) A condom was used; that means no risk of HIV, regardless of latex vs other condoms, and regardless of the lubrication used.  2) The chance your partner had HIV is low.  3) If she had HIV, and no protection was used for vaginal sex, your chance of getting HIV was somewhere around 1 in 2000.  4) Genital secretions on hands or the outside of the genitals is not a risk for HIV.  5) No STD can cause symptoms the next day; the groin pain could not have been due to an STD; and anyway, no STD causes that symptoms.  6) Finally, your other symptoms don't really sound like acute HIV infection; and other causes (like any of a number of garden variety viruses) are infinitely more likely than HIV.  And yes indeed, many (or all) your symptoms could be due to anxiety and nothing more.  But I simply do not trust your self-assessment of enlarged lymph nodes.  It's hard enough for a trained professional, and in my experience almost nobody who believes their nodes are enlarged actually have enlargement on examination.

So my direct answers are:  1) No measurable risk of HIV.  2) Almost no chance your symptoms are due to HIV.

Based on risk assessment and your symptoms, I would not have recommended testing.  However, HIV clearly is on your mind, and undoubtedly my reassurance will not be sufficient.  You should get tested just to ease your mind.  Assuming you have no other HIV risks, you can be certain the result will be negative.

So just get tested and mellow out in the meantime.  Your only problem is the anxiety over your infidelity.

HHH, MD