Aa
Risky encounter: HIV or others?
Dear Doctors-
I am 28, male, heterosexual, educated, male.
On 8/7, while drunk, my "bicurious" side came out, I had sex with a gay guy (a stranger) for the first time. Always safe in my heterosexual encounters, I was sure to use a condom. Sometime during the 10 minute romp the condom slipped off and I didn't notice it due to my drunkenness and the dark room. For anal, I was the insertive partner only, protected only half the time. For oral, we reciprocated, unprotected entirely. Prior, I asked if he has HIV, he said no. After, we talked and I realized he has never been tested, but just assumed he doesn't have it! Unfortunately, he said he doesn't ordinarily use condoms. It mortified me but I monitored my health over the past few weeks and took a calm approach in the meantime to being tested. I considered PEP initially, but reviewed this website and others and saw the 1/500 odds. So I was calm, that is, until now. If the stats are right (are they? the most quoted are from a 1992 CDC study only...), logic and reason have eluded me, replaced by sheer terror and anxiety- I can hardly sleep, no appetite, nightmares. Beginning this past Thurs (3 weeks), I had onset of a medium-intensity sore throat, onset of low-grade fever (38C), night seats, all of which continue. No other symptoms, no upper-respiratory symptoms that might relieve my HIV concerns. I have read the forum and all of the info on odds. Further, I know that reasonable people can become basket-cases based on symptoms. (Have any on this forum turned out to be HIV-positive?).
My plan: to visit my doctor right away for anxiety, and for the full STD suite of tests at 5 weeks.
My additional questions: I had unprotected withdrawal sex with my girlfriend at 2 and 13 days after the encounter. Is she at risk as well? Do common STDs give these symptoms also? What else should I do? I have never been in a worse mental state in my life- I am so scared and feel inevitable doom. Please help. Respectfully, an Idiot
I am 28, male, heterosexual, educated, male.
On 8/7, while drunk, my "bicurious" side came out, I had sex with a gay guy (a stranger) for the first time. Always safe in my heterosexual encounters, I was sure to use a condom. Sometime during the 10 minute romp the condom slipped off and I didn't notice it due to my drunkenness and the dark room. For anal, I was the insertive partner only, protected only half the time. For oral, we reciprocated, unprotected entirely. Prior, I asked if he has HIV, he said no. After, we talked and I realized he has never been tested, but just assumed he doesn't have it! Unfortunately, he said he doesn't ordinarily use condoms. It mortified me but I monitored my health over the past few weeks and took a calm approach in the meantime to being tested. I considered PEP initially, but reviewed this website and others and saw the 1/500 odds. So I was calm, that is, until now. If the stats are right (are they? the most quoted are from a 1992 CDC study only...), logic and reason have eluded me, replaced by sheer terror and anxiety- I can hardly sleep, no appetite, nightmares. Beginning this past Thurs (3 weeks), I had onset of a medium-intensity sore throat, onset of low-grade fever (38C), night seats, all of which continue. No other symptoms, no upper-respiratory symptoms that might relieve my HIV concerns. I have read the forum and all of the info on odds. Further, I know that reasonable people can become basket-cases based on symptoms. (Have any on this forum turned out to be HIV-positive?).
My plan: to visit my doctor right away for anxiety, and for the full STD suite of tests at 5 weeks.
My additional questions: I had unprotected withdrawal sex with my girlfriend at 2 and 13 days after the encounter. Is she at risk as well? Do common STDs give these symptoms also? What else should I do? I have never been in a worse mental state in my life- I am so scared and feel inevitable doom. Please help. Respectfully, an Idiot
Dear Doctor Handsfield,
A few updates:
1) My antigen and antibody tests were both negative at 3 weeks. My physician says that this is very good news but inconclusive until the 6 week mark, as mentioned above.
2) My symptoms are gone, they lasted 5 days total.
3) I was able to contact the "gentleman" and asked him to be tested- he agreed, results are pending. He has changed his story from before and says he is usually safe, but not always (though he has still never been tested until my insistence now). I took this as lower odds that he would be positive.
4) I have arranged to meet monthly with a psychologist to discuss the immense stress this has caused me (mostly relieved now), as well as my curiosity about bisexuality since this has also caused me angst and mixed feelings. Further, I'm now keenly aware through this website and others that MSM are by far at most risk for HIV.
For now, I feel that resuming safe-ONLY sex with my girlfriend is okay, unless you indicate otherwise.
I will post the results of the 6 week test at that time. Thanks again for your candid advice and support.
Respectfully yours,
A few updates:
1) My antigen and antibody tests were both negative at 3 weeks. My physician says that this is very good news but inconclusive until the 6 week mark, as mentioned above.
2) My symptoms are gone, they lasted 5 days total.
3) I was able to contact the "gentleman" and asked him to be tested- he agreed, results are pending. He has changed his story from before and says he is usually safe, but not always (though he has still never been tested until my insistence now). I took this as lower odds that he would be positive.
4) I have arranged to meet monthly with a psychologist to discuss the immense stress this has caused me (mostly relieved now), as well as my curiosity about bisexuality since this has also caused me angst and mixed feelings. Further, I'm now keenly aware through this website and others that MSM are by far at most risk for HIV.
For now, I feel that resuming safe-ONLY sex with my girlfriend is okay, unless you indicate otherwise.
I will post the results of the 6 week test at that time. Thanks again for your candid advice and support.
Respectfully yours,
MEDICAL PROFESSIONAL
By the way, I should have suggested a likely alternative diagnosis, which is all over the front pages these days: your symptoms are consistent with H1N1 influenza. You could be tested for it.
MEDICAL PROFESSIONAL
Sorry, I have no information about new data on susceptible cells in the rectum; my expertise is in the epidemiology of transmission but not the biology of it. But this makes sense based on what I know. I already gave a more updated reference for HIV transmission rates.
Your doctor and I obviously are on the same wavelength and your last comment indicates his responses to many of the same questions you asked several hours ago -- including the fact that earlier stress reduction is an important reason for early diagnosis, as is the possibility of starting therapy sooner if the result is positive. It is not certain that early therapy makes a difference in the long run, but many experts believe it's a good idea, in hopes of blunting the viral load and therefore the severity of initial CD4 cell depletion. He correctly informed you about the dual test both p24 antigen and HIV antibody and is a reasonable recommendation by your doctor. If both components are negative at 3 weeks, it is very reassuring, but not as definitive as an RNA test for the virus itself. And I certainly agree with follow-up testing at 6 weeks, assuming the initial tests are negative.
Let us know the results. Good luck.
Your doctor and I obviously are on the same wavelength and your last comment indicates his responses to many of the same questions you asked several hours ago -- including the fact that earlier stress reduction is an important reason for early diagnosis, as is the possibility of starting therapy sooner if the result is positive. It is not certain that early therapy makes a difference in the long run, but many experts believe it's a good idea, in hopes of blunting the viral load and therefore the severity of initial CD4 cell depletion. He correctly informed you about the dual test both p24 antigen and HIV antibody and is a reasonable recommendation by your doctor. If both components are negative at 3 weeks, it is very reassuring, but not as definitive as an RNA test for the virus itself. And I certainly agree with follow-up testing at 6 weeks, assuming the initial tests are negative.
Let us know the results. Good luck.
Hi Jim-
Thanks for your kind words. I know the odds are in my favor, but apparently people seem to catch these bullets all the time, given the number who have it. I thought I was being responsible and safe, but I let my guard down for just a moment.
Dear Doctor-
I have followed your advice and seen my physician. He said there was no point to evaluate my symptoms and ordered a test. Apparently the standard test that is done at his clinic is both for antibodies and antigen. He echoed this site's info- that antibodies would be unlikely to appear now, and antigens would be likely to appear. He also stressed the need to repeat the test at 6 weeks, if it negative. He also thinks that the odds are strongly in my favor and that's why he wanted to order this first test right away- both to deal with my anxiety. In the event that it's positive, I can get treatment right away. I'm not sure what difference the two-week earlier treatment would make... Anyway, I will post the results in 48 hours.
Thanks for your kind words. I know the odds are in my favor, but apparently people seem to catch these bullets all the time, given the number who have it. I thought I was being responsible and safe, but I let my guard down for just a moment.
Dear Doctor-
I have followed your advice and seen my physician. He said there was no point to evaluate my symptoms and ordered a test. Apparently the standard test that is done at his clinic is both for antibodies and antigen. He echoed this site's info- that antibodies would be unlikely to appear now, and antigens would be likely to appear. He also stressed the need to repeat the test at 6 weeks, if it negative. He also thinks that the odds are strongly in my favor and that's why he wanted to order this first test right away- both to deal with my anxiety. In the event that it's positive, I can get treatment right away. I'm not sure what difference the two-week earlier treatment would make... Anyway, I will post the results in 48 hours.
Hey hang in there. Just follow the good doc's advice. The odds are still REALLY in your favor. I'll keep my fingers crossed and my hands raised from one human being to another. Take care.
Sorry, I had meant in the follow-up to ask if you've found other studies that correlate with the 17 year old CDC findings. Is there anything more recent or have you found anecdotal evidence that backs this up or that is to the contrary?
I am just trying to understand my true risk and honestly, I'm looking for reassurance- I'm shaking with fear. Although the stats would indicate otherwise, with over 40k newly infected Americans per year, I'm afraid I may now be one of them. Perhaps the disease is easier to transmit than the statisticians estimate?
I am just trying to understand my true risk and honestly, I'm looking for reassurance- I'm shaking with fear. Although the stats would indicate otherwise, with over 40k newly infected Americans per year, I'm afraid I may now be one of them. Perhaps the disease is easier to transmit than the statisticians estimate?
Thanks for your prompt response. I am totally mortified and think that I made the wrong decision about PEP. About asking his status prior, I did- it was only after talking to him that I realized that he is stupid enough to think that he's not infected without having been tested. This plus the condom slippage. I will never drink again. I am really at a loss now- although usually calm and rational, fear and emotion is totally overtaking me, I cannot believe this. I thought perhaps that I was making up the symptoms, but it definitely hurts when I swallow and the thermometer doesn't lie- pretty consistent at 37.8+-0.5.
A question, what is the benefit of testing for the virus itself versus the antibodies? ...If I'm infected, then that's it anyway right? Also, can I request the viral test or is it up to the doctor usually?
Also, there was something recent that I read about a new study claiming that the rectum was far richer in HIV cells than previously thought. Can you shed light on this?
I've sent a calm email to the guy asking him to be tested and about his previous exposures, but I'm totally scared, Dr Handsfied. I am not the kind of person to make such foolish mistakes and have (/had) a promising life in front of me. I thought I was being safe in responsible and this was the first time I've ever had sex with a man. How can it be...
A question, what is the benefit of testing for the virus itself versus the antibodies? ...If I'm infected, then that's it anyway right? Also, can I request the viral test or is it up to the doctor usually?
Also, there was something recent that I read about a new study claiming that the rectum was far richer in HIV cells than previously thought. Can you shed light on this?
I've sent a calm email to the guy asking him to be tested and about his previous exposures, but I'm totally scared, Dr Handsfied. I am not the kind of person to make such foolish mistakes and have (/had) a promising life in front of me. I thought I was being safe in responsible and this was the first time I've ever had sex with a man. How can it be...
MEDICAL PROFESSIONAL
Welcome to the forum. I'll try to help.
Data on per-exposure HIV transmission risks have been published more recently than 1992. The main source today is from CDC in 2002, and the basis for the roughly 1 in 500 risk for the insertive partner in unprotected anal sex. Here is the abstract:
http://www.ncbi.nlm.nih.gov/pubmed/11773877
You obviously had a pretty high risk exposure. I wish you had followed the routine advice we give on this forum, for men having sex with men to discuss HIV status before having sex, and to not go ahead -- or at least be especially careful about condoms for anal sex -- with partners who are positive, unsure, evasive or, as in this case, just don't know.
From the standpoint of transmission risk, the odds are in your favor. And in general, as you likely have seen elsewhere on this forum, symptoms generally are poor indicators of new HIV infection -- and your symptoms came on somewhat late, since ARS symptoms usually start around 10-14 days after exposure. On the other hand, your symptoms do concern me, and combining that with the nature of the exposure, I think your fears of infection are not unfounded. Other STDs are not likely causes for such symptoms, but of course you could have some garden-variety, harmless virus.
If it turns out you have HIV, your girlfriend is at quite high risk, especially from the exposure at 13 days. People with HIV are most infectious -- i.e. have the highest viral loads -- during the first 2-3 weeks of infection, before developing symptoms or positive antibody tests. On the other hand, her risk is probably lower than it would have been with intravaginal ejaculation.
It remains true that in the ~5 year history of this forum, nobody has reported a documented new HIV infection. One person several years ago claimed a new infection but it became clear he was lying. Another person several months ago gave a good story with a positive antibody test result, but it was a rapid test, which carries a risk of false positive results. Unfortunately, he never returned to let us know the result of confirmatory testing.
All things consdidered, the odds remain in your favor. But you should not ignore this. You should immediately see a provider knowledgeable about HIV, such as an infectious diseases specialist; or call your local health department and ask for advice in finding the right provider. Testing for the virus, without waiting for an antibody test to become positive, might be warranted. In addition, you should contact your male partner and tell him what is going on, and ask (insist) that he be HIV tested. It would be highly reassuring if the result were negative.
This is not what you wanted to hear. But you need to think soberly and act rationally. See a knowledgeable provider and please report back what is found.
Good luck-- HHH, MD
Data on per-exposure HIV transmission risks have been published more recently than 1992. The main source today is from CDC in 2002, and the basis for the roughly 1 in 500 risk for the insertive partner in unprotected anal sex. Here is the abstract:
http://www.ncbi.nlm.nih.gov/pubmed/11773877
You obviously had a pretty high risk exposure. I wish you had followed the routine advice we give on this forum, for men having sex with men to discuss HIV status before having sex, and to not go ahead -- or at least be especially careful about condoms for anal sex -- with partners who are positive, unsure, evasive or, as in this case, just don't know.
From the standpoint of transmission risk, the odds are in your favor. And in general, as you likely have seen elsewhere on this forum, symptoms generally are poor indicators of new HIV infection -- and your symptoms came on somewhat late, since ARS symptoms usually start around 10-14 days after exposure. On the other hand, your symptoms do concern me, and combining that with the nature of the exposure, I think your fears of infection are not unfounded. Other STDs are not likely causes for such symptoms, but of course you could have some garden-variety, harmless virus.
If it turns out you have HIV, your girlfriend is at quite high risk, especially from the exposure at 13 days. People with HIV are most infectious -- i.e. have the highest viral loads -- during the first 2-3 weeks of infection, before developing symptoms or positive antibody tests. On the other hand, her risk is probably lower than it would have been with intravaginal ejaculation.
It remains true that in the ~5 year history of this forum, nobody has reported a documented new HIV infection. One person several years ago claimed a new infection but it became clear he was lying. Another person several months ago gave a good story with a positive antibody test result, but it was a rapid test, which carries a risk of false positive results. Unfortunately, he never returned to let us know the result of confirmatory testing.
All things consdidered, the odds remain in your favor. But you should not ignore this. You should immediately see a provider knowledgeable about HIV, such as an infectious diseases specialist; or call your local health department and ask for advice in finding the right provider. Testing for the virus, without waiting for an antibody test to become positive, might be warranted. In addition, you should contact your male partner and tell him what is going on, and ask (insist) that he be HIV tested. It would be highly reassuring if the result were negative.
This is not what you wanted to hear. But you need to think soberly and act rationally. See a knowledgeable provider and please report back what is found.
Good luck-- HHH, MD
You are reading content posted in the HIV - Prevention Forum
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
Can I get HIV from surfaces, like toilet seats?
Can you get HIV from casual contact, like hugging?
Frequency of HIV testing depends on your risk.
Post-exposure prophylaxis (PEP) may help prevent HIV infection.
