Transmission, Anxiety, and All the Above

[Marston]

First of all, God bless you for this site.  It is a source of encouragement and comfort to the thousands of us out there who are scared and/who are unable to receive a negative diagnosis and move on. I had a one-time anal receptive exposure in October 2003. Foolishly on my behalf, it was unprotected.  The next day, i realized my mistake and within 32 hours, I was taking an anti-viral.  Turns out, he was positive.  I tested negative at 3, 6, and 12 weeks.  I never was sick during that time (i checked my lymph nodes multple times daily).  It was single exposure, and i new my chances of seroconversion were greatly reduced.

In 2007, I started becoming sexual again, but only with one guy.  We are not in a committed relationship, and i know he has been tested and has routine blood work done.  Also, he is ONLY a top and never swallows or does drugs.    Our sexual practices are highly safe:  during intercourse, he uses a condom, and just before ejaculation, he withdraws, removes the condom, and finishes the job with his hands.  Never once has the condom broke. And we don't swallow.

This will sound silly, but on July 15 he ejaculated on me, primarily on my stomach.  I do think a drop or two hit my arm.  Near my wrist on that same arm, there was a healing mosquito bite.  It was not bleeding, and the scab area was forming. To be honest, i'm not sure a drop ever hit there in the first place.  Nevertheless, panic set in again.  I washed my arm within a minute, and later that day i brushed the area with peroxide.

How accurate is my self diagnois:  I had a scary experience, tested negative at 12 weeks (and I had CBCs done in 05 and 06 and all were normal), developed severe anxiety, and, as a result, i'm having flashbacks and am terrified every time i have sex and my ability to think rational is out the window.

Thanks for your patience.  The last thing i want to do is to get tested again; the anxiety is just too much.  Thanks for any advice you may havel.

[H. Hunter Handsfield, M.D.]

Thanks for the thanks about the forum, but I don't know how much I can help you.  You are religiously following safe sex practices, and getting semen on the skin is not an HIV risk -- zilch, nada, zero, nichevo (that's Russian).  And a negative test 12 weeks later proves you didn't cacth HIV.

But I will make some comments about your sexual choices.  You are overdoing the safe sex in one way (condoms plus withdrawal and avoiding swallowing, for example) while apparently missing a central component:  apparently you don't know your partner's HIV status!  If you do and he is HIV negative (and if you are confident he isn't having unprotected sex with other men), then the other precautions you describe are unnecessary and perhaps unpleasant for either or both of you.

If you don't know his HIV status, that's sort of weird.  As I have said innumerable times on this forum, one of the most important aspects of safe sex for men who have sex with men is "do ask, do tell" -- i.e., never have sex with a man without first frankly discussing each others' HIV status and avoiding anal sex with those who are HIV positive, or who are evasive about it.  I cannot understand a regular, ongoing MSM partnership without mutual HIV knowledge between the partners.  Of course, if your partner has sex with other guys from time to time, that changes the picture a bit, especially if those activities include unprotected anal.  Many MSM make such decisions openly in their partnerships -- but even so, regular HIV testing plus routine safe sex (condoms for anal sex) is highly protective.

However, now I'm off into counseling land, which is not my expertise.  The bottom line (no pun intended) is that you can be sure that you aren't now HIV infected.  But I think you and your partner might need to address your relationship, your HIV status, and your approaches to safe sex.

Regards--  HHH, MD

[H. Hunter Handsfield, M.D.]

OK, sorry about the PEP comments.  I thought all your questions were in reference to the more recent semen-on-skin event, which of course didn't even warrant HIV testing, let along PEP.

[Marston]

Thanks. I'm entering counseling soon; one with a therapist and another with a Christain counselor.  You picked up on something:  my sexuality is an issue, and the latter of the therapists is the one will help me deal with that.

Just to clarify: the PEP was for the event that took place in October 2003, not the silly mosquito bite incident.

[H. Hunter Handsfield, M.D.]

PEP??!!  After that non-exposure event??  The risk of deatlh due to an adverse reaction to the therapy was higher than the chance you caught HIV from the exposure. I'm amazed you were able to find a provider willing to prescribe it, assuming you accurately described the circumstances.

There are no data on whether PEP delays the seroconversion window.  You're going to have to ask that of the provider who prescribed it.  But since there was no chance you could have caught HIV, I don't see that it matters.

That action plus the overall tone of your quesitons, including your self-described anxiety, suggest you might benefit from professional counseling to deal with your sexuality, your apparently overblown HIV fears, and so on.  I suggest it out of compassion, not criticism.

[Marston]

Thank you for the advice. I appreciate you more than you can ever imagine.

I have talked to this guy and he assure me he was negative. He has been tested in the past, has routine blood work, and, most importantly, he said he has not had unprotected sex.  I do believe that part.

I guess my only concern going into this was that i had the 12-week test at the 12-week mark post exposure; it was not 12 weeks after the conclusion of my PEP treatment.

Again, God bless you.  If you think the above concern is "concerning," just let me know.