HIV General Information

[NeedInfo2]

Dr. HHH,

I tested negative @ 4, 9, & 12 weeks.  But around the 11th week after possible exposure, I started experiencing a stinging sensation on the tops of both my feet/toes and around the ankles as well as the backs of both my hands/fingers, wrists, and occasionally up the forearms. Most painful areas are under the laces of my shoes when wearing shoes and walking, and on the back of my hands near the thumb and forefinger.  

My story is I met a woman on the internet after chatting and getting to know on another, had protected vaginal sex with unprotected oral sex (gave & received).  She says she is clean.

My question, I feel that my ELISA test were conclusive.  Do you recommend another test?  How soon would peripheral neuropathy accure if a person was HIV+?  Starting to worry...

Thanks, this forum is a source of good information.

[anxiety65]

This thread is so impressive.  There are many intelligent commenst made by posters that I am sure are a help to everyone.  I am concerned about the comments about screening out responses to low risk individuals with high anxiety.  I think answering these questions is a tremendous help.

Now just to confirm the anxiety from words.  The good doctor's response to me was very comforting.  But his last sentence; "It is almost impossible to acquire HIV from my exposure" does this mean no exposure?  Then the killer for me was "If your test happens to be positive, it won't be from the exposure you described"....My legal mind began to think that this was a disclaimer to the advice given.  So words to someone wrought with anxiety are always carefully written and may have unintended meanings.

Thanks to the Doctor and thanks to all who post.  What a great forum.  I hope poor anxious posters are not screened out.

Doctor's response to 3/18/06 post:
See many other threads on this forum with more detailed responses to your questions than I will provide now. Search for "HIV transmission risk", "oral sex", "cunnilingus", "ARS symptoms", "HIV symptoms", and "time to positive HIV test".

The quickie responses are that nobody has ever been known to acquire HIV by cunnilingus or by hand-to-genital contact, regardless of sores on the fingers or mouth, and despite what you might read, your symptoms do not suggest HIV. Temperatures below 97.5 are common in anybody from time to time, and low temperature is not a sign of HIV; the opposite is true--almost everybody has a fever. Finally, you don't need to wait 90 days; a negative HIV test ~6 weeks after exposure would be almost 100% reliable.

Bottom line: it is almost impossible that you have HIV acquired during the exposure you describe. If your test happens to be positive, it won't be from the encounter you describe.

Good luck-- HHH, MD

[monkeyflower]

Yeah. I actually read about that statistic, because that was the subject of a couple of threads here on this board. That risk is with someone who is known HIV positive - which translates into over 50 years of daily blowjobs with someone who is known HIV positive. If you don't know your partner's status, it's even lower. So, it really is MORE than lightning strike risk. Even at that, though, I believe I also read that the risk was "made up", based on comparisons to other risky activities. I think it's very vague, because it's still just not really known. How many people do you know who engage in just one sexual practice?

So now I'm on my soapbox, lol. It should make you feel better to know that you are FAR more likely to die from homicide, suicide, and septicemia (seriously - who knew?) than you are HIV. Not to mention the big ones, like heart disease, diabetes and cancer. Literally hundreds of thousands of people are diagnosed with serious chronic illnesses every year - over 18 million people currently have diabetes alone (CDC, 2002) - and just tens of thousands are diagnosed each year with HIV. Despite all the hype, HIV is still pretty low on the charts.

Also, the number of people who die in the US annually from the flu is more than double the number who die annually from HIV. Yet people don't freak about the flu, they take *horrible* care of their bodies (overeat, don't exercise, smoke, drive recklessly, etc.), and they still freak over the most insignificant STD risk. Some people might find my statistics irrelevant, but I think it says *everything* about our priorities in this country.

[H. Hunter Handsfield, M.D.]

The perceived risk of oral sex hasn't changed in recent years, and there is no evidence of political slant in how CDC or anybody else interprets the data (speaking as a Clinton Democrat, by the way).  There isn't even any active research to address the risk of oral-genital HIV transmission, because the available data suggest the risk is so low that it isn't worth doing any further investigation.

HHH, MD

[monkeyflower]

I don't know - I think the specific answers are tailored to the specific questions. If they have to be consistent, regardless of the poster's actual risk level, then you might as well just post a FAQ and not answer any questions at all.

Hopefully that's not part of the forthcoming changes, btw... because when there are interesting questions, this site is awesome. The repetitive "I kissed a strange woman, now my back hurts. I'm sure I have HIV." questions, followed by the "Yes, but there was *tongue*, and I'd brushed my teeth that morning." responses seem to be a relatively new phenomenon.

[Willl]

It's what he believes is in the scope of the forum and what he is trying to accomplish with any certain questioner. I have pointed out nuances in replies before and this is how he responded. I think people reading the forum try to apply the responses as all-encompassing and general application for everyone. Where in fact, he is trying to address the specific situation, including the original posters perceived emotional state.

Unfortunately, I believe the changes to come in this forum in the near future will be deletion of all such low risk HIV related questions, or an archive or FAQ of such HIV transmission (oral, massage parlors, kissing etc). So that such interpretations to repetitive questions like these will no longer be an issue. For the functionality of the forum it will be great, but for those that have anxiety driven HIV issues, they will not be able to get relief for what they feel is their specific situation. So the benchmark for these questions will be in the form of something like a FAQ.

[curiousinternalmedicine]

You wrote: "Don't read too much into detailed wording of responses to various questioners."
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Dear Doctor - Firstly - Thank you for the wonderful work that you do for panic stricken, guilt ridden people like us. This is not a crticism - I have great respect for your work and am humbled the way you help out in between your busy day. If I may -"the detailed wording" sometimes DOES cause a bit of confusion and can add to the worries. Please see below from a reader of your forum bringing this issue to aidsmeds. He is thinking you had a change in position - however - if he stayed with the forum long enough he would have seen that you go between "zero risk" to "low risk" a lot given the nature of the encounter...men giving the fellatio vs. woman, gay vs. straight. This is again not a criticism - and you are not a therapist to hold hands to deal with people's FEARS- however - maybe a benchmark will be beneficial so that people do NOT have to hang on to your details of the wordings. Also, the 0.5 in 10,0000 is a best guess estimate by CDC and not an actual documented number. So - why the low risk assignment and yes - I understand in life we live with a lot of risks. Again - I write with deep appreciation and admiration.

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I don't know if this is the right place for my posting but I was very glad to see that medhelp.org in it's STD-section changed their opinion for insertive oral sex. The questions are answered by H. Hunter Handsfield, M.D., Senior Health Research Leader at the Battelle Center for Public Health Research and Evaluation, Seattle, Washington, and Clinical Professor of Medicine at the Center of AIDS and STD, University of Washington. As you can see in the archives he answered questions for insertive oral a few weeks ago with the "virtually no risk" or "risk is close to zero"-sentence. In the actual answers he says that there is "zero risk" or "no risk" for getting hiv by receiving a blowjob.

I know that this answer is exactly what you think but I guess that it's quite surprising that medhelp changed the answer. Maybe it's just like splitting a hair but I felt very nervous the day I found medhelp and read about the "close to zero"-risk in an answer by a clinical AIDS and STD professor. Now this "close to zero"-risk is a "zero"-risk and this is good for all the worried-wells like me.

[monkeyflower]

"...for those that have anxiety driven HIV issues, they will not be able to get relief for what they feel is their specific situation."

Honestly, I doubt that any response, even "zero risk," is ultimately helpful to the anxious posters. I think most intellectually understand they are at little risk, but their anxiety and guilt drive them to keep posting here and on other boards. No forum can provide that continual need for reassurance.

[Willl]

You missed my point.

[Willl]

Back to the accepting of low risk questions to begin with.
There are exceptions regarding those posting about low risk exposures versus those who show "anxiety driven HIV issues". For instance the Dr. that came here recently anxious about getting HIV from oral. He had the same information available in the archive as everyone else but wanted his situation addressed specifically. He got a very thorough response and I didn't notice him replying in the same thread over and over needing reassurance.

If it is repeat posters taking up opportunities for others to post a legitimate question, then their IP addresses could be blocked. My point is how can you determine who will be an abuser of the forum because of a low risk anxiety issue and who just wants their specific case addressed then moves on with their life?

[monkeyflower]

I remember that post. He was quite clear that he was experiencing health anxiety as a result of the loss of a loved one, is in therapy, and just looking for a reality check. That's a little different from the usual "I kissed a sex worker and now I have a coated tongue and my back hurts. These are *real* symptoms, so I know I have HIV."

[Willl]

I agree, reassurance from the world's greatest HIV expert (whomever that may be) would unlikely convince the worried wells that come to these forums.

[NeedInfo2]

Thanks for your reply.  After following this board for a little while, I was pretty sure what your reply would be but sometimes its good to hear.  Its amazing how the mind can run away with your emotions and let fear take over.

I'll follow up with my GP and get him to refer me to a neurologist to get checked out.  Again, thanks.

[H. Hunter Handsfield, M.D.]

Don't read too much into detailed wording of responses to various questioners.  Several times I have pointed out that my responses may vary a little depending on the context of the question, the needs of the persons asking it, etc.  Also look at the many threads on "time to positive HIV test" about the links between testing advice, the nature of the exposure, symptoms, and time since exposure.

To my knowledge, I have never recommended against HIV testing if there was some plausible risk of transmission, even if that risk is very low.  Also, I am very liberal in recommending testing for anxiety management, even when the medical indications are unclear or absent.  If you can cite specific comments by me that disagree with my recollection, feel free to point them out.

Plans are underway for some modifications of the STD Forum in an attempt to limit the number of repetative questions, anxiety-driven low-risk HIV exposures.  Stay tuned.

HHH, MD

[H. Hunter Handsfield, M.D.]

I agree your 12 week test is conclusive and I do not recommend additional testing.  You were at low risk anyway, your symptoms don't suggest HIV, and anyway symptoms never are anywhere nearly as reliable as the blood tests in determining HIV infection.  

Peripheral neuropathy--if that is what you have (but seems unlikely)--is a manifestation of longstanding, overt HIV with severe immunodeficiency (ie AIDS); it is rarely a symptom of early HIV infection (if ever).

Good luck--  HHH, MD

HHH, MD