[Question #11034] many risky exposures (MSM)

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17 months ago
hello dear doc,
I am a 22-year-old bisexual man who identifies as heterosexual. Unfortunately, I had no awareness or knowledge about STDs until 11 months ago. I am ashamed to say that I had unprotected sexual intercourse with both men and women (and almost all of them were men, that is, MSM) for about 4 years. The sexual encounters I had with men were generally anal sex, and I was the recipient, that is, the risky role. A year ago, a genital wart appeared in my anal area and after a while it started to itch severely. Then I was treated with cryotherapy and now I think it's gone. But I am very worried about HIV. Because I have had unprotected sex with many men and I know that HIV is generally a homosexual disease. I last had a relationship with a man 9 months ago. (There was no anal sex, there was mutual oral sex and kissing.)
I took HIV ag/ab and other STD tests on the 75th, 80th, 85th, 90th, 110th, 130th, 180th, 190th, 229th days after intercourse, all negative. First of all, despite all the risks I experience, are the tests reliable? With your permission, I will ask my questions in the next part.
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H. Hunter Handsfield, MD
17 months ago
Welcome to the forum. Thank you for your confidence in our services. I think we can help.

While it is unfortunate you were naive about STD risks for so long, I'm glad you've become aware of the issues. Since your main concern is HIV, I'll address that first -- then a few words about other STDs.

Indeed you have been at risk for HIV, especially from receptive anal sex (bottoming) -- but also from any insertive anal sex (topping) you've done with other men. And maybe at risk from one or more of your femaie partners, but HIV is so rare currently among most women (in North America and Europe, anyway) that few exclusively heterosexual men ever become infected sexually. In any case, you have been very seriously overtested for HIV. All HIV AgAb (4th generation) blood tests are concluisve 45 days after the last exposure. All your results after the 75th day were superfluous. It is certain you do not have HIV.

Presumably "other STD tests" all those times included gonorrhea and chlamydia (which should have been done on throat and rectal swabs in addition to urine), and likely blood tests for syphilis. Presumably all were negative or you would have said otherwise -- other than your anal HPV infection. (I'm glad to hear that's apparently in control.)

Assuming your sexual lifestyle continues in much the same pattern, you should find an expert -- it could be a community or public health clinic or any of a number of other counseling sources -- to advise you on safe sex practices going forward. I'll only mention them by name -- it will be up to you to suss out the details:  1) Ideally, condoms for all anal sex, both top and bottom. 2) Discuss HIV/STD status with all partners before proceding with sex -- then special attention or avoidance with partners who are HIV infected (and not on treatment), don't know, or seem evasive about it. 3) Pre-exposure prophylaxis (PrEP) with anti-HIV drugs. 4) If not on PrEP, there may be occasions for post-exposure HIV prophylaxis (PEP). 5. Doxy-PEP -- i.e. the antibiotic doxycycline in a dose of 200 mg within 3 days of unsafe anal sex. (Doxy-PEP is the newest increasingly advised STD prevention strategy for men who have high risk sex with men and is higly effective against syphilis and chlamydia, and about 50% protective against gonorrhea.) 6) Periodic testing for serious and/or common infections, especially gonorrhea, chlamydia, syphilis and HIV. 7) Vaccination against hepatitis B virus (HBV). 8) Vaccination against HPV, which protects against the 9 HPV types that cause 90% of cancers and anal or genital warts (not counting any types you already have acquired, which could be some or most covered by the vaccine). As already implied, each of these approaches has its complexities and the choices about them vary a lot from one person to another -- which is why individual in-person advice is recommended.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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17 months ago
Thank you for your answer sir. But I can't ask my questions, I get a warning even though I don't exceed the word limit. I think I must have made a mistake.
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17 months ago
Thanks for your answer. With your permission, I have a few questions.
1. I had a swollen lymph node in my neck for a long time. I think this is due to candida. Because there was white on my tongue and when I cleaned it, the lymph node became smaller. So, is candida a sign of STD?
2. I live in a middle eastern country. In the country I live in, if a man has had sexual intercourse with a man even just once, blood cannot be taken from that person for life. This worries me. What could be the reason for this?
3. Why are HIV blood tests said to be 99.9% accurate, not 100%?
4. Should I stop worrying about HIV?
5. If HIV underwent a new mutation, would current tests detect it?
6. I had sex with someone in February and exactly 2 or 2.5 months later, I had joint pain, eye redness and red spots on the skin. (There was no or very little fever, there was no sore throat) Do these suggest ARS symptoms?
I think I solved the word problem
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H. Hunter Handsfield, MD
17 months ago
1. It is unlikely you had candida (yeast) infection. White coated tongue usually is not yeast, but a nonspecific reaction to almost any viral infection or other illness. Candida does not cause lymph node enlargement, but colds and other viral infections often do so. The node resolving had nothing to do with cleaning your tongue (which wasn't necessary anyway); both your tongue and the node were going to get better on their own.

2. Blood can be "taken" of course, but not used for transfusion. All countries worldwide have had similar laws since the beginning of the HIV/AIDS epidemic, because until a few years ago testing for HIV missed some HIV infections. Now that is no longer true, and several countries -- including the US -- recently have relaxed those laws, and probably most countries eventually will do so as well. However, homophobia also has influenced these laws; some people believe this was always the primary motivation for them. Some countries where homophobia is most common may not change for a long time, if ever.

3. It is impossible to prove a negative. That is, I cannot prove that someday someone might have HIV and the AgAb (4th generation) blood test will miss the infection. That's why some official sources state 99.9% instead of 100%. There have been few if any documented cases of HIV that were not positive by AgAb testing 45 days or more after becoming infected. Some older HIV blood tests are not this accurate, but there has never been a case of HIV in which some combination of blood tests revealed the infection.

4. If your sexual lifestyle continues as you describe above, you definitely SHOULD be at least a little bit worried about HIV. Even with maximum safety, if you continue anal sex at all you should consider HIV a possibility and be tested for it from time to time. If you cease all anal sex, you can consider yourself to be at zero risk.

5. The current blood tests detect all known mutations so far. Future mutations that will make the tests unreliable are very unlikely.

6. Conceivably ARS could cause such symptoms, but rarely. More important, if the test results you describe above occurred after the February exposure, they prove for sure you do not have it. And as a general rule, symptoms almost never are useful in judging presence or absence of HIV infection. Even with typical symptoms, usually there are other causes; and about half of new HIV infections cause no symptoms anyway. You should pretty much ignore symptoms and rely entirely on periodic blood tests.

All this goes into more detail than normal on our forum. But let me know if any of this requires clarification.
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17 months ago
The information you provided has greatly eased my concerns. By the way, I'm sorry I wrote it wrong, the whiteness on my tongue goes away when I brush it, then it starts again. The lymph node in my neck has also shrunk but is still palpable. Would it shrink if it was caused by HIV?
My exposure in February was also last year. But your statement that it matches ARS symptoms scared me a little. Isn't 2 months too late for ARS?
It's not really related to the topic, but my biggest concern is this: My sex life is not going to disappear anymore. Maybe it's because my sexual identity has just been formed, I don't know. I don't want to have sex with men anymore and I'm disgusted by it. But I am afraid of coming out to someone of the opposite sex because I am afraid of my HIV test being positive later. Can I be sure now that I'm negative?

Thanks for your help doc. you are the best


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17 months ago
There may be a translation error, sorry for my English
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H. Hunter Handsfield, MD
17 months ago
You do not have HIV. I will answer no further comments or questions about whether your node or other symptoms could be caused by HIV. Stop self-examining the node. Probably nothing is wrong. If you remain concerned, see a doctor about it.

I said nothing that should be alarming about ARS. I said you do not have it. It is impossible you have HIV and that fear is not a reason to avoid sexual contact with women.

Your problem with your sexuality is psychological. Most men who find themselves sexually attracted to men remain that way for life. You need professional counseling.

That concludes this thread. Thanks for the thanks; I'm glad to have helped. Best wishes to you. Please note that repeated questions on the same topic are not permitted. Please no new questions about your past sexual exposures with men and your worries about HIV as a result. Thank you.
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