Dear Doctor, 

First of all, thank you so much for your very valuable help you give on this forum.

I have been living in depression and anxiety for the past 2 years.

I had 3 situations that I am very worried about:

The first is a couple of lap dances at a strip bar two and a half years ago. I was fully clothed (shirt, underwear and jeans and the dancers were naked. I massaged the dancer's inner thighs , breasts and back and they touched my face and neck. While a dancer was grinding on my jeans, I ejaculated and wet my jeans. I am very worried that exchange of fluids (any genital secretions passing through my clothes + my ejaculation), me touching her neck and face have contracted hiv or any other std. I also visited the toilet a couple of times during the dances, so l'm also worried that I could have contracted hiv or any other std through my hand to my genital area.

In the next day, I developed on and off pain in my pelvic area and some burning sensations in my penis head and rectal area.

I went to a urologist and he gave me an antibiotic and antibacterial, said it's probably an inflammation of the prostrate from the stimulation, pain would go away after marriage and regular intercourse (I have no sexual encounters to date) I still get the pains every now and then till today.

 My second and third situations happened a year ago. I Visited a borthel  where I didn't engage in any sexual activity, I only rubbed a csw's breasts for 10-15 minutes and on my way out, I scratched my hand while opening the door. I left the place felling very worried that I caught something.

Symptoms:

next day I had bad pelvic pain + burning on the tip of the penis. After 2 days I started to develop inner thigh pain (which persists until today) I became extremely anxious and started to experience one problem after the other: 

Slight temperature elevation (37.3-37.4) during first month then stopped taking temp. readings, body aches that come and go in: inner thighs, between upper forearms and biceps, armpits, upper back, right chest nipple (increased sensitivity) and later on behind my knee (slightly swelled) and a frozen left shoulder, Head pain on left side above ear and on the top of the scalp, Chronic diarrhea and loose stools, frequent urination (twice every hour, I wake up at night to urinate once or twice), on and off sour taste in mouth, white tongue, eye floaters, swollen lymph node under jaw that didn't decrease in size ( started on right side then on left side as well), Pain in upper stomach (right under rib cage), lower, mid back pain and side pain on the right side of body, on and off Slight burning sensation of left side of face, left hand Palm, slight shaking of left thumb. 

I have had 5 negative antibodies tests for hiv 1 & 2  after 2,3,5,7 and 12 months from last situation, but I'm not sure whether it's a 2nd or 3rd gen ( I called the lab and they were unsure!) I also had a blood picture taken a number of times and everything was ok except for a low wbc count that stays in the 3000 range. ( except once it went up to 5700).

My questions are:

1. Is it possible that the antibodies tests missed the infection, especially since they could be old 2nd generation tests? I have read that some people never develop detectable antibodies. Do I need a Pcr test because of my "symptoms"?

2. Do I need to test for other stds?

3. A week after the first incident I had a tetanus vaccine shot because I stepped on a nail. Can this have any effect on the hiv antibodies tests? (Or cause any of the symptoms that I have?)

4. I had 2 roots canals on both sides of my jaw, could this cause the chronic swollen lymph nodes under my jaw?

5. I had my gallbladder removed last April due to small gall stones causing pain in lower back after meals. Could my continued loose stools and back pain before and after the operation be caused by that?

6. After the first strip club incident, I started to notice small raised bumps  that would from time to time produce solid white pinhead sized discharge  in the center that I could rub off ( no  pain, no blisters) they sometime form thin scabs. I had hsv 1 &2 blood tests after 7 months and were both negative, visited a dermatologist that said it didn't look like an std, maybe milia or nothing at all (anxiety). Does the diagnosis sound reasonable?

7. Can all of this be caused by extreme guilt, anxiety and excessive reading on the internet?

My wedding is in 1 week and i am in EXTREME anxiety and depression because of the health problems I'm experiencing.

I'm scared to death that I might infect my wife with anything.

Thank you SO much for your help in advance.

You describe non-exposure events that could not have resulted in any STD. They call them "sexually transmitted" for good reason -- and the term means direct contact with sexual organs. Without your penis entering a vagina, rectum or mouth, generally there is no risk. STD bacteria and viruses simply are not transmitted by the kinds of exposures you describe.

In addition, your symptoms are not typical for STDs. It is not possible for STD symptoms to start less than 24 hours after exposure; 2-3 days is the minimum, and for nongonococcal urethritis the minimum is 5-7 days. Equally important, there are no STDs that can cause pain in the pelvic area or thighs, back pain, general body pains, or the other symptoms you mention. Your symptoms are most typical for the physical manifestations of anxiety, not for any infection. Finally, you were seriously overtested, but the negative results are reliable and prove you did not catch any of the infections for which you were tested.

To your specific questions:

1) Your test results prove without doubt that you did not catch HIV. The difference between 2nd generation and 3rd or 4th gen HIV tests is in how quickly they become positive (3-4 weeks vs 6-12 weeks). After 3+ months, the second generation tests are 100% reliable.

2) Based on your exposure and symptoms, no STD test was necessary at all and certainly no more tests should be done.

3) No vaccines or medications have any effect on reliability of any tests for HIV or other STDs.

4) The root canals possibly could cause inflamed lymph nodes under the jaw. In any case, no STD does that, including HIV. (Lymph node inflammation from HIV is always body-wide, not just one location.)

5) I can't say whether gall bladder surgery would cause such symptoms. But HIV and STDs do not do this.

6) Neither HIV nor other STDs can cause such skin problems.

7) Whenever someone suspects his or her own symptoms have an emotional or psychological origin, usually s/he is right. That is by far the most likely cause of all your symptoms. Anxiety probably doesn't cause symptoms all by itself, but it certainly makes minor symptoms or even normal body sensations more noticeable or bothersome.

You have absolutely nothing you can transmit sexually to your wife. You really needn't worry about it. Best wishes for a great wedding and successful, romantic, and altogether rewarding marriage.

Best regards--  HHH, MD

Dearest Doctor,

I really can't thank you enough for your reassurance..A HUGE burden has been lifted off my shoulders. I was worried to the extent that it took me some time to get a grip to read the answer to the question I posted.

Thank you so much for your kind wedding wishes, very nice of you.

God bless you for all the huge help you're providing to very anxious people like myself.

Best regards.

Take care and stay safe.