[Question #2015] second opinion

100 months ago

Dear Dr Hook,

I feel I have to come back to you with my concern of HIV related to my first post on this site in February. I could not put it behind me, neither was I brave to have a test. I have anxiety and because of it my personal (sexual relationship with my wife who is wondering why we do not have sex for few months) and work life are affected.

I read other persons’ questions on this site and sometimes I read your and other doctor statements that masturbation, fingering and kissing are no risk for the transmission of hiv. Sometimes I see that you do recommend testing for people who were involved in such activities. I am totally confused. Particularly, the reply of Dr. HHH on question #1959 made me very worried. He said that ulcers in the mouth can be (tough rarely) caused by hiv! I also had other typical symptoms like sore throat with whitish spots on the tonsils (Tonsillitis, as my doctor told me this name) , fever for a couple of days, enlarged and painful (if touched) lymph nodes at the location of tonsils (not anywhere else). Finally, the symptoms happened around two weeks since I had mutual masturbation intercourses in China. The symptoms lasted for a week, but then, when I thoughts, all is over, I had a few night sweats, do not know why since I did not have fever as I felt.. I had itching in my anus, which is gone, and I feel even now that my dents are more sensitive than usual.

You told me that that these symptoms have nothing to do with hiv. But did you read them carefully and missed nothing? How does your conclusion match with what Dr HHH said in this #1959?

If it is oral herpes from kissing (why did not I get it before in my 45 years..), then can this infection also transmit hiv?

On the medhelp site I read a story of one guy who seems got infected by fingering vagina, though not clear if he did not have a brief penetration as well. You also told him that his risk from fingering was close to zero, nevertheless it happened..

I bare finger a guy. I did not have any open wounds, even closed ones. But who knows..

I was fingered by a guy, but I am not sure he used body liquids on his hands. He used massage oil, that’s I am sure, the other I did not noticed, but it was 2 months ago and I could have forgotten. I read in some answers from you and dr HHH that introducing body fluids into rectum is a risk.

The thoughts “what if” and “yes, but” are in my head. My brain understands I need to get tested, but I just cannot do it. What if… my family, my wife and two kids will never forgive and understand me… I am deadly scared and cannot have normal life anymore.

Would you assume I am infected? What is risk of having sex with my wife without a condom?

H. Hunter Handsfield, MD

100 months ago

Welcome back to the forum. Dr. Hook and I take questions without regard to requests for either of us. We have worked closely together for over 30 years and our opinions and advice are always the same, even if we have different styles.

I read your previous discussion with Dr. Hook and agree with all he said. The exposures you describe were not risky for STD, and your symptoms do not suggest HIV either. Almost certainly you do not have it.

But you already know the answer to your fears. Have an HIV test. I have no patience (and neither does Dr. Hook) with not testing for fear of the results. It is not the test that gives someone HIV. You have it or you don't. Almost certainly you do not, but if you do, you have to know -- both for medical and ethical reasons. For example, it is not appropriate for you to not be having sex with your wife and not explaining the reason. You simply must be tested. In addition, when people delay testing out of fear, anxiety always is reduced when testing is finally done -- even if the result is positive. (Same for women who delay mammograms, people who delay colonoscopy for cancer screening, and so on.) The fear of the result is more anxiety producing than even a positive result. And you can count on a negative result anyway, assuming no other risks besides the ones described.

So suck it up and just do it. I will have no further advice about any of this until and unless you return with a follow-up comment with your test result. In the meantime, I see no risk to your wife from unprotected sex.

I'm sorry if this isn't what you wanted to hear, but that's the way it will be. Best wishes-- HHH, MD

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100 months ago

Dear Doctor Handsfield,

Thank you for your answer.

I do understand the testing does not give infection. I will do it.

You wrote twice "almost certainly you do not have it". Is it because there is a slight chance I could get it from the activities I described or because you do not know whether I had other encounters involving "real" sex?

You said that you see no risk of having sex unprotected with my wife. Can I understand this advise as assurance that you do not think I am infected from the activities described or because you estimate my risk of being infected and also the risk I can transfer the virus (in case I have it) to my wife and looking at the odds, you think they are too small to worry about?

Finally, you did not make any comments on my references to the cases on this site and the medhelp site. Is it because you think they are irrelevant to may case?

Thank you!

H. Hunter Handsfield, MD

100 months ago

There is no realistic chance you caught HIV from the exposure described; if a test were positive, almost certainly it would be from some past exposure with "real" sex. You can safely have sex with your wife because almost certainly you are not infected. Do NOT interpret "almost certainly" as meaning there is a realistic risk; there is not. Your anxieties are leading you to misunderstand other threads you have reviewed. The point of those was how rare such transmissions are, but you are focused on the fact of any possibility at all. There are no sexual contacts that can be proved to be no risk for HIV, so any scientifically oriented opinion will always acknowledge some possible risk. But if the chance is less than the possibility of being killed by a lightning strike, who cares?

There will be no further replies of any kind until you post your test result. Don't ask anything else until then.

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99 months ago

Dear Doctor,

I re-read your answer, and one part about the “ my symptoms are not suggestive of hiv” bothers me a lot.

I read in some internet sources and also many questions in medhelp site, that the fewer (I had it for ~3 days), enlarged lymph nodes (I had in my neck, painful, did not noticed them anywhere else), mouth ulcers (cancer sores) that came about 4 days after onset of the symptoms, and night sweating (came in about a week after the onset of the symptoms and lasted for few days: really soaked wet t-shirt, but I am sure I did not have fewer, so unusual to me!) are all the typical signs of earlier hiv.

I do not think you have not seen patients with the symptoms like mine and not having hiv, have you or Dr Hook?

Now, how does it corresponds with the common opinion that mutual masturbation, fingering either receptive or insertive, kissing and other activities without penetration are risk free for hiv? Just a coincidence? I am certain that I never had any penetrative sex with anybody except my wife. I have always discussed the hiv status of my partners. So, how could it happen that I got those symptoms while having negligible (according to your, Doctors) risk for hiv?

I am so scared, Doctor, please excuse me for the third question here. Please understand me.

H. Hunter Handsfield, MD

99 months ago

Yury, Yury, Yury. I do understand you. Most important, I understand that your reasoning is irrational. Sorry to sound so critical, but you just don't get it. I have seen hundreds of patients with such symptoms and almost none had HIV. The symptoms of HIV occur in a large number of medical conditions, most of them minor and most of them far more common than HIV. Just think about it: everyone with pneumonia has cough and fever, but the large majority of people with cough and fever do not have pneumonia. Almost everyone with meningitis has headache and fever, but almost nobody with headache and fever has meningitis. Exactly the same with HIV symptoms: among people with fever, sore throat, skin rash, etc -- symptoms typical of a new HIV infection -- the large majority have something else.

My main advice remains unchanged: get tested for HIV. Unfortunately, you have used up the two follow-up comments and replies included with each question, so this thread will be closed, so you will not be able to return to tell us your HIV test result. Sorry about that, but those are the forum rules. The forum does not permit repeated questions on the same topic or exposure. Since this is your second question on the forum, it will have to be your last; future new questions about this exposure, testing, and your fears about HIV will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, continued answers to anxiety-driven questions tend to prolong users' anxieties. Finallly, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.

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