[Question #312] worried beyond belief

105 months ago

i'm a hetero female and i have not had sex in 4 years. routine testing for hiv and other stds 3 years ago was all clear. in spring this year i had a one night incident with a man who i knew had many sex partners. he also shoots nude models for a living. he says he was all clean and tested but dunno. i gave him blow job unprotected and swallowed when he came. i had a small oral ulcer on my inner lip. he may have had a tiny cut on his P. i didn't think anything of this incident till now. last 30 days or so i have had a severe stomach ache and diarrhea. i also had a resistent sinus infection that required 2 rounds of antibiotics in the fall, though i have had them in past years but never with this much antibiotics. routine blood work (cbc etc) is normal and my doctor says i'm at risk of hiv from what i did...but i'm too scared to get the test. i haven't slept in one month really. i am not eating normally and am really depressed. i have a son i am raising on my own and feel like i ruined his life by giving myself hiv. i am in need of help to get beyond this but don't know where to start because i am too scared to be tested and cant let it go. please help. what are my odds?

H. Hunter Handsfield, MD

105 months ago

Welcome to the forum. Thanks for your question.

I understand your concerns and fears. However, they really are not justified. Heterosexually transmitted HIV is a lot rarer than media stories might make you think, and even in the very unlikely chance your partner a few months ago had HIV, the average transmission risk for a single episode of unprotected vaginal sex is around 1 in a thousand. Even if he had a "tiny cut" on his penis -- which I have to suspect is more your anxiety speaking, not an actual memory of it. Your symptoms -- lip ulcer, stomach ache, diarrhea -- do not even hint at HIV as the cause.

Your doctor either doesn't understand the details of HIV behavioral risks and odds, or you misunderstood him. I stand by my judgment above that you are at extremely low risk of HIV from the exposure on your mind. Given your negative test result 3 years ago, only this one encounter in the meantime, and your symptoms, I would judge the odds you have HIV at well under one in a million.

Finally -- and I hope this doesn't come across as too harsh or unfeeling -- you need to suck it up and get tested for HIV. I have no patience with not getting tested for fear of the result, whether it's HIV or any other health problem that can be picked up by testing asymptomatic people (mammography, colonoscopy, etc). You either have HIV or you don't; the test doesn't give you the infection. And research and clinical experience have proved that when people delay testing for fear of the result, anxiety and fear decline when they learn the result, even if it is positive. Worry over the possibility of infection has more psychological impact that the "wrong" result.

So get tested. It will be negative and you won't regret it. You may also benefit from counseling and/or medical treatment for your obvious depression, but in my opinion testing is an absolute requirement to get you moving on that path.

I hope this has helped. Stay mellow as you wait for your test result. In 11 years of doing online forums like this, and thousands of questions similar to yours, not one person has turned out to have HIV. You won't be the first!

Best wishes to you-- HHH, MD

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105 months ago

Thanks Dr. H,

This has been helpful. I will go get the test, in the week even though it scares me. I have a long history of anxiety.

With this encounter, I didn't have vaginal sex, just oral with swallowing ejaculation , but at the time there was a small ulcer in my mouth and I had just cut the skin of his penis accidentaly with my long nail (didn't see blood but he was definitely in pain). Does this change my risk? Also I'm from Canada, but probably same as the U.S. I guess

Anyway your advice has helped. HIV isn't the only medical test I've avoided due to fear.

H. Hunter Handsfield, MD

105 months ago

I'm glad to have helped and perhaps moved you to go ahead with testing -- and maybe even had some influence on future health screening tests.

Thanks for the clarification. The additional information makes it even less likely you caught HIV. I assumed you also had unprotected vaginal sex. HIV is very rarely transmitted by oral sex. One estimate by CDC is that if the penile partner has HIV, the oral partner has 1 chance in 10,000 of being infected. That's equivalent to giving BJs to infected men once daily for 27 years before transmission might be likely. Swallowing HIV is low risk, whether semen or a bit of blood, and a sore in your mouth (canker sore?) also doesn't make any significant difference. Nobody can guarantee that such an exposure is completely risk free, but the odds are overwhelmingly in your favor. At a personal level, I can tell you for sure that if somehow I were in your circumstance, I would not be at all concerned and would not be tested for HIV or any other STD. And yes, there is no significant difference in risk assessment between Canada and your gun-besotted neighbors to the south!

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105 months ago

Well I did it and got the test yesterday and have to wait a week for the result. I was doing ok and putting it out of my mind like you said, but then I remembered two things.

1. This person has travelled a lot to areas where HIV is endemic to film documentaries and though he said he was recently tested clear, he says he is always with new people and was with someone the week before me so he could've just got the virus and had a high viral load?

2. I have a long history of reflux esophagitis diagnosed by endoscopy (last one in 2013). I usually take tums only but didn't that week I was with him because it wasn't that bad. Though in the past I've coughed up bits of blood.

Given these facts, can I still expect a negative result? How can I de-stress during this week?

H. Hunter Handsfield, MD

105 months ago

Congratulations on being tested. I'm so glad to hear it! You won't regret it.

The additional information doesn't worry me at all and shouldn't worry you. Your partner still is very unlikely to have had HIV. Could he have recently acquired infection and have a high viral load? Sure. It's also possible I'll be struck by lightning before you read this (it's stormy in Seattle today). The odds probably are about the same. And even with a high viral load, oral sex remains virtually zero risk -- see my first reply. And reflux esophagitis with past bleeding also doesn't increase the risk.

In theory, we're at the limit of two follow-up replies, but I'll keep the thread open so you can let me know your test result in a few days. In the meantime, sit tight, mellow out, and lean back this evening with a nice glass of wine. Your test will be negative.

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104 months ago

Hi Dr. H,

My doctor has been away so I have been unable to follow up with him , but my clinic calls me every time I have a bruise, nick, or scratch. And they haven't called in 2 weeks, so I *think* that means my test is negative. I just wanted to thank you for pushing me to be tested...otherwise for the rest of my life this issue would have weighed on my mind. Now I can focus on other things, and even other health problems I may neglect.

Akkie

H. Hunter Handsfield, MD

104 months ago

Thanks for the follow-up. I agree the clinic would have called you immediately if your HIV test were positive. Still, they should also let you know for sure that it was negative, which probably would serve to erase any lingering anxiety you may have about it. In some states, there are lingering laws and rules (left over from the early era of HIV testing) that require given HIV test results in person, and even when those laws are no longer in force, I have been aware of some medical practices that still follow such pollcies. So you might call and let them know you aren't so anxious any more, but just want to confirm the expected negative result.

In any case, I'm glad to have helped you focus on other, perhaps more important aspects of your health care. Best wishes and happy holidays.

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