[Question #3150] HIV anxiety

38 months ago
Hello doctors! First of all, happy new year.

I am a male that had sex with a CSW in Brazil (where HIV rates among csw are a little bit higher than in America). The sex was protected (condom) vaginal and oral, both protected. 

I think I am anxious because it was my first experience outside my relationship and I became very anxious about the possibility of having HIV. 

Since than I've made 3 HIV exams:

One at 25 days post exposure (3rd gen Lab)
One at 31 days post exposure (fast blood finger test)
And one at 53 days post exposure (4th generation duo test p24)

All came back negative. But I am very anxious that I could infect my wife, although I've told her everything about this situation and she assured me that everything is ok with me. 

I've already talked to a doctor here, he said I didn't need any further test, but he stated that the HIV window is 3 to 6 months. I know he's probably out of date and doesn't know the new CDC standards to 4th generation tests. 

But I wanted to hear from an expert. Am I good? Can I forget this episode and move on and just relax, be sure that I am HIV free?
Do I need another test at 3 months?

I know you guys answer questions like this everyday, and I would be very glad to hear your response.

Thanks for your time.
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Welcome to our Forum.  I'll be glad to comment and hope that i can help you mover forward with confidence that you did not acquire HIV from the exposure you report.  Let's start by considering your statistical risk for HIV.  While you are correct that HIV is more common among Brazilian CSWs than in North America, the prevalence of infection is still low- certainly less than 5% (1 in 20).  Further the risk of acquiring HV from a single act of unprotected vaginal intercourse with an infected person is less than 1 in 1000 and with condoms, risk is reduced by more than 99.9% (there are no instances in which someone has been proven to acquired HIV from receipt of oral sex from an infected persons).  Thus, even before you tested, your risk for acquiring HIV was tiny.

With testing however, you have now proved that you were not infected.  The CDC has revised their assessment of when HIV test results are conclusive and now state that at 6 weeks (42 days) combination HIV antigen/antibody tests such as you were tested with are conclusive.  Thus your tests prove that you were not infected.  It is now time for you to put your concerns about having acquired HIV from the exposure you describe aside and move on without concern.  I hope these comments will help you to do this.  EWH
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38 months ago
Thanks EWH, It will sure help me move on.  

I will try to settle my anxiety and put an end to this situation, it has already taken too much of me. 

Thanks for your help and time. Have a great year. 

With regards, from Brazil. 

 
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
You are welcome. I'm pleased my comments were helpful.  Happy New Year to you as well.  EWH
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38 months ago
Dr Hook, I'm pretty sure I am all fine thanks to your answer. 

But I would like a word of advice about how to deal with anxiety in this cases, if you have one.

Everyday I am more confident that I am alright and that my exams are conclusive, yet sometimes we (anxious people), tend to think about "what if". Do you have any advices, or as you may have seen many cases like mine, something that could help? 

Thanks for your answer, and I hope you and Dr HHH continue to do the amazing job you're doing as I believe this is my final reply before this thread is closed. 
Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
I'll be happy to make a suggestion or two but before I do, I need to remind you that I am not a mental health specialist and thus my advice is not science based in the way that or answers about medical problems are.  In my experience continued concerns about STIs (including HIV) are related in large part to guilt.  In many societies, casual sex is frowned upon and is particularly badly thought of if the casual sex takes place when a person has a regular partner who does not know that he/she has decided to have sex outside of the relationship.  In other words, when the sexual activity represents a breech of trust, persons are particularly nervous about the consequences of their risk.  These sorts of breeches of trust can occur when a person has sex outside of an established relationship or is felt to be outside of the expectations of a person's community ( for example, sex with a CSW or if one is considered heterosexual, decides to have sex with a same sex partner).  Similar concerns, related to guilt occurs when people do other things which they fear may be considered socially unacceptable such as covert drinking or drug use.  Then, all of these guilt concerns can be readily amplified if a person seeks information which on the internet where many erroneous and incorrect statements are found.

My opinion only.  Your test results are reliable and you need to believe them. Staying off the internet, admitting your misstep to your partner or talking your fears through with a professional counselor all may help you move forward.  EWH
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38 months ago
Yes, I believe in your point of view. 

Guilt can fuel anxiety. I'm very grateful that I have a wonderful wife that comprehended the situation and forgived me. 

And as for being away from the internet, a major part of my anxiety came from outdated and imprecise sites that can fuel anxiety. (And I am staying the hell away from them)

I'm already seeking professional mental health to help me deal with my anxiety disorder. 

I believe in your words as I believe in the test results. Now time will help me to deal with my guilt but I strongly believe this will pass. 

Your words were of great help, keep doing the great job! 


Edward W. Hook M.D.
Edward W. Hook M.D.
38 months ago
Thanks for your appreciation.  I'm pleased my comments were helpful.  At this time, this thread will now be closed.  I wish you the best.  Take care.  EWH---