[Question #3219] HIV anxiety!

37 months ago

Hello,

I am straight male, really nervous about having contracted HIV from a brief sexual encounter I had 16 days ago with a white American girl (28 years old). Her HIV status is unknown to me (she has not been tested recently), but according to her, she had a boyfriend until 2 month ago and had unprotected sex with him few times. His status is also unknown. I wasn't sexually active for many months before tha

During this encounter, we kissed for maybe 10 minutes (tongues involved), then I performed oral sex on her for a couple of minutes (didn't get to her vagina - but her clitoral are was wet, and it got into my mouth - no open wound in my mouth). Also, I pleasured her with my fingers for a couple of minutes (no wounds on my fingers either). Lastly, while I was robbing my penis on her clitoral area, it suddenly slipped into her vagina. It only took couple of seconds and I pull out immediately. I ejaculated couple of seconds right after that.

 

Almost 13 days after the encounter my throat started feeling slightly sore – with feeing like phlegm is blocking it. Today (day 16) my throat is slightly better, but muscles of my neck have become slightly painful and stiff (right below ear towards throat), though I can’t feel swollen lymph glands. I have no more symptoms as of now. I smoke a couple of cigarettes a day. I am not sure if my current symptoms are because of rampant flue in winter and very cold and dry weather, they are ARS symptom, or merely because of sever anxiety I am experiencing.

 

My questions please:

1.       What are ARS symptoms? when do they appear and how long would they last? and could my symptoms be those of ARS? or might they be due to severe anxiety?

2.       What are the odds of me being infected with HIV? do you recommend getting tested at 6 weeks mark or sooner?  

3.       How can I manage my severe anxiety about this situation? (I can’t sleep, can’t eat, get heat flashes, have gotten dry mouth, …). It is really eating me alive

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
Welcome to the forum. Thanks for your question.

There is no significant risk of HIV from this sort of event. Statistically, it is very unlikely a woman such as you describe has HIV. Kissing, hand-genital contact (e.g. fingering), and cunnlingus (oral-vaginal sex) are zero risk.The very brief vaginal penetration also is extremely low risk, very close to zero. As for your symptoms, they are not at all typical for a new HIV infeciton. As you suggest yourself, by far the most likely cause is a garden variety upper respiratory viral infeciotn.

1. Typical ARS symptoms are fever, sore throat, lymph node inflammation enlargement (body wide), and often a non-itchy body-wide skin rash. You can google "ARS symptoms" for a lot more detail.

2. I would estimate he chance you caught HIV from this event at well under 1 in a million.

3. This is an STD/HIV advice service, not one for psychological counseling or advice. The best we can do is provide the facts about risk, which I have done -- and which should be reassuring, and certainly I hope they are. If your fears and these symptoms continue despite knowing these facts, all I can suggest is professional counseling.

I would also suggest an HIV blood test -- not because of actual risk; from a strict risk standpoint, you don't need testing at all. But a negative test result should help reassure you that you don't have HIV. Although you need to wait a few weeks for conclusive testing, at this time (16-17 days) a negative antigen-antibody ("duo", "4th generation") HIV blood test would be 70-80% conclusive.

Really, mellow out. This was a zero risk event for HIV. There's really nothing to worry about. If somehow I were in your situation, I wouldn't even be tested.

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

HHH, MD

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37 months ago
Dr Handsfield,

Thanks a lot for your reassurance. It is really heartwarming. Please let me give you a brief update on my condition at 24 days mark post exposure.

My throat is almost not sore anymore, but there is still mucus there. I didn't have any other major ARS symptoms either.

However, there is the general mild redness (not so acute) that appears and disappears (in less than an hour) on my cheekbones from time to time (maybe once a day or less). Also, a few non-itchy rashes appeared on the same area (one at a time again maybe less that once daily) and disappeared on their own in less than an hour. No rashes on my trunk or limbs.
I also get heat flashes when I go to bed at nights. It goes away in a couple of minutes but makes me sweat on the head and legs.

I know all these can be symptoms of anxiety and stress, or due to me being constantly scanning my body. I could've had those things before and never even considered them.

Anyways, my questions are: 
1. could those be ARS symptoms (especially those few rashes and redness)?
2. if not, can I completely rule out possibility of ARS (as I am past week 3) and stop scanning my body for any symptom?
3. if yes, do you recommend getting tested at this point just to see what the result would be?
4. Could those symptoms be due to other STDs which might possibly have become activated in my body?

Thanks a lot again for your support.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
1. These symptoms do not suggest ARS. Whenever someone suggests his or her own symptoms are due to anxiety, usually s/he is correct.
2. Close attention to possible symptoms (which I guess is what you mean by "scanning") will never reveal something you would not notice anyway, whether for ARS or anything else.
3. I already advised testing. See my reply above. I'm confident that it would be negative. You're now about 22 days since the exposure. I recommend waiting until 28 days, at which time th test wil be 98-99% conclusive.
4. No other STDs would cause these symptoms.

In the 14 years (since 2004) I have been answering daily questions in this and a previous forum, with thousands of questions about HIV worries after a worrisome exposure, not one person has turned out to have caught HIV. You will not be the first. If and when that happens, almost certainly it will be from a genuine high risk exposure (like anal sex between two men) -- not a trivial risk event like yours!

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37 months ago

Dr Handsfield,

I got 10 Panel STD test yesterday (day 29) at QD and the results came back all negative today – except for HSV-1. My questions are:

1. Have you ever had a case where a 4 weeks negative HIV1/2 antibody/4th Gen had turned positive in 6 or 12 weeks?

2. In my specific case (you estimated the odds of infection close to zero in the first place), do you see any slight chance that it turn positive in 6 or 12 weeks? and do you recommend getting tested again few weeks later?

3. I have a strong body and never have had any decease except for flu once every couple of years. Could it be the case that the virus hasn’t been able to get activated in my body at day 29 since my body defense is pretty strong?

4. Are other negative results on the 10 panel test 100% conclusive at 29 days mark past the encounter (especially Syphilis – PRP with reflex to Titer/FTA – AB)?

5. The lab told me that HSV-1 is not dangerous and a remarkable percentage of adults have that virus, and there is no need for an immediate treatment. They told me that I can get over-the-counter drugs if/when I get cold sore in my mouth or on the lips. Do you corroborate that? and if not, what is your recommendation?

Thank you very much again for all your help!

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
1) No, I have never seen this. Combining the low risk of the exposure you describe plus your HIV test, which is 98-99% reliable, there is no realistic chance you have HIV.

2) Your test will not become positive any time in the future, assuming no new exposure.

3) No. There is no evidence whatsoever that being in good or poor general health has any effect on susceptibility to HIV, time to positive blood test, or anything else.

4) Blood tests for syphilis and viral hepatitis require 6 weeks for conclusive results. Tests for HSV require 4 months. Negative results at 4 weeks are highly reassuring but not proof you were not infected.

5) Partly true:  about half of all adults in the US have HSV1. If you have not had recurrent oral herpes (cold sores) 'til now, probably you never will. But if that happens, there are no OTC treatments that have any significant benefit. Whoever you spoke to about that is simply mistaken. In that event, you should see a physician to confirm the diagnosis and perhaps give you proper treatment by prescription.

That completes the two follow-up comments and replies included with each question, and so concludes this thread. Thanks for the thanks; I'm glad to have helped.

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37 months ago
Thanks a lot Dr. Handsfield!

You didn't mention Chlamydia and Gonorrhea. Is negative results for those two conclusive at this point?
37 months ago
and Hep A, B, C.... sorry I forgot to include heps!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
37 months ago
You didn't say what tests were included in the panel you had. There is no standard panel. It was a waste of money to test for viral hepatitis, especially A and C:  zero risk from such an exposure. But those tests need 6 weeks if you really want conclusive results. Gonorrhea/chlam'ydia urine test is conclusive any time more than 3-4 days after exposure.

Don't sweat the details. You're home free, given the low risk nature of the exposure, condom use, and negative tests, even if some are not quite conclusive. You don't necessarily need a conclusvie test to be 100% confident:  if the risk for a particular infection is 1 in a million and you then have a test that detects "only" 90% of infections, then after testing the possibility of infection si 1 in 10 million. I would hope you agree that's zero for all practical purposes!

Take care and stay safe.
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