[Question #3429] Same mistakes advice needed

89 months ago

I did not expect to be back on this forum, but here I am.

Firstly I just wanted to thank Dr Hook for his previous advice back in 2016.

So now onto my new issue.

Nearly 3 weeks ago I slept with a woman and the condom broke so it was unprotected for a very short time maybe less than a minute, we then used a condom and carried on with no failure.

I did not think anything of it, as I thought this was a low risk event, now again I find myself in the same place I was back in 2016, which for me was a dark time.

I have been feeling very remorseful and guilty about my actions, so my anxiety is creeping in.

So around 10 days after this I come down with something, blocked runny nose, low grade fever, nothing over 37, this lasted for 3 days, the last few days I have an uncomfortable feeling in both my armpits and groin.

I know my last questions were similar and it could be my guilt and anxiety coming into play again with what I have done.

Just to let you know that we are both from the UK and have known each other for around 10 years, she was married for a long time but has since separated, she is not promiscuous but I do not know of her history before me.

I know that symptoms mean nothing but I got sick after 10 days after, so for the last few days other than the feeling in my groin and armpits I have had loose stools, and my appetite has gone slightly.

Other than that no other symptoms.

No rash, sore throat or extremely high fever.

I do plan on getting tested on 19.03 which would mean 4 weeks had past to get a 4th generation test, for my own sanity.

I am worried that I could hurt my family with my stupid actions, I have been distant from my wife and she has noticed this.

If I were your patient what advice would you give me?

Does this sound like anything I should worry about?

Can I resume relations with my wife?

As always your advice is appreciated as is your time.

I know you are probably disappointed I am back, no more so than myself making the same mistakes again.

Thank you

H. Hunter Handsfield, MD

89 months ago

Welcome back to the forum, but sorry you found it necessary. I scanned your previous discussions with Dr. Hook a little over a year ago. Most of the answers to your current questions are pretty well covered there -- so you won't be surprised by my replies. Your mistake may have been the same, but so are the answers.

First, your symptoms are not suggestive of ARS, which does not cause nasal congestion, runny nose, etc; as discussed with Dr. Hook, absence of fever is also against ARS. I'm confident your underarm pain is anxiety related, magnifying trivial symptoms and/or normal body sensations. In any case, the lymph node inflammation of ARS is painless.

Second, you describe a partner who almost certainly does not have HIV. But the quickest answer to your fears, by far, is for you to have a heart to heart discussion with her, which should be easy since she is an old friend. Tell her your worries and see what she says about her HIV status. Maybe you'll find she has the same concerns and is just as worried as you are: after all, if you fear she could be at risk, why wouldn't she have the same worry about you? If you were to both have an HIV test now, you would know 100% that neither of you is infected and no further testing would be required.

If your friend isn't interested in this plan, then I would still consider it sufficiently low risk that you don't need testing for HIV, and if somehow I would in your circumstance, I would continue sex with my wife without worry. But I'm not you. If you continue to worry about it, you could have an HIV test (preferably antigen-antibody, ie. 4th generation) 6 weeks after the event, which would be concusive evidence you weren't infected. However, the risk is low enough that I don't think you should hold off on sex at home for that long.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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89 months ago

Hi Dr Handsfield,

Thank you for coming back to me so quickly.

I guess I wanted reassurance from someone like you who has helped so many, Thank you for this great service that many of us use for near enough the same reasons more or less.

I have taken your advice and I have since spoken with my friend who says that she has not slept with anyone else for around 2 years and always used protection when she did.

I have been the first sexual contact to which she has had in this time, so this would count as low risk I would imagine?

After this I definitely felt a lot better, I am now sleeping better and my appetite has returned.

I still have the uncomfortable feeling under both arm pits and in my groin which I am trying to ignore and put down to my anxiety about everything that has happened.

It's not so much pain just feels like there's pressure/pulsing sensation at times making it uncomfortable,if that makes sense.

Do you have many others complaining about the same thing?

I know you said you would not even recommend testing in this circumstance but I still plan on getting tested next week for peace of mind which would be over 4 weeks, which the drop in centre I will be attending advised what the window period was for the 4th generation test,plus for all other sti's.

I know this is not fully conclusive, could I ask why it is now 6 weeks and not 4 weeks as it was before?

I know that some places say the window period is 12 weeks but I am guessing this is because they are being over cautious?

Again thank you for putting my mind at ease through all of this I really do appreciate everything you have said.

H. Hunter Handsfield, MD

89 months ago

Thanks for the follow-up information; I'm really glad you followed up with your partner, and it sounds like you are as well.

"I still have the uncomfortable feeling...." Your description indeed "makes sense" and I agree with your self diagnosis. Innumerable forum users have similar concerns and complaints: the specific symptoms vary widely, but rather vague discomfort, pain without tenderness, and similar sensations are common themes. Just scan any 10 threads at random in the HIV Prevention and Safe Sex category.

I honestly think it's overkill to be tested in this circumstance, but I understand your desire to do it. Lab results aren't always any more accurate than expert opinion, but it's common for anxious persons to be further reassured by negative test results. But please don't go overboard, e.g. with some comprehensive panel of 10+ tests, most of which are for sure irrelevant to this exposure. At most, have a urine test for gonorrhea and chlamydia and blood tests for HIV and syphilis. Don't spend the big bucks on herpes, viral hepatitis, HTLV, and other nonsense.

6 weeks vs 4 weeks for the antigen-antibody (4th generation) HIV blood tests: New data became available, that's all. Our opinions and advice always are based on the best available science, and scientific data often are not static as new research is done. A published review of all the available HIV tests (https://www.ncbi.nlm.nih.gov/pubmed/29140890) included data that in 1-2% of cases, it takes 6 weeks for these tests to be conclusive, and CDC published an accompanying ediorial endorsing that conclusion (https://www.ncbi.nlm.nih.gov/pubmed/29140891). Note that for CDC, this represents a change from their previous advice for 3 months. When these publications appeared, we revised our advice accordingly. But be clear: in the vast majority of cases the AgAb tests are conclusive at 4 weeks, and many clinics and experts continue to advise 4 weeks. Waiting 6 weeks test is recommended primarily for people with truly risky exposures, which you did not have. Any advice for testing at 12 weeks is either being overly conservative or based on older tests, with guidance not being updated in light of evolving knowledge.

Thank you for your kind comments about our services.

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88 months ago

Hi Dr Handsfield,

I hope you're well.

Thanks for your kind advice.

Just a quick update, today I had an insti 3rd generation rapid test which was negative, this is now over 5 weeks since the condom mishap.

I know you said I didn't even need testing,really I'm doing it for peace of mind, reading over other answers and questions here and MedHelp, my questions are:

• This would now be over 90% accurate if I am not mistaken? With 99% at 8 weeks?

• If my 'perceived' symptoms which have been going on for a few weeks,were down to something it would have shown positive at this time? (Sorry I know silly question considering my exposure)

They did try and take blood but couldn't find a vein, the woman did not seemed overly concerned about my exposure, so did not keep trying to draw blood.

So as per your advice I will not test again, and use my result to calm my nerves, unless you think I should just for the conclusive result?

They also took urine for the other stds, it's all free so didn't pay for any over the top tests, results will be in next week I'd imagine.

I told my friend I was getting tested and she again said that if I needed to for peace of mind then I should go If I really needed to.

I still have the uncomfortable feeling in my groin that comes and goes, still not a pain just dull ache type of feeling, again trying not to think about it, as when I'm out and about it tends to go and there is no ache.

No other 'symptoms' as such.

I've been trying to keep busy and take my mind off things and also found out my wife is pregnant with our first child which panicked me somewhat but then I re-read what you wrote which helped with the irrational thoughts of the worst possible scenarios etc.

I'm hopeful that what I am currently feeling will help others in evaluate what most have which is low risk to practically zero (oral sex etc)

Also that anxiety and stress can cause all sorts of issues with your body,I've lost 7 lbs in a couple of weeks!

I want to thank you again for the advice you have given me,with so much conflicting information out there it's hard to know what to believe or out of date.

Reading answers on here from you and Dr Hook have been a massive help for me.

H. Hunter Handsfield, MD

88 months ago

• "This would now be over 90% accurate if I am not mistaken? With 99% at 8 weeks?" YES

• If my 'perceived' symptoms...." YES. HIV antibody is always present and detected by testing within a few days of onset of symptoms caused by HIV.

"So as per your advice I will not test again, ...." I think that is the correct decision. I see no need for any fruther testing.

Your symptoms continue to be most typical for anxiety magnifying trivial symptoms or normal body sensenstions.

Thanks for the kind words -- we're always pleased when we can hellp at all, and "massive help" is especially rewarding. Take care and stay safe.

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