[Question #4214] Unable to Move On - Please Help Dr HHH Dr Hook

32 months ago
Dr HHH Dr Hook

I was doing fine until i read this.

https://www.medhelp.org/posts/HIV---Prevention/HIV-risk-with-CSW/show/1905821#read_responses

What Scared me to death was this statement:

Condoms do fail from time to time; and once in a while an unexplained HIV or STD transmission event occurs even when there has been no obvious condom breakage

I dont know how to interprete this and compared to 1000s of post read on condom protected sex and feeling fine, this statement broke that foundation on which i had almost believed that if the condom does not break or slip there is no need to test or worry.

Please help me i have no one to talk to and this statement has got me stuck.

Although i had an HIV RNA PCR test at 10days and an HIV DUO at 28 days both Negative.

I have lost all confidence on safe sex.

Sorry after this has been explained..it would be my last post ever and i shall then move on and make certain concrete decisions on my way of life.

 






H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Welcome (back?) to the forum. The search function is being modified and I cannot easily check for previous threads you may have posted. If you have, please provide the question number(s).

You are seriously over-interpreting a standard, straightforward statement often made by all STD/HIV prevention experts. Some patients with HIV say there has never been a known condom failure during their sexual exposures. In most cases, there probably were other exposures they didn't know about or they simply forgot; others are lying out of embarrassment to admit they didn't use condoms properly. However, it is like that some condom failures are unrecognized. But it remains true that people who use condoms regularly for sex and who never have a known failure almost never get HIV.

You are mistaken in believing that consistent condom users don't need to test for HIV. They do. We and all STD/HIV experts always recommend that even consistent condom users get tested for HIV (and other STDs) once in a while, like once a year. You should do that. However, it is very unlikely you will ever get HIV. But for such testing, please do not waste your money on PCR testing. Have only an HIV duo test 6 weeks (not 4 weeks) after your last sexual exposure. Do not do it after every sexual event, only once a year. And stop worrying so much!

HHH, MD
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32 months ago
Thankyou for your replies Dr.

My Question Numbers were

Question #4008

Question #4038

I noticed you mentioned 6 weeks for the HIV DUO after last exposure, have your recommendations or guidelines changed?

You have always mentioned HIV DUO at 4 weeks/28 days is conclusive.

I did do an HIV DUO test at 28days and an HIV RNA PCR at 10 days does this mean i should now go again at 6weeks for an HIV DUO?

I am now more scared of a False Positive with a lot of testing.

Dr requesting you to please read my earlier posts.







H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Aout a year ago a paper was published that reestablished the maximum window period for the duo test as 6 weeks. For the past year we have advised 6 weeks. 

But you do not need another test. The combination of negative PCR at 10 days plus duo at 4 weeks is conclusive.

"False positive" means the test is positive in someone without HIV. You have never had a positive result, therefore you have never had a false positive result. With the duo tests, false positive do not occur. Don't worry about that.
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
I have looked at your other threads. This is your third irrational, anxiety driven question. Such questions are not permitted; this will have to be your last one. This is not an emotional support service and as Dr. Hook said last time, future questions are liable to be deleted without reply and without refund of the posting fee.---
32 months ago
Glad i posted here Dr i was totally unaware of the new guidelines that changed this year.

Few Followup Questions:

1. I was fine after the 2 tests i took but the week after i took the DUO test i had rectal bleeding and an anal fissure from a very hard long stool out of constipation and excessive football playing may be..but when i read online about anal fissures a lot of sites mentioned hiv causes anal fissures in very rare cases...this flared up my anxiety again and here i am again. Does HIV cause anal fissures in 5 weeks? Or the information out there is outright wrong?

2. I know anal fissures are very common and the hard stool was the reason in my case? But please help me relax my mind on this.

3. Given my post and protected condom exposure that did not break as i checked thoroughly and also filled it with water - was testing warranted at all?.

4. Can i have unprotected sex with my wife or should do 1 more HIV DUO test at 6 weeks?

Thankyou for your time.






32 months ago
Dear Dr given the guidelines changed, the above questions would be my last few ever, i promise, please answer them, its a request.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
1) No, HIV doesn't cause anal fissures; you found unreliable sites or misunderstood what you read. I suppose it is possible that anal fissures could be more common in people with advanced HIV infection, i.e. overt AIDS. But certainly there is no chance a new HIV infection could do this. 

2) Hard stools can cause fissures. Try laxatives or fiber supplements and eat lots of fruits and vegetables.

3) No, there was no need for testing on account of that particular exposure. But I stand by my advice that you be tested once a year, as long as you continue to have sex outside a committed, mutually monogamous relationship.

4) Nobody can ever guarantee you aren't infected after any particular sexual exposure. But the risk is low enough that most people would continue unprotected sex with their wives, and that is what I would do if somehow I were in your situation. The chance you will be killed by lightning in the next year is far higher than the chance you caught HIV.
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31 months ago
With all due respect to you sir, but statements like these fuel more anxiety amongst readers of various answers on any forum.

"4) Nobody can ever guarantee you aren't infected after any particular sexual exposure." - i did not understand what this meant in my specific case.

A rational mind probably would be able to understand this but an anxious mind in an already irrational state would think even after sharing the details of the exposure why is the Expert still unsure of his advise and triggering uncertainty in the posters mind.

After reading that statement i went in for 2 more HIV DUO tests from 2 different labs at 6 weeks NEGATIVE.

I know it was irrational on my part, but i m sure you understand what i am trying to explain.




H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
31 months ago
You are over-interpreting straightforward statements that are as clear as I can make them. And no, I do not entirely understand what your remaining concerns are.

My strong advice is that you entirely stop searching online about HIV and its risks. You are not at risk for sexual acquisition of HIV unless and until you have unprotected vaginal or anal intercourse. Please stop asking about other kinds of exposure. And please note my comments above about repetetive anxiety driven questions. This will have to be your last one on the forum. Thanks for your understanding.
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