[Question #4260] Followup #4174 & General Sexual Health Questions

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83 months ago
Hi Doctors. I have a couple followup questions, & also a couple general questions on the bottom for future reference. It was more difficult to find answers in the forum from other questions. Just got results back from 35-day ag/ab test, negative.  I know you recommend 6 weeks for 100% conclusivity, but how would you consider the 5 weeks, considering the low risk exposure I had?  Would you say 99.99%?  Would this test, along with the 20 day test prove to be conclusive, considering all?  Numbers help my anxiety, thus the question.
Was doing fine after my 20 day test, until I developed new symptoms of heavy itching in various places all over my body, specifically at the base of my neck/upper chest, heavily on my back, behind knees, on thighs, etc, & a rash on my bicep. I have since topical injuries that won't heal (acne spot on neck, bruise on inner thigh that I have no idea how I inflicted, etc).  Rational side says its all anxiety, & the symptoms have nothing to do with STD's & HIV, & I should leave this encounter in the past, however, anxiety/ocd dwells on "if there is even an inkling of a chance".
Other than above, I have further questions for future reference:  If a condom comes off completely (either taken or slipped) OUTSIDE the receptive partner, & then same condom is put back on BEFORE returning to penetration, is this still considered the same amount of protection? Could you elaborate on the percentage of the amount of new infections every year via vaginal (heterosexual) intercourse, and anal (MSM or Heterosexual) sex? Does vaginal secretion touching the head (not urethra) or penile skin have any risk? Or only through urethra & serious fresh cut? These questions stem from curiosity, rather than from my incident. Finally, please list precautions to take to ensure MAXIMUM protection with unknown status partners.

Thanks for all you do! You guys are amazing!
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Edward W. Hook M.D.
83 months ago
I'm sorry you continue to worry about the encounter you described earlier.  I'll go straight to your questions:

1.  Formerly we told clients that 4 week combination HIV antigen/antibody tests provided conclusive results.  Based on reports of a VERY few cases which were detected after that, the CDC revised its recommendation to use a 6 week cut-off to define conclusive results.  Neither of us on this forum have ever seen or heard of one of these "late" cases. Thus, I would urge you to consider your 5 week result conclusive.  I see no reason for further testing.

2.  I agree, this is anxiety. Itching is the most common symptom of what we call "hyper awareness".  Almost anyone who chooses to focus on possible sensations at just about any part of their body will then experience the normal skin sensations that we all edit out of our daily lives as local itching.  I suspect this is what is happening to you.  Similarly, in the setting of hyper awareness and repeated self-evaluation, we regularly see people cause bruising, open sores or delayed healing.  You need to believe your test results.

3.  If a condom comes off entirely during sex a new condom should be used and if the intercourse is unprotected, there is a risk for STI. The exception to this is when the penis slips out of a condom as the penis is being removed from a sex partner. Even this should warrant a new condom.

4.  The data on the proportion of HIV infections resulting from vaginal vs rectal sex vary by nation and other variables.  This is not a useful question.

5.  Getting genital secretions on the head of the penis during non-penetrative sexual activity is a no risk event.  This is the reason that there is no risk for HIV from mutual masturbation in which partners get each others' genital secretions on one another as is typically the case. 

I need to remind you about our prohibition of repetitive, anxiety-driven and "what if" questions.  Your follow-up questions are entering this realm and may cause the thread to be closed without further questions.  Try to relax and move on.  EWH
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82 months ago
Thanks for the answers to the follow-up.  They were merely for curiosity.  I know i am negative for everything, so I'm not worried about anything.  Out of curiosity, I have read differing opinions over the internet.  Out of curiosity, how long does HIV survive outside of the body?  I have read anywhere between minutes to an hour.  I know it is very fragile, so this is purely for curiosity.

Just to update, it turns out the "heaviness" in my pubic region is Streptococcus  (Group B).  I understand this is not an STD, and am currently on a regimen of Doxycycline to get rid of this.  All else is clear.

Thanks again for your services Doctors.  This is my last post in regards to this, and I hope to not have to be on this forum for anything related to me again.

Best regards.
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Edward W. Hook M.D.
82 months ago
Thanks for your follow-up.  Group B step can certainly cause a variety of problems, often in the skin.  I hope that the doxycycline is helping.

You are correct about HIV being quite a fragile virus and being susceptible to the effect of drying, low body temperatures, etc.  Precisely how quickly the virus dies is not clear although most scientists would say in seconds to minutes and no doubt depends on the temperature and humidity of the environment, etc.   Before the virus dies however, it becomes non-infectious and both because of these same variables as well as mechanical factors relating to the ability to cause infection, there are no documented cases of environmental transmission of HIV or transmission from person to person on someone's hands and for all practical purposes, this characteristic should be considered immediate upon leaving the body and contacting the environment. 

Take care.  EWH
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