[Question #4977] Follow Up to Q # 4570

26 months ago
Hi Dr HHH and Dr. Hook

I asked the referenced question a few months ago and have a few follow ups. I will start by saying I have extreme sexual anxiety and a lot of anxiety regarding getting an HIV test. 

I have read this board and medhelp and believe the odds are strongly in my favor for a negative result but there is always something telling me I’ll be the outlier.  Would you agree odds are in my favor based on my past post and this follow up?

Since I received oral sex from a TS, are
My odds higher than if I received oral from just women? I know the risk for insertive oral is very
Low (maybe zero) but does the fact that I had this with a TS increase the risk, and if yes how likely would the odds be?

Regarding heterosexual sex, if a condom is always used and it never failed, even with multiple partners, would this be considered a “high risk” behavior for me (insertive vaginal sex)?....or are the odds strongly in my favor here with no condom failure for all insertive vaginal sexepisodes?

Can you please comment on why white heterosexual males are the lowest infection rate per the cdc website (672 in the last year per cdc)? What is different biologically about white heterosexual males that makes them the least prone to hiv infection? Lastly am I still considered in the “white heterosexual male” category when it comes to
HIV probabilities despite my one brief insertive oral exposure with a TS?

I apologize for anything that was repetitive and formmy anxiety and thank you for the great job you guys do. 




H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Welcome back, but sorry you found it necessary. FYI, you used a different email address and username in your previous question, which is against forum policy. Please merge your accounts into one.

You provide no new information from your past question. Having reviewed that, I really have nothing more to add. You don't report an HIV test result. Have you been tested, as recommended last time? If not, I suggest you do it now. Most people with anxieties like yours are more reassured by a negative test result than by reasoned explanations of biology, probability and statistics, no matter how expert the source. And based on all you have said, you can be sure the result will be ngative.

To your specific questions:

"I...believe the odds are strong in my favor for a negative result but there is always something telling me I'll be the outlier":  The odds definitely are overwhelmingly in your favor.

"Since I received oral sex from a TS, are My odds higher than if I received oral from just women?":  If male to female transsexual, i.e. originally a male anatomicallly, then in terms of HIV risk, s/he was a man having sex with men (MSM), and MSM are the highest risk group in the US and other industrialized countries. In other words, the chance s/he had HIV at the time of exposure was much higher than for most heterosexual women. So of course the chance you were infected was correspondingly higher. But still extremely low. There has never been a reported, proved case of HIV transmission oral to penis.

"Regarding heterosexual sex...?":  Unrecognized condom failures happen, and there are some straight men with HIV who report consistent condom use without recognized condom failures. But whether such exposure are considered "high risk" or not is a matter of personal opinion. The chance of course depends on the type of partner, obviously higher for sex workers and injection drug users than other women. The odds of infection for any particular exposure with a condom are extremely low, but that low rate rises with increasing numbers of exposures. Obviously.

"HIV probabilities despite my one brief insertive oral exposure with a TS?":  Under one in a million.

I'll be happy to comment further if you decide to be tested and let me know the result. But I won't have any further comments or advice until then. OK?

HHH, MD
---
---
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
By the way, you would need to post your HIV test result (with any follow-up comments) within 4 weeks. Threads are closed 4 weeks after the posting date. And that would be your last chance; repeated questions about the same exposure and risks are not permitted, so no more questions until/unless your risk history changes substantially or you have a question on a different topic.---
---
26 months ago
Hi Dr HHH

Thank you for your reply, just one additional question, can you elaborate on why white heterosexual males are the lowest HIV infected group per the cdc website? Is there something biological that causes this?

Thanks and I will no longer post after this. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Sorry I forgot to reply to that part. Thanks for the reminder.

It's quite complex, so pardon the longer reply than you probably were expecting. The reasons are entirely behavioral, not biological susceptibility. HIV is just one example of the multiple medical and social ills far more common in African Americans in the US than in whites or those of Asian ethnicity (whose HIV rates are similar to that in whites). Latinos and Native Americans are midway in HIV risks, and all those other effects of racism, social policty, and US history that create conditions conducive to crime, violence, imprisonment, addiction, and risks for HIV and other STDs. Interestingly, and you mighht find this suprising, on average African Americans have no more sex partners than white or Asians, but patterns of sexuality are different, largely due to a male:female imbalance. Because of higher mortality in young males plus high rates of imprisonment, in effect black women have to share their male sex partners -- unintentionally and often unwittingly -- more than whites or Asians. This seemingly modest factor is a more important driver of STD and HIV rates than number of partners. On top of this, access to health care, the quality of health education, the amount and quality of education in general, income, and overall quality of life have major effects that together work to enhance STD/HIV risk in AAs and in Latinos and Native Americans compared to whites and Asians.

You still have one follow-up coming, if you would like to follow the advice about HIV testing and post the result.
---
26 months ago
Follow Up on new topic:

Is 26 days too late for ARS symptoms to appear after exposure? I have seen posts say 10-15 days and others that say 2-3 weeks. Can you confirm the time frame for ARS symptoms to show up?

In addition, if someone has fever, sore throat, muscle aches, stuffiness and a cough BUT no rash and widespread lymph node swelling are these ARS symptoms?

Would the symptoms of ARS appear at the same time: or could the sore throat come like 3 days after the fever?

Lastly, in general how long do ars symptoms last? Would 5 days be too short?

Thank you!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
26 months ago
Yes, 26 days is much to late for onset of ARS. Usual onset 7-14 days, rarely if ever longer than 3 weeks.

Those symptoms are not typical for ARS, especially because ARS deosn't cause either cough or nasal congestion/stuffiness. Probably all the individual symptoms appear over several days, but not necessarily all at once.

Generally 2-4 weeks in duration. I doubt ARS ever clears up as quickly as 5 days.

That concludes this thread, which must be your last one on our forum on these topics, under any email address or username. Your questions all are similar, and the answers -- which by now you can predict -- will not change; and the forum does not permit repeated questions on the same topic or exposure. Future new questions along these lines will receive no reply and the posting fee will not be refunded. This policy is based on compassion, not criticism, and to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thanks for your understanding. 

---