[Question #5282] Need Assessment Over Risk

24 months ago
Hello, doctors

Before I begin, I will admit that I have anxiety over HIV, and I'm trying not to give in to it. If you could please review my risks and advise me whether I should test at the appropriate time or not. 

For your information, my last full panel STD tests were in the beginning of January, all negative. 

I was out of town the week before last, and on the morning of 4/11 I met a young woman and we ended up getting together. The only act of sex we had was unprotected oral sex (her performing fellatio on me). She did tell me she recently has joined in the army, but that she knows several drug users back home, and that her ex who has she has long been apart from was a secret heroin user, through snorting. 

However, I moved on to Las Vegas, and that following Sunday (4/14) I woke up with a wound on my upper arm on my shoulder. I thought it was rather large to be a needle wound, but a small scar did appear and upon googling track marks from needle use, it did appear very similar. The wound had no blood, but it was sore with no bruise present yet. I am not an injection drug user, but I was out in the strip, drunk, and I stayed at an airbnb, which led to me thinking up several scenarios. I have no recollection of any stabbing pain, but I cannot figure out where this wound came from. 

Upon returning home I went to see my PCP. The nurse practitioner and her NP observing student saw the wound and said they didn't believe it to be from a needle, and to not worry about it. This was a little over two days after I first saw the wound, and it had just begun to bruise. As of today the wound has scabbed and healed, and the "track mark" abrasion is still present but almost completely gone. 

I feel like I have symptoms, but I also feel that they are psychosomatic due to my extreme anxiety at times. 

Please, can you give me your opinion on my situation. 

Thank you, 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
24 months ago
Welcome to the forum. Thanks for your interest and confidence in our services.

I hope I can help -- although I suspect you realize that anxiety typically is not resolved solely by factual scientific information or expert opinion -- the issue in HIV anxiety isn't understanding the truths about risks, symptoms, etc, but the underlying psychology. Most anxious persons remain anxious despite what they learn scientifically. (This isn't criticism, just a statement of an obvious psychological fact.) So I'll address these questions, but additonal measures may be needed to help you. Sometimes that includes testing, even when there is little or no risk, because some people are more reassured by test results than by scientific facts and prbabilities, or by professional opinion, no matter how expert. (I don't take it personally!) Or somtimes with professional counseling.

OK, the lecture is done. To your specific issues and questions:  First, most tests in standard STD "panels" are highly reliable. Assuming your negative tests included HIV and syphilis blood tests and negative urine for gonorrhea and chlamydia, for sure you have none of these -- recognizing that it takes a few weeks after the last exposure for conlcusive HIV and syphilis tests. If you were tested for HSV, the results also are  reliable, especially if negative for HSV2, but only after 12-16 weeks from the last possible exposure. In general, I am against other tests in STD panels:  hepatitis B and C are unnecessary and should not be done except in special risk circumstances, like being the regular partner of a person known to be infected.

Unprotected fellatio is low risk for all STDs and virtually zero risk for some. For example, there has never been a proved case of HIV transmitted mouth to penis. The STDs acquired more regularly by oral sex (gonorrhea, herpes due to HSV1, nongonococcal urethritis, syphilis) usually cause obvious symptoms -- so without urethral discharge or penile sore(s), almost certainly you were not infected. It sounds like your partner could be at some STD/HIV risk, but most likely she isn't infected -- and I stress again that oral sex carries little or no risk.

Moving to Las Vegas, I'm not sure what you're asking. Are you worried that the "wound" was a symptom of HIV or other STD? If so, don't worry. No way. If you're concerned it could have been the result of a needlestick you didn't notice at the time, you can also drop that line of reasoning. Very difficult to imagine. And if somehow it did, the notion that it was from a needle or syringe contaminated with HIV -- also extraordinarily unlikely from a statistical standpoint. Thus, I agree exactly with your nurse practitioner:  forget it.

It's hard to comment specifically on your symptoms, since you don't describe them. But I'll point out that whenver someone suspects his or her own sympotms have a psychological origin, usually s/he is right.

My overall opinion of your situation?  No measurable risk of HIV or any other STD and no need for testing. If you have a regular partner, you should continue your normal sexual practices without worry. If you continue to have occasional sexual experiences that make you nervous, have routine testing (only for HIV, syphilis, gonorrhea, and chlamydia) from time to time, like once a year.

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

HHH, MD
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