[Question #6758] Scared after events

12 months ago
Hello,

I had several intercourses.I was receptive anal partner and he used condom. That was 14th January. Got tested 11th February with hiv duo test and outcome was negative. Meanwhile from 23rd January till 11 March  I had contacts. A woman rubbing with her wet vagina against my penis on 23rd January, a guy gave me unprotected oral on 5th February, I gave protected oral to shemale 8th February. On 10th February I had protected sex with female from Brazil. 18th February I was again receptive anal partner, he used condom and stated he was hiv negative. On 7 March I had slight fever 37.5 C for about 2 days. I slept almost for 2 whole days. Also muscle and joint pain, maybe swollen lymph nodes throat(difficult to analyse for me), fatigue, sometimes slight headaches. Before March 2 I was sometimes feeling unwell too and maybe swollen lymph nodes too. On March 11 I received 2 handjobs on a day I was feeling better. Yesterday I saw tiny brown dot in mouth. Last night I had to vomit and I was not feeling sick yesterday but not great either. I was tested for influenza, adenovirus and rsv. All negative for latter 3. Also more than month lots of smegma on penis (yes, I wash myself) Could my symptoms be hiv related and that in the heat of the moment I got infected? Didn't see broken condom or so I think. I also hiv duo test is shifted to 42 days instead of 28 days. Is that shift for prep users? How confident can I be when I test with duo on 18 March. 

Greetings 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
Welcome to the forum. Thanks for your confidence in our services.

It sounds like you're going about your sex life with moderate but not perfect safety in regard to HIV. Sex with other men, especially receptive anal sex, has to be considered high risk, even with a condom. (Condoms do fail sometimes, and more commonly with anal than vaginal sex.) On the other hand, everything else you describe is 100% safe; congratulations for your overall approach with safe sex only. The only thing I would also advise is to have a conversation with partners -- especially other men -- about HIV status before having sex; and defer contact (or no penetrating sex) with those who are HIV positive an not on effective treatment, who don't know. or seem evasive about it. "Do ask, do tell" is an important element of safe sex for men having sex with men.

Genital apposition with women, without penetration, is risk free for all practical purposes, and so is hand-genital contact. Your symptoms are not at all suggestive of a new HIV infection. You don't have fever:  98.6F is not the top normal human body temperature; it's the average over the course of a day, and everybody's body temperature varies to as high as 37.5 or even a bit higher over the course of a day (typically highest late afternoon or evening).

Those comments address most of your quesitons. I agree you should be tested for HIV from time to time, as much for reassurance as for actual risk. The "shift" to 42 days in our advice happened almost 2 years ago, so it isn't all that new. And the duo tests are highly reliable at 4 weeks; it's rare (under 1-2% of cases) for it to take 6 weeks.  You can expect a negative result when you get tested; don'tlose any sleep over this in the next 3 days before you are tested.

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

HHH, MD
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12 months ago
Hello Dr,

Thank your for your reply. When it comes to anal intercourse, I always ask the status before having sex and always use condom with no exceptions. The 2 times when I was receptive partner on 14th January and 18 February I asked repeatedly to them and the first guy was married with kids and always uses condom. The second gay was long ago divorced,has children and wants to stay clean but he received unprotected oral from me and swallowed my semen. I read that swallowing is risk free here and on gaysite from Holland it is a risk. Afterwards it got me thinking on he clean he really is but he claimed to be. The Brazilian woman I had sex with, I also asked if she was hiv negative and she said yes. In my country they are about 20,000 living with HIV in a 10 million population. About 50% of the newly diagnosed are men having sex with men.

I assumed a condom that doesn't fail, is not something to worry about and perfectedly safe against hiv. Is condom use and prep the ideal combination for receptive anal sex to be less risky? Or should I avoid just anal sex to be sure about hiv?

I admit to be very anxious about becoming infected and it is hard to enjoy for me. I had worries about my encouters lately and was really sick. Should I retest at 6 weeks in your opinion ? 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
Sorry for the unusual delay in getting to your follow-up question.

You describe very low risk partners, probably unlikely to have or acquire HIV. Are condoms that don't fail "perfectly" safe against HIV? Probably not quite, but highly reliable. A few infected men give apparently believable stories of complete and consistent concom use. Maybe exposure to secretions near the condom rim that then get worked down toward the tip during sexual maneuvering? Not really known, and indeed I am unaware of any scientifically PROVED cases of HIV acquired by men correctly using an intact condom.

If you continue to select your partners with the care described and use condoms carefully and consistently, I think you can count on being virtually 100% protected against HIV.
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12 months ago
Hello, 

I got tested 28 days later after last encounter that was protected anal. Due to feeling sick and being worried, I was scared. So my results from hiv duo test were negative for hiv. 
In your opinion, is prep use and condom use for anal receptive, truly reassuring against hiv infection? Prep users can still get infected but I presume they didn't use condoms. 
Is receiving oral without condom totally risk free for hiv? Giving oral without condom and with ejaculation risk? Not assuming here that I will give oral without but just want to know. 
Just glad my results are negative. Thanks for your previous reply. 
12 months ago
Hi again, 

I read a post from someone else here about oral. Your reply was that oral is basically safe for hiv. I should have read other posts. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
12 months ago
That test result is nearly 100% conclusive. For truly conclusive result, test again 6+ weeks after the event.

There has never been a proved case of HIV transmitted by oral sex (oral to penis) and only a few in the other direction (penis to oral); and none by oral-vaginal contact. Probably these activities are not completely risk free, but the risk is extremely low.

That completes the two follow-up questions and replies included with each original question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe, as you have been.
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