[Question #8606] Is it a phobia or a reasonable fear?
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42 months ago
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Hello.
I would like to ask your help to evaluate if my fear is a phobia or it is reasonable.
3 months ago I was seeing a man, just before we had sex he tested negative for HIV and he said he was not sexually active for a year. We had protected vaginal sex with a condom and he gave me unprotected oral sex once or maybe twice. I did not have any symptoms.
He left me after 2 months of dating.
Now I am scared of HIV, thinking what if the test was not performed right or what if he cheated on me while we were together... ( thinking that because he left me in a harsh way).
Given the fact that we always used condoms for vaginal sex and they did not break, are my fears for HIV reasonable or am I having a unreasonable phobia?
Would you be worried if you were in this situation?
I am mostly worried just of HIV.
I know that you concider recieving oral sex mostly not a risk.
Would you be relaxed about HIV in my situation? Am I at risk?
Thank you very much and congratulations for your work.
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H. Hunter Handsfield, MD
42 months ago
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Welcome to the forum.
Even a "fear or phobia" can be "reasonable". I would say your risk of HIV from the events described is extremely low, probably zero -- my reasoning follows below. But that doesn't mean your concerns aren't appropriate or reasonable.
Some general facts: Assuming your partner has sex only with women and is not otherwise at special risk for HIV (immigrant from an HIV-endemic area like much of Africa, injection drug user, etc), and assuming you're in the US, the chance he has HIV is well under one in a thousand. And that's before even considering his stated HIV test result: adding that, and assuming he is telling the truth, the odds he had HIV during your relationship was probably on the order of one chance in a million, tops. (To be infected, either he had to be telling a bald-faced lie, or he was in the window period, which would have required him to have high risk exposures in the 4 weeks before you and he first had sex.)
And as to your specific exposure events, even without a condom, if he had untreated HIV, the average risk to you would have been one in a thousand for each episode if UNPROTECTED vaginal sex. With condom protection, a hundred times lower than that, i.e. one in 100,000 for each vaginal sex event. And there has never been a proved case of HIV transmission by cunnilingus (oral-vaginal contact) -- which doesn't mean it can't occur, but does show the chance is exceedingly low.
Considering all these facts together puts the probability you caught HIV at one in a billion, tops. I hope you'll agree that means zero for all practical purposes. Other STIs are more likely, since they are far more common. However, if your partner really hadn't had sex with anyone else for the preceding year, then the chance of an active, transmissible bacterial STD (gonorrhea, chlamydia, etc) is extremely low.
What to do now? From a strictly medical or risk perspective, I see no need for testing or other actions. That said, when someone is worried about infection (whether or not the worry is statistically justified), negative test results are often (usually?) more reassuring than professional opinion or statistics. Also, if and when you begin a new relationship, that prospective partner might be reassured to know you had been tested and negative. On that basis, you could consider having HIV and syphilis blood tests, and urine or vaginal swab testing for gonorrhea and chlamydia. Almost certainly all would be negative, probably helping resolve any residual concerns you may have.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
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42 months ago
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Thank you for your response.
My partner denied being interested in man, he claims he is heterosexual and no history of drug abuse. He did not hesitate to take the test and offer even to do it in my city if I wouldn’ t believe him. He is from western Europe, caucasian.
Regarding HIV if I understood you right, the sex was safe in any case but you would reccomend the test strictly for psychological reasons?
Did you in your career ever enconter somebody who got infected with proper condom use or oral sex?
If you would be me would you be worried?
I am kind of very scared of testing even though I think it is all in my head.
I got tested before this realtionship after the last one and I was negative. I was always very careful and always practiced save sex and would never engage in unprotected vaginal sex if I would not see a persona test first or know him for a long time.
Thank you!
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H. Hunter Handsfield, MD
42 months ago
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"Regarding HIV if I understood you right...?" Correct; you understand. Essentially zero risk for HIV, but consider testing strictly for reassurance.
"Did you in your career ever encounter...?" No. But that's irrelevant, don't you think? Rare events happen, despite being rare. I have never cared for a patient struck by lightning, but that obviously has no bearing on your risk of being struck.
No, if I were you, I wouldn't be at all worried about HIV. But I'm not you -- and the very fact that you feel a need to ask these questions, after my science-based reassurance above, seems to indicate that my advice alone isn't going to be sufficient to resolve your fears. In that case, of course you should be tested.
Of course you must not avoid testing for fear of the result. It isn't the test that gives someone HIV -- they have it or they don't. If they do, they have a responsibility to know it. Same deal for mammograms and breast cancer, colonoscopies and colon cancer, etc. And research shows that when testing for any adverse condition has been avoided for fear of the result, anxiety declines after testing is finally done, even if the result is the feared outcome. The anxiety and worry about the result is always worse than knowing.
That said, there is no realistic chance you have HIV. Testing or not is entirely up to you -- and only if you will find the reassurance helpful.
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41 months ago
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Thank you your answer was very reassuring.
I would like to ask another question, if you could explain why some HIV tests are reported as positive/negative and why some are reported with a number that usually is negative when less than 0.9 and positive if more than that? What that number actually mean?
Sometimes it can be confusing seeing a number even if the report says normal if 0-0.9.
Does a laboratory or hospital always alert a person that a test is positive if it really is? ( seing s number can be quite confusing)
Thank you for the explanation and thank you for the good work you are doing
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H. Hunter Handsfield, MD
41 months ago
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Most laboratory-based HIV tests use ELISA technology, which typically gives a numerical result for the test outcome and a different number as "control". The numerical results were designed to be provided to the health professional ordering the test, with only the pos/neg interpretation conveyed to the patient. But of course in today's connected world, patients usually see the numerical results, and indeed it can be confusing. The numbers do not directly reflect the amount of antibody detected, but the relative strength of a biochemical reaction -- which isn't the same which is affected by many factors other than antibody level. As long as the control number is under the cut-off value (usually 0.9), the result is totally negative, meaning zero antibody was detected. The same specimen assayed with 10 different tests would give 10 different numbers, which can vary quite widely between say 0.2 and 0.75, etc. All such results are equally negative.
That concludes this thread. Thanks for the thanks-- I'm glad to have been of help. Best wishes and stay safe.
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