[Question #8802] Risk assessment/oraquick
 |
39 months ago
|
Dear Dr HHH and Dr Hook,
I am glad i have found you on this site. I have been reading your expert opinions on Medhelp the past few weeks following two incidents that have robbed me of peace of mind.
First incident was on 2/25 where i had protected insertive anal sex with a TS CSW in a third world country where the hiv prevalence rate is high (as high as 2/3) amongst sex workers. Condom was still on me and seemed intact upon withdrawal. I should note this is my first experience with a TS and will be my last.
Second incident was on 3/10 where i received oral sex from a female CSW in the same country.
Following these incidents, back in the US and I have been anxiety ridden, full of regret and guilt. I am afraid i might have put my wife at risk.
Because of the anxiety, i started medicating myself with edible THC of about 15mg daily since April 1st.
On 3/28 (32 days post 1st incident) i took oraquick home swab test and it was negative
Last week i had nausea and vomit and a fever (38.1 orally measured) All cleared in less than 12 hrs. The fever got me concerned because i dont usually have fever (last one i had was 10+ years ago)
On 5/1 (66 days post 1st incident; 53 days post 2nd incident) i took another Oraquick and was negative.
1. Am I at risk of HIV from these incidents? Should i worry about possibility of condom failure without me knowing? How about receiving oral sex, is that absolutely zero risk?
2. Does injesting THC on a daily basis like i am interfere with the oraquick test? Does it delay seroconversion or interfere with the test in anyway?
3. Is Oraquick test reliable at 7.5 weeks (post incident 2) and 9.4 weeks (post incident 1)? Should I test at 12 weeks again?
4. I read one of Dr HHH's reply about Oraquick missing about 2-3% infections as some people do not produce enough antobodies in the oral fluid used in the oraquick swab testing, and these people never show positive on the test. Should i worry about this? Is there particular type of people (demographic or behavioral) that tend not to produce detectable antibodies in their oral fluid?
5. Are my symptoms ARS HIV related?
Thank you
I am glad i have found you on this site. I have been reading your expert opinions on Medhelp the past few weeks following two incidents that have robbed me of peace of mind.
First incident was on 2/25 where i had protected insertive anal sex with a TS CSW in a third world country where the hiv prevalence rate is high (as high as 2/3) amongst sex workers. Condom was still on me and seemed intact upon withdrawal. I should note this is my first experience with a TS and will be my last.
Second incident was on 3/10 where i received oral sex from a female CSW in the same country.
Following these incidents, back in the US and I have been anxiety ridden, full of regret and guilt. I am afraid i might have put my wife at risk.
Because of the anxiety, i started medicating myself with edible THC of about 15mg daily since April 1st.
On 3/28 (32 days post 1st incident) i took oraquick home swab test and it was negative
Last week i had nausea and vomit and a fever (38.1 orally measured) All cleared in less than 12 hrs. The fever got me concerned because i dont usually have fever (last one i had was 10+ years ago)
On 5/1 (66 days post 1st incident; 53 days post 2nd incident) i took another Oraquick and was negative.
1. Am I at risk of HIV from these incidents? Should i worry about possibility of condom failure without me knowing? How about receiving oral sex, is that absolutely zero risk?
2. Does injesting THC on a daily basis like i am interfere with the oraquick test? Does it delay seroconversion or interfere with the test in anyway?
3. Is Oraquick test reliable at 7.5 weeks (post incident 2) and 9.4 weeks (post incident 1)? Should I test at 12 weeks again?
4. I read one of Dr HHH's reply about Oraquick missing about 2-3% infections as some people do not produce enough antobodies in the oral fluid used in the oraquick swab testing, and these people never show positive on the test. Should i worry about this? Is there particular type of people (demographic or behavioral) that tend not to produce detectable antibodies in their oral fluid?
5. Are my symptoms ARS HIV related?
Thank you
 |
H. Hunter Handsfield, MD
39 months ago
|
Welcome to the forum. Thanks for your confidence in our services. I happened to log in just as you posted your question; most users shouldn't expect nearly real-time replies!
---
Despite your fears, your HIV risk was very low; the combination of that low risk plus your negative test results are nearly 100% conclusive. You really need not be worried. That said, as you already understand the test results themselves are not quite conclusive: the oral fluids test misses at least 2-3% and perhaps up to 5% of HIV infections, no matter how long after exposure.
Those comments start to answer your specific questions, but to be explicit:
1. With an intact condom for anal sex plus the near-zero risk of HIV transmission oral to penis, these were nearly (but not quite) zero risk exposures, even if your partners had untreated HIV.
2. There are no medical conditions, medications, or drugs that have any effect on HIV test reliability or timing. Your THC use has no bearing on these issues.
3. The oral fluids test reaches maximum sensitivity (95-98%) at around 12 weeks. That's very good and your two negative results should be highly reassuring, but in itself this test is never conclusive.
4. Correct; see above.
5. ARS symptoms start within 2 weeks of infection, so the timing is wrong; and these are not typical symptoms either. You probably had viral gastroenteritis, unrelated to the sexual experiences you have described.
All things considered, the chance you have HIV is near zero -- under one chance in many million. However, some anxious persons are more reassured by a negative (and conclusive) test result than by expert opinion based on probabilities and statistics. If that applies to you, have a lab-based antigen-antibody (AgAb, "4th generation) blood test. If you do so, you definitely can expect a negative result.
I hope these comments are helpful. Let me know if anything isn't clear.
HHH, MD
------
|
39 months ago
|
Thank you Doctor.
I like the odds of 1 in many million. That is less than the odds of getting struck by lightening!
A few more questions please:
I heard/read condom breakage is obvious to miss and nothing to guess about. Is that your opinion too? As far as I can tell it was intact (I even saw the semen collected in the condom)
For the unprotected insertive oral sex, is there recent data to suggest it is no risk activity? I thought the very low oral risk is from giving and not receiving. Some orgs dont even include oral sex as route for hiv transmission (sf city clinic for example) The unprotected insertive oral sex in my case lasted less than 30 seconds and without ejaculation if that has any bearing in the risk assesment.
I tried to explain away the fever I had last week as indirect consequence of my ongoing anxiety (i read stress and anxiety weaken immune system and make one susceptible to infections). Is that plausible explanation?
Thank you.
|
H. Hunter Handsfield, MD
39 months ago
|
CDC has estimated HIV risk from various sexual practices, based on interviews of infected persons and their sexual lifestyles and exposures. For fellatio, the estimate is 1 in 10,000 for the oral partner if the penile partner has HIV, and 1 in 20,000 for the penile partner if the oral partner is infected. So your single episode of insertive oral is in the 1 in 20,000 range. That's equivalent to receiving BJs by infected partners once daily for 55 years before infection might be likely -- i.e. zero for all practical purposes.
There are no published data on whether people notice condom breakage, but I can't imagine how it would go unnoticed, unless maybe if someone were seriously intoxicated from drugs or alcohol.
Anxiety doesn't cause fever and probably doesn't impair immunity enough to make someone more susceptible to common infections. As I said, there is no reason to suppose your transient illness has anything to do with the sexual events of several weeks earlier.
You don't have HIV. Feel free to prove it again with a conclusive test as suggested above, but stay mellow in the meantime.
---