[Question #8815] When bad things do not stop happening

39 months ago

Doctors

Sadly I am back. My recent inquiry was about me using my fingers with a small nick or cut to finger a gal from the ivory coast. I ended up having oral thrush. (i was on and off antibiotics and steroids in Jan) for sinus issues. I was concerned about both hiv 1 & 2 (mainly 2). After our discussion I ended up getting one more thrush lesion. Because of this I tested with the alere hiv 1/2 rapid duo the very next day.

The test was done on April. The result was negative. This was 96 days past exposure. A few days prior to this test I had been talking to a girl from my past. We hadnt been together for about 3 years. I asked about her status and she said she is tested for hiv annually and has not been with anyone sexually since me 3 years ago. We ended up having kissing, me sucking her breasts and me fingering her. Then we had brief sex. I used a condom. This event was on April 21.

Three days latter I had what felt to be an hpv outbreak under my testicles / scrotum (taint area) and one on my inner thigh. I went to the dermatologist and he confirmed he saw a cluster of warts and froze them off. I have had them before. I asked if warts increase of risk of hiv infection he said no.

Today 5/8/22. I woke up with a single thrush /goo lesion near my bottom back tooth. I scraped it off. Now I dont know what to do. I thought i was being safe.

Questions:

1. Was this a risk for hiv or anything else?

2. Does an active wart attack increase my risk? (they probable were there when I was with her)

3. Does frozen off warts increase my risk? I read many different opinions,

4. How long should I wait after having warts frozen off before being sexual?

5.Why do I keep getting thrush and testing negative?

6. What is wrong with me?

7. Do I need hepatitis testing?

8. As you know warts can be anywhere in the genital region, I know you cant always cover them with a condom so what do you do?

Thanks for your time. I am at a loss.

H. Hunter Handsfield, MD

39 months ago

Welcome back, but I'm sorry you found it necessary.

As you already know, the original exposure you described was zero risk for HIV as well as for all other STIs. The more recent event also was entirely safe in regard to HIV, since you know your partner tested negative and you used a condom; and also zero risk for other STDs. Therefore, no symptoms you have now or might develop in the future are not the result of HIV or any other infection from these events. The HPV "outbreak" you noticed three days later had nothing to do with that sexual exposure; it's just when you noticed the new warts.

You have also been informed about the reliability of HIV testing. To repeat or reinforce what you should understand from Dr. Hook, the HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. Negative test results (done sufficiently long after exposure) always are reliable and conclusive regardless of the level of risk at the time and regardless of whatever symptoms there are (including oral yeast infection). You also are over-focused on various medical conditions that are more common in HIV infected people. For almost all of them, including yeast infections (thrush), the large majority of cases occur in people without HIV. Your past antibiotic treatment is a likely explanation of your yeast infection, including the current recurrence (if that's indeed the actual cause of the "goo" in your mouth).

To your questions:

1. No, as you have been told.

2,3. Your dermatologist is correct: warts do not increase HIV risk if exposed, whether or not treated. And anyway, since your blood test results prove you don't have HIV, the risk at the time of the exposure is irrelevant. You could have told me you mainlined HIV infected blood: I would still tell you that you do not have HIV.

4. You can have sex as soon as healing is complete (but also see no. 8 below).

5. Why thrush? I don't know why you still have yeast infections (or even if you still do); see my comments above. It's not at all rare in people without HIV! You test negative for HIV because you don't have it.

6. I'm not your doctor and on this forum we don't get into health issues other than HIV and other STIs. However, I don't see any evidence of any potentially serious health problem. Continue to work with your doctor(s) if you remain concerned.

7. Hepatitis is not possible from either of the exposures described and does not cause any symptoms you have mentioned.

8. If you have not told your new (old) partner about your recurrent genital warts problem, it would be a kindness to do so now, and to also inform potential new partners, so they can decide whether or not to have sex with you.

Best wishes-- HHH, MD

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39 months ago

Dr. Handsfield,

Thank you for your detailed response. I am not concerned about my first risk. I tested on April 25. This was 96 days after my first risk. It was negative. (4th gen rapid test)

I am concerned about the (2nd) risk I had on April 21st. My follow-ups are;

1. What if the African American girl I had an encounter with (from my past) was not honest about her testing & the fact I had warts, would this still not be a risk? The is information I found that has me concerned, please see below. Did these men wear condoms?

https://www.aidsmap.com/news/dec-2013/men-penile-hpv-infection-have-increased-risk-acquiring-hiv

https://www.bumc.bu.edu/busm/2018/08/21/untreated-genital-warts-may-increase-risk-of-hiv-transmission/

2. Hiv-1 testing seems clear cut 6 weeks is definitive. My question is about Hiv-2. I know the antigen does not look for hiv-2 in the 4th generation tests (rapid alere test). So when is hiv-2 testing definitive?

3. Do I require hiv testing?

4. Hypothetically could I sleep with someone unprotected with fear of infecting them with hiv?

5. Over the years I have had several warts froze off. Does that mean my system will never clear the infection or is that still possible?

6. Regarding the thrush how could I still have issues after treatment and since I have not taken antibiotics or steroids since this past January?

7. In your response to my initial questions you stated in (2&3) And anyway since your blood test results prove you dont have hiv the risk at the time of the exposure is irrelevant you could have main lined hiv infected blood, I would still tell you that you do not have hiv. I dont understand this statement.

8. How long do threads stay open on the forum?

Thank you for this truly informative forum.

H. Hunter Handsfield, MD

39 months ago

1. Of course I cannot say your more recent partner (April 21) doesn't have HIV. But all evidence is against it. People rarely lie when asked directly about HIV/STI testing. And you used a condom, for goodness' sake! As for HPV, you can find anything you want on the web, including studies that support HPV as a possible risk factor for HIV. There are many more studies with the opposite finding, and all experts agree that HPV does not significantly raise the risk of HIV if exposed.

2. The AgAb tests are conclusive for HIV2 at around 8 weeks. But HIV2 is exceedingly rare in the US anyway, and it's also less easily transmitted than HIV1. Really, it's nothing to worry about.

3. Yes, you should be tested for HIV. Not because you are actually at risk, but because it is obvious that the scientific facts and my expert opinion are not going to convince you. Clearly you're going to keep worrying about having HIV until you prove to yourself you do not. This does not mean I believe there is any chance you are infected; I suggest it strictly for reassurance. Your result will be negative. (If somehow I were in your situation, I would not be tested.)

4. Yes.

5. HPV often persists and can recur years later. Over time, recurrent warts usually decline in frequency and number, but I have no way of predicting this for any particular case.

6. Once someone is carrying yeasts, they often re-grow and cause symptoms. It usually doesn't mean immune deficiency. And as I have also said, you should not assume you have thrush again unless and until the new problem has been professionally diagnosed.

7. Let's try this: Even if your risk of HIV were the highest possible, such as injection of HIV-infected blood into your own vein, your test result would prove that infection did not occur. Given the near-zero chance of HIV from the events you have described, you should be extra confident in your negative test results -- including the additional negative result you'll have if you go ahead with another test.

8. Threads are closed after two follow-up comments/questions and replies or after 4 weeks, whichever comes first.

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39 months ago

Dr. Handsfield,

Thank you for your response. I had one more (what appeared to be) thrush sore since our last exchange. To my questions;

1. Going forward considering the warts, does it mean anytime I have vaginal sex (with condom) I should be tested afterwards because of my slight increased hiv risk?

2. In general I am a healthy guy besides sinus issues that often require lots of antibiotics and steroids. A month ago I had sinus surgery to try and reduce these issues. As mentioned also have these mouth sores and occasional thrush problems. You said "Once someone is carrying yeasts, they often re-grow and cause symptoms. It usually doesn't mean immune deficiency." Does that mean hiv antibody tests would not work for my body (I know that the antigen would then pick up hiv-1 but what about hiv-2) or would I have to be extremely immune impaired for this to be of concern?

3. I was tested 96 days after I fingered the gal with a nick on my finger who was originally from the ivory coast (i know hiv-2 is more frequent there). Is this conclusive?

3. Should I get tested at 6 weeks or 8 weeks or some other time to rule out hiv 1 & 2? (after second risk)

4. If I get tested for hiv at your suggested time interval and its negative and sometime after I get more sores or thrush should I immediately think I have hiv?

5. I just want to have a normal life and not be worried about hiv but how can I when symptoms continue?

6. I do see a counselor and I am treated for ptsd. Am I psyching myself out always thinking the worst or should I be frightened?

Thanks for your time.

39 months ago

Dr. Handsield,

One other thing I wanted to mention is that I also got the sinus surgery to avoid getting longstanding sinus infections & then having to take antibiotics and steroids to kill these infections. I know a lot of antibiotic & steroid use can trigger thrush. I was trying to be proactive.

H. Hunter Handsfield, MD

39 months ago

I'm happy to answer these final questions, but I have to comment that you are getting WAY more into the weeds on the nuances risks of STIs, especially HPV and HIV, than necessary. Question 6 probably explains it: almost certainly you are indeed psyching yourself out. You definitely should not be frightened -- getting you to be unfrightened has been our only goal in both this and your preceding thread. It does seem you've having trouble understanding or perhaps believing our replies.

1. You have twisted my words. HPV does not elevate HIV risk, not even a little bit. And neither I nor Dr. said or implied HIV testing after every new sexual encounter or partnership. Of course that would change after unprotected sex with a known infected partner -- but you should be asking about HIV status before having sex and avoiding those who are infected. Otherwise, a reasonable approach would be to consider testing once a year or so.

2. Those statements say nothing about reliability of HIV testing. There are NO drugs or medical conditions that affect HIV test timing or reliability, except HIV drugs themselves. I believe this repeats information we have advised previously.

3 (two questions): I see no need to repeat myself. Please read previous replies.

4. No.

5,6. Do your best to understand that all symptoms that suggest HIV occur far more commonly with various non-HIV conditions. This question obviously implies the need to continue with counseling for your anxiety, PTSD and (I suspect) OCD.

I see no question and have no reply to your closing comment.

As explained above, that completes this thread. Please note the forum does not permit repeated questions on the same topics, exposures, etc. This being your second, it will have to be your last: future questions along these lines will be subject to deletion without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. Further, experience shows that continued answers tend to prolong users' anxieties rather than relieving them. Finally, such questions have low educational value for other users, one of the forum's main purposes. Thank you for your understanding. I do hope the discussions have been useful and will help you move along without worry. Best wishes and stay safe.

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