[Question #9310] HIV concern

34 months ago

My story: I oral mutual oral sex (no ejaculation) and then had brief unprotected anal intercourse with a trans-woman. I was the insertive partner and had penetrated her for approximately two minutes. It was a lapse of judgment, but after 2 minutes, I became frightened and pulled out, washed myself off, and that was it.

Unfortunately - and I know you’ve heard it thousands of times - “symptoms began to appear. From 4 days post exposure until 32 days (today) - I’ve had a sore on my gums, dry cough, sweating at night, an on and off sore throat. I’ve lost my voice, etc. In all honesty, I’ve spent hours online obsessing about ARS. I live in Southern, CA and I went to an HIV specialist. He didn’t laugh me out of the room, but he told me with conviction that I had NOTHING to worry about - that HIV is not transmitted through brief insertive, but rather, from receptive anal - in which the person takes ejaculation into their body. I’ll spare you the details, but again, he told me I have absolutely nothing to worry about (in regards to HIV).

I’ve tested via INSTI Rapid test at 23 days, 28 days, and 31 days … ALL negative. But, the symptoms still persist. And I’m still obsessing about HIV. My question to you: Was this HIV specialist correct? Can I put HIV behind me? Or am I still at risk? I must admit, I'm an educated man ... but also obsessive as hell - I feel like I'm losing my mind. Thanks in advance.

34 months ago

First off, I really want to express gratitude and appreciate for the work you good doctors do on here - I can always expect a “No B.S. response” from you - and you take the time to look at everyone’s individual circumstance as opposed to simply parroting what the CDC says on their website. So, again, thank you.

My story: I had oral mutual oral sex (no ejaculation) and then had brief unprotected anal intercourse with a trans-woman. I was the insertive partner and had penetrated her for approximately two minutes. It was a lapse of judgment, but after 2 minutes, I became frightened and pulled out, washed myself off, and that was it.

H. Hunter Handsfield, MD

34 months ago

Welcome to the forum. Thanks for your kind words about our service, and for obviously reading other threads before asking your own question. Having done that, I'm guessing you have predicted my reply: probably you have seen that when HIV testing is done sufficiently long after the last possible exposure, negative results always overrule symptoms. I agree exactly with the HIV specialist, as you report his analysis.

The details:

You indeed had a potentially risky exposure: many such partners are HIV infected, although many of them are on effective anti-HIV treatment, which eliminates any risk of transmission. One reassuring approach would be to contact her, if you can, and inquire about her HIV status, treatment, etc. However, there is plenty of other unequivocal evidence you don't have HIV. First, I agree two minutes is a fairly brief exposure, with lower risk than typical insertive anal sex. Second, 4 days is too soon for onset of ARS symptoms. Third, despite what you might have seen online or elsewhere, your symptoms are not particularly suggestive of ARS (e.g. cough).

Fourth and perhaps most important, it is impossible to have HIV symptoms more than 3-4 days and still have a negative HIV antibody test. It isn't HIV itself that causes ARS symptoms, but the immune response to the virus -- and the immune response is reflected in detectable antibody. Technically, it is conceivable you acquired HIV without symptoms: it takes up to 8 weeks for the third generation antibody tests, like INSTI, to become positive. The chance later testing would be positive is under one in many million, and if I were in your situation I wouldn't be retested. But if you continue to worry, you could have an AgAb (4th generation) test 6 weeks or more after the event, or another third gen test like INSTI after 8 weeks.

So all is well. It's up to you whether to have another test. Even if you do, stay mellow in the meantime. There is no realistic possibility you have HIV.

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

HHH, MD

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34 months ago

Dr. Handsfield - I just wanted to thank you for your response. As you know, there are other HIV forums which simply tell the "worried" that any penetrative act is HIGH risk and needs a 3 month negative, etc. While I can appreciate the cautious approach, it doesn't take into account particular nuances of each person's exposure. On the other hand, I find the feedback on this forum to be sound, practical, informative, science-based ... while at the same time, taking the time to address the INDIVIDUAL episode/concern as opposed to just telling everyone to "test until 3 months." Anyway, I don't have to go into details of other sites (I'm sure you already know), and I'm certainly not attacking their approach. I'm simply appreciating YOUR approach ... it truly means a lot. Thank you.

H. Hunter Handsfield, MD

34 months ago

You indeed understand the basic philosophies and practical approaches we endeavor to follow. Thank you for your understanding and your kind words about our services.

Given these thoughts, perhaps you would like to consider making a donation to the forum sponsor, the American Sexual Health Association. ASHA is the nation's premier nonprofit agency that supports sexual health with emphasis on STI prevention. There's a Donate link at the website -- as well as loads of information about sexual health and in particular STI education and prevention: www.ashasexualhealth.org.

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