Total wreck for the past month

[pikaia]

Hi all,

I'm a 20-year-old gay male. A month ago, I had a group sexual encounter while heavily intoxicated with alcohol (something I hadn't done before and will NEVER do again). I performed oral sex on one guy and he did not ejaculate. That is not the issue—he also fingered my anus some time after fingering and having anal sex with another guy. I'm not sure how much time elapsed between the two fingering incidents, but it felt like 30 minutes to an hour. In between, he left and may have gone to the bathroom to wash, but I'm not sure. I later read that rectal secretions can carry several times more HIV than either blood or semen.

Just under 3 days after this incident, I came down with a fever, sore throat, and muscle aches. The fever and aches went away in about 24 hours (I took aspirin), but the sore throat persisted for about 2 weeks. For the last week, a low grade fever has seemed to return, but I had also been sunburned and the weather has been extremely hot, so I just can't tell. I've been having diarrhea, which is a common response to stress for me. A couple of days ago, I began experiencing a stiff neck and shoulder pain—this may be due to my sitting up for hours in a lower bunk bed in front of the computer (reading about HIV—what else?) I've been a total wreck the entire time; a feeling of dread and doom is hanging over me constantly. Last night, the final nail in the coffin seemed to come: I noticed a reddish rash on my jaw and upper neck. What's maddening is that I have often had a problem with razor burn due to shaving against the grain, so I don't know if I should attribute the rash to that or something else. I also started noticing a sharp but mild throat pain when I swallowed last night, and it's still there. It must be an ulcer. Basically, I'm experiencing all the symptoms of ARS. I know I can't self-diagnose, but it just matches too well. I've never been more frightened in my life. I often feel absolutely certain that I have HIV.

When I first started experiencing these symptoms, I contacted the other guy who'd been fingered and he assured me that I was fine, that he had been through what I'm going through and had been tested twice, negative both times. He said he hadn't had sex in between his last test and my incident. He's one of my closest friends and I don't think he's lying—I just can't shake the idea that he got tested in the window period and seroconverted later. If this had happened recently, he would have been even more infectious.

Does it look like there's any chance I'm OK? I'm going to get test soon and then follow it up at 3 months, but the fear is just eating me alive. Could some of my symptoms be due to anxiety as well?

I also just want to say that reading through this forum (which I've been doing a lot of lately) has given me an enormous amount of comfort and hope, no matter what my diagnosis ends up being.  I'll be coming back here again, at least to let you know my test results.

[Andy Velez]

You are worrying needlessly. None of the  activities you're worried about put you at risk for HIV transmission. If you haven't already read our lesson on Transmission, I suggest you do so.

Fingering, even if the guy's finger was still steaming from the other butthole he was playing around with is not a risk for transmission. As for giving oral, although from time to time we get reports of someone insisting that's how they became infected, those cases never seem to hold up under scientific scrutiny. By contrast, there are ongoing longterm studies of sero-discordant couples, both gay and straight, who have lots of unprotected mutual oral and only protected vaginal & anal sex. The results over extended periods of time have been that not a single sero-negative partner has become infected.

Your symptoms are not in any way HIV specific. If they persist you should discuss them with your doctor. I don't see any need for HIV testing in relation to this recent incident. We do in general recommend that anyone who is sexually active ought to regularly have a full STD panel done regularly -- at least annually. Other STDs are much easier to acquire than HIV.

And you will be wise to keep in mind avoiding mixing casual sex with excessive drinking. It's a mighty dangerous combination.

This time out I don't see any cause for further concern about HIV.

Cheers,

[pikaia]

Thanks a lot for your reply, Andy. I'm immensely glad to hear that. But I've always read that sharing sex toys is a risk for HIV -- is this really that different?

[RapidRod]

As Andy correctly advised you. Fingering is not a risk of contracting HIV.

[pikaia]

I got tested 32 days after the incident and was negative. I know this is well within the window period and I supposedly was not at risk, but the testing was necessary in order for me to maintain my mental health—just thought I'd check in and let you folks know what happened. Again, thanks for your help.

[Andy Velez]

No surprise that you tested negative. Glad you found the exchanges here to be helpful. Good luck to you.

[pikaia]

Sorry to bother you folks again. I was feeling fine about all of this since my last post... until today, when I noticed what seems to be a red lesion on my penis a couple of millimeters across. Something similar happened a couple of weeks ago in the same place. I've started worrying again because I've now had basically all of the symptoms. I know that this part of my penis used to become painfully sore from time to time even before I became sexually active, but I can't remember whether or not I had actual visible lesions then.

All I can think of right now is HIV, but surely there is a better explanation? HSV-1, or some skin condition?

[RapidRod]

There is nothing more we can help you with. You did not have a risk of contracting HIV. If you have a concern see your doctor.

[pikaia]

Is it worth mentioning that day after the initial incident, I noticed a tiny reddish spot in my mouth where I sometimes chew? Hopefully not.

[RapidRod]

No it not worth mentioning. You had no risk.

[Ann]

Pik,

If you have strange spots or lesions on your penis, the sensible thing to do is show it to a doctor. Nobody can diagnose your spots over the internet. For all we know, you could have syphilis, so see a doctor.

Whatever your spots are, they are not indicative of hiv infection. Nothing you're reported here is a risk. However, if you're sexually active, you should be having a full sexual health care check-up, including but not limited to hiv testing, at least once a year and more often if unprotected intercourse occurs.

If you aren't already having regular, routine check-ups, now is the time to start. As long as you make sure condoms are being used for intercourse, you can fully expect your routine hiv tests to return with negative results. Don't forget to always get checked for all the other sexually transmitted infections as well, because they are MUCH easier to transmit than hiv.

You do not need to test over this specific incident, but if you've never tested and you're sexually active, perhaps it's time.

Ann

[pikaia]

This is more for other WWs than the experts, since someone will inevitably stumble across this topic who's in the same situation as mine...

I went in for my second test 14 weeks after the incident, and today my doctor called with the result: negative. There were moments when I was 100% sure I had the virus, and why not? I had virtually every symptom of ARS after what I truly believed was a risk for HIV. And... I'm too tired to write a long lecture. But when Andy and co. tell you that you've had no risk, LISTEN TO THEM! When they tell you that symptoms mean nothing as far as HIV goes, LISTEN TO THEM! And don't believe everything you read elsewhere on the internet. If  you want to believe that HIV can be transmitted, say, over the telephone, you'll probably find some website that backs that up. Misinformation is everywhere.

[pikaia]

Never thought I would be posting here again, but I didn't learn my lesson. I am now certain I have HIV.

Last Friday, I had a sexual encounter with a man I met at a bar. Casual sex usually makes me more nervous than satisfied, so I don't know what I was thinking. Anyway, we were both drunk, had unprotected oral without ejaculation, he penetrated me anally with his finger, then tried to so with his penis, first with a condom on. I stopped him but he tried again later. The second time, I believe he was not wearing a condom. The problem is that he may have fucked me eventually. I just don't remember.

A couple of days ago I started feeling a burning sensation when pissing, which has mostly gone away now. Gonorrhea? I'm going to get tested and find out, but it seems insignificant now. Until today it didn't even occur to me that he may have fucked me – surely I would have stopped him.

Or not. This morning, less than five days after the encounter, I came down with textbook ARS symptoms. Fever, chills, muscle aches, irritation near the upper tonsils. The sore tonsils have gotten a bit better, the myalgia has stayed about the same, and the fever has gotten worse. I mean this is a bad fever, and I only get one every few years. It may be the worst since my first post here.

If this guy was even thinking about fucking me without a condom, then surely he has done it to other guys, who've had it done to them by other guys, et cetera. I assume he is positive. And I have to assume that he did penetrate (rape?) me at some point. And you know the rest.

I am simply stunned by this. It's too big to get my mind around. After my first scare, I knew I would take every precaution against HIV. Yet I didn't. I don't even like casual sex, and this guy was absolutely nothing special. It was a coincidence the first time, but again?

While it may not be possible to diagnose ARS based on symptoms, I think I'm as close as it gets. I've been under a lot of stress lately (largely worrying about gonorrhea or herpes... seems like weeks ago) but it's not flu season and I don't know what else could cause this. I've also read that rapid onset of ARS may mean a more aggressive virus.

Just cannot believe it. It's an out-of-body experience. Whenever my sexuality has come up with family or friends, the response is always "fine, you are who you are – but be safe." I've had serious issues with depression and anxiety in the past over things that seem insignificant compared to HIV, so I truly don't know if I'll be able to deal with this.

[pikaia]

Update: I still have a fever but it has gone down a lot. The other symptoms are much, much milder and might be disappearing. I did have some yellowish post-nasal drip.

Is it common for ARS to last 24 hours or less?

[RapidRod]

You've never had an exposure.

[pikaia]

I was very drunk and remember being penetrated by something that may have been his finger(s) but may have been his penis. I don't want to think I would have allowed that to happen, even as drunk as I was, but I'm just not sure. My instinct tells me that he did it.

The symptoms are basically gone (24 hours later) except for a headache and what feels like a mild fever. Very strange. All I took was an Ibuprofen tablet sometime yesterday afternoon.

[Andy Velez]

You're hanging around in the area of "what ifs." That's never a good thing to do.

Nothing you are reporting is suggestive of ARS or in any way HIV specific. But that's not a surprise because I don't think you had anal intercourse. For one thing your butt would likely be somewhat sore if that had happened since apparently it would be an uncommon occurence for you.

Strictly for your peace of mind I suggest you get tested at 3 months to confirm your negative status. And I do expect you will test negative for HIV.

The big red flag in all of this is your getting so drunk that you really don't know what you may have done. Mixing casual sex with excessive drinking is a very dangerous combination and one you need to avoid in the future.

I expect you to come out of this ok, but get tested just to be sure.

[pikaia]

Thanks a lot, Andy and Rod. You're right that I don't engage in receptive anal sex... well, ever. My ass was a bit sore the next day, but I know that he penetrated me aggressively with his finger.

I will never have casual sex again and I will never mix sex and drinking under any circumstances. Absolutely never. But I think I've learned the lesson too late. I really do believe I have HIV.

High risk partner (he attempted sex without a condom) -> possible high risk exposure -> fever, muscle aches, sore tonsils (but NO cough, so not the flu) -> how could I not have it?

I still have what feels like a low-grade fever and malaise (not severe) along with some stiffness in my neck, although that could be related to the way I've been sitting/sleeping.

The thing that kills me is that I'm not promiscuous, not a "party boy" or anything of the sort. I'm reserved, relationship-oriented, not into the gay scene and until this incident I've been very, very careful. I've always taken my health for granted and never really appreciated the good things I have.

I've had a very difficult last few years and just very recently turned the corner, really started to find myself and make the kind of life I want to live. My family has been incredibly supportive the whole time. And now this happens. It's so wrong. If I test positive, what could I possibly say to them?

My biggest problem has always been negative thinking. I look at the bad things, get into a bad state of mind, and more bad things happen because of it. I've seen how this works and have been trying so hard to be optimistic, but sometimes I slip. That's what happened last weekend – I was recently unemployed and had been dealing with relationship problems, and was feeling hopeless, so I went to that bar to get drunk and hook up. Not long after, I was offered a job and several good people have shown interest in dating me – of course my hopelessness was unfounded. I knew my negative thinking was going to hurt me, but I let myself get caught up in it, and this time the consequences may have been permanent. It's absolutely unbearably cruel and unfair. I cannot believe it.

I truly believe I'll be a new person, free from this kind of thinking, if I test negative. I don't pray, but... I'm praying for just one more chance.

I'm going to get tested in six weeks (and at three months if that's negative). Until then, I don't know how to live with this feeling.

[Andy Velez]

Now that you have mentioned "aggressive anal fingering" I am more persuaded than ever that you did not have anal intercourse. But it's still a good idea for you to get tested and remove any doubts. Your certainty that you're infected means absolutely nothing. Feelings are not facts.

During your waiting time you would be well advised to make a real effort to focus on other matters in your life. Yes, that can be done and it helps to make the waiting time pass more easily than you may imagine is possible.

I'm expecting you to come out of this ok ultimately.

[pikaia]

Very soon, I may find out what actually happened. I suppose his answer will reveal nothing about my status. Nonetheless I'm terrified. My temperature still feels slightly elevated and I had a relatively mild but noticeable night sweat last night.

[pikaia]

We didn't have intercourse, protected or otherwise, so I don't think I had a risk.

[Andy Velez]

And I don't either. So while you are waiting to test you need to focus your attention on other matters in your life.

There's nothing more we can do for you here. And to repeat, I expect you to test negative.   

[pikaia]

I'm 99% sure that I only engaged in oral sex, and that no ejaculation occurred. I assume there was some pre-cum. However, I read a study indicating that some mouth cells can become three to six times more susceptible to HIV if exposed to the amount of alcohol found in beer—under lab conditions, without the presence of saliva, enzymes, etc.

Even if this holds true in the real world, is my risk still negligible? What if my "partner" was recently infected and had a high viral load? He admitted that he has had unprotected sex but says he is tested regularly and is negative. Obviously I can draw no conclusions from that.

More recently, I performed fellatio (for less than 20 seconds with no ejaculation) with a canker sore inside my mouth. Is this also a low-to-no-risk situation?

[Andy Velez]

I'm going to say this as simply as possible: the only confirmed risks for the sexual transmission of HIV are unprotected vaginal and anal intercourse. Anything else is only a "theoretical" risk.

As long as you consistently use condoms for vaginal and anal intercourse you will be well protected.

Yes, it really is that simple. Stop with the drama and the what ifs. You have not had risks for HIV.

[pikaia]

Thanks for your help and patience. I am reassured; however, there is a new development.

I took what I thought was a regular HIV antibody test around a week and a half after the incident—not in relation to that incident, but as part of my yearly sexual health checkup—and was told it was negative. However, I received the medical bill today and it included an additional DNA test which I did not order and which my insurance does not cover.

My first fear was this: that my antibody test was reactive or indeterminate, and that the lab therefore carried out a DNA test, which then returned a false negative. They then simply reported my result as negative.

Obviously I was in a panic, but I did some research and it seems like I was confusing the DNA test with the Western blot. It seems that HIV DNA tests are not used for diagnostic/confirmatory purposes due to high rates of false positives. However, I'd like some clarification from the experts (since I can't call the lab until tomorrow).

1. Have you ever heard of a case of a reactive or indeterminate antibody test followed by a negative DNA test—in which the patient turned out to have HIV?

2. Have you ever heard of a lab using the procedure I described (antibody followed by DNA)?

3. Does the Western blot involve any kind of DNA detection? In other words, would it ever be referred to as a DNA test on a medical bill?

I realize there's a very good chance this was just a mix-up and I was billed for a test I never took, but I know little about HIV testing science and would appreciate some reassurance. Thanks again.

[RapidRod]

Thanks for your help and patience. I am reassured; however, there is a new development.

I took what I thought was a regular HIV antibody test around a week and a half after the incident—not in relation to that incident, but as part of my yearly sexual health checkup—and was told it was negative. However, I received the medical bill today and it included an additional DNA test which I did not order and which my insurance does not cover.

My first fear was this: that my antibody test was reactive or indeterminate, and that the lab therefore carried out a DNA test, which then returned a false negative. They then simply reported my result as negative.

Obviously I was in a panic, but I did some research and it seems like I was confusing the DNA test with the Western blot. It seems that HIV DNA tests are not used for diagnostic/confirmatory purposes due to high rates of false positives. However, I'd like some clarification from the experts (since I can't call the lab until tomorrow).

1. Have you ever heard of a case of a reactive or indeterminate antibody test followed by a negative DNA test—in which the patient turned out to have HIV?

2. Have you ever heard of a lab using the procedure I described (antibody followed by DNA)?

3. Does the Western blot involve any kind of DNA detection? In other words, would it ever be referred to as a DNA test on a medical bill?

I realize there's a very good chance this was just a mix-up and I was billed for a test I never took, but I know little about HIV testing science and would appreciate some reassurance. Thanks again.

1. PCR-DNA tests are not approved for diagnostic use, they are monitoring tests for known HIV positive individuals.
2. No, read #1
3. No.

[pikaia]

Thanks. I suppose that if someone did perform this test by mistake, it's only further evidence that I don't have HIV.

[RapidRod]

No it wouldn't. You could be positive and under the detection level of the test.

[pikaia]

Anyway, it turns out I only took the antibody test.

[pikaia]

OK, this is not good. To be honest I wanted to PM jkinatl2 about this, but I see that's not allowed—so I'm posting it here.

I've been sick with a cold for the last week, which began almost two weeks to the day after my last possible exposure. The cold turned into bronchitis near the end of the week. None of this worried me too much as the symptoms were not really similar to ARS.

However...

Since Saturday, after my other symptoms have mellowed or cleared up, I've been running a low-grade fever. A fever at the end of a cold? What? I'm concerned that this is indeed ARS and is just coincident with the end of the cold; or that I seroconverted in March, and this is all the result of a compromised immune system. Do either of these seem plausible.

To clarify, here are my recent exposures. This was three different partners, all unknown/unconfirmed status, and in each instance there was no ejaculation but likely precum.

3/16/12: Aggressive, unprotected deep throat oral while intoxicated.
4/15/12: Fairly sustained unprotected oral with bump (canker sore?) on roof of mouth.
4/16/12: Very brief (<20 s) unprotected oral with definite canker sore (after all that worry—how fucking stupid!).

I've read most of Jonathan's posts on oral sex, and they've been reassuring. You are awesome! I'm now very familiar with the Page-Shafer, Romero, and Vittinghoff studies.

Now, what really concerns me—and I hesitate to post this because I don't want to frighten others like me—is some recent lab science I've come across that strongly suggests oral infection occurs, and details its mechanisms.

The studies are:
http://www.ncbi.nlm.nih.gov/pubmed/22077822
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2491655/
http://www.menstuff.org/issues/byissue/oralsexsafety.html (best link I could find for this)
http://news.bbc.co.uk/2/hi/health/4123193.stm (again, couldn't access full article)

To be honest, I really don't know what to make of it all. I believe it undermines the idea that the mouth is completely hostile to HIV, while supporting the claims of people who say they were infected orally. In terms of lab science, it looks like the closest thing to actually making it happen to a person.

On the other hand, if it's that easy, why didn't it happen in the long-term studies? The HOT study is especially relevant here, as, from what I understand, the subjects average three partners within six months—so there may have been hookups involving alcohol, and probably encounters with recently-infected folks with high viral loads. But then there were some cohort studies mentioned here where oral infection was thought to have occurred. Regarding precum, Page-Shafer says that it's not a factor in transmission. That panel she participated in agreed that without ejaculation it's an extremely/exceedingly rare, hypothetical event. (Actually, that seems to be Kim's position on oral transmission in general).

I'm very confused.

Is anyone here familiar with this research? Could it warrant a change in the site's position on oral risk? Again, sorry to be dumping it all here.


I expect to graduate to the main forums soon. I've been thinking of nothing but HIV and dreaming about it if I sleep at all. I know HIV isn't the end of the world, medically speaking, but I'm absolutely not ready to deal with it. And good god would it kill me if it was a fucking canker sore. I'll know soon enough.

Anyway, thanks again for all your help.

[Andy Velez]

You have a history of over-reacting about risks for HIV.

Nothing you are reporting of your activities suggests that you were other than only theoretically at risk for HIV. While I will not say it is impossible to become infected through oral sex, it is way way beyond unlikely.

You can get tested at 3 months after the most recent such incident and collect what I expect will be another negative result.

We're not going to indulge you in a lengthy back and forth about your oral sex concerns. If you continue to return about these oral sex incidents you are going to find yourself getting a Time Out from the site. Consider yourself warned. 

[jkinatl2]

The studies you quoted are interesting in that they investigate the methodology of HIV infection in vitro. And while that is a fascinating pursuit, we - humans - are not test tubes or petri dishes. We are in vivo. What can be manipulated in a lab might or might not have real-world implications. And it only sometimes has direct linear correlation.

As Ann has mentioned before, one group that is very difficult to study (I daresay impossible to ethically study) is the recently seroconverted, with soaring viral loads. It is theoretical that this group, when paired orally with a subject with notably poor oral hygiene/health, can perhaps (theoretically) facilitate infection.

Of course, people with HIV who are not on meds can also have fantastically high viral loads. I do not have access to the data in the serodiscordant studies at the moment, but it would be interesting to find out what range, exactly, of viral loads were tracked during the three studies. If someone ever wants to do the legwork for me on that, cool. It would also be interesting to see if the studies concerned themselves at all with other factors which might or might not facilitate oral infection. Poor (and I mean poororal hygiene might be a factor, particularly in those who use drugs like crystal meth. Meth not only causes really atrocious oral conditions (google "meth mouth") but the mechanism by which it does so, by inhibiting the production of saliva, might theoretically be a "perfect storm" scenario by which HIV can be orally passed.

I say theoretically because study after study of serodiscordant couples simply has yet to yield any infections through oral activity. It's impossible to assign a degree of risk to an event which, in study after study in vivo, has yet to be catalogued. I can't, for example,  fathom an ethical study of serodiscordant couples where the negative partner must be an ongoing and chronic meth user to that degree of oral compromise.

This is why, early in the pandemic, the list of potential risk factors for HIV was so vast. We simply did not have enough real-world subjects staying alive and healthy long enough to study their sexual habits, let alone habits in serodiscordant settings.

In the real world, in the vast scope of human existence, it would be folly to say that anything is categorically impossible. No matter how far-fetched the scenario, someone somewhere has tried it, IS trying it, or will undoubtedly try it. These outliers are simply so far off the charts that it veers into the realm of the absurd to even contemplate them seriously.

When discussing the HIV risk (or lack thereof) from getting a finger in your anus, for example, we say that IF someone had JUST cut the top of their finger off and them immediately jammed it into your anus, there may be a risk of HIV infection. THAT is an outlier. But it would be arrogant and naive to assume that somewhere, sometime during the course of the pandemic, someone won't experience exactly that scenario. I'm afraid to google that potential fetish - because I know that if I can imagine it, it's likely happened.

But that does not mean we live in fear. And though I enjoy a scientific discussion as much as the next guy, I have to agree with Andy here. Further exchanges with you on this topic at this time in your life would not only be counter-productive, but cruel on my part.

You keep mentioning symptoms, as though they really mean anything insofar as diagnosing HIV. The ONLY people I am aware of who were diagnosed at seroconversion were those who became acutely ill. Acutely. Not low grade fever stuff, but hospital grade symptoms. And even then, only a doctor with a keen eye and a creative mind would even think to consider Acute Retroviral Syndrome.

Simply put, you have an irrational fear of HIV. You have decided that you will "migrate to the main forums." As fluid and personable as your writing style might be, it would be mean-spirited on my part to engage you further. Because this is something you have internalized into a meta-event. And I think it's probably well past time that you talk to someone about it. A counselor, a psychologist, whomever. Not an HIV educator, and not those of us on these forums.

At this point, we're not helping, we're hurting.

And for that I apologize.


Test, if you must, over this incident. Adjust, if you have to, your boundaries as far as sexual practices with which you feel comfortable. But you'll do yourself a favor by taking your mind elsewhere. You stated:

I've been thinking of nothing but HIV and dreaming about it if I sleep at all.

You have to realize that this is not rational thought. It's obsession. And I can no longer in good conscience facilitate that obsession. Therefore I must respectfully withdraw from the discussion. I seriously, sincerely wish you the best of luck in overcoming this. No one should live in fear.

[pikaia]

I've thought about what you said (which was truly above and beyond the call of duty) and I agree with you. Thank you. I'm going to stay away from sites like this until I have a test result to report.

And in a small way, I feel like my fear has contributed to the stigma around HIV, so I apologize for that.

[pikaia]

Since last night I've had a bad ringing in my right ear. It might be linked to seasonal allergies, but my allergies have never included persistent tinnitus before, and medication has not reduced it. I've noticed a few people on the net saying their tinnitus began around the time they were diagnosed with HIV.

Anyway, I guess that's all moot because it's been over six weeks since my last exposure and over ten weeks since my first. I've no excuse not to test. I should be back here later today with the result.

[Andy Velez]

And that's another symptom that is not in anyway related to HIV. 

[pikaia]

The result was negative.

Given the time frame and the nature of my activities, I will accept this as reliable, and I'm incredibly relieved. But I'm really not sure if I can handle this gay thing right now. Might be time to try doing it with women.

[Andy Velez]

Well that's very good news indeed. Enjoy it and get on with your life and always remembering to use condoms for intercourse whether with men or women.