Another Oral - Anxiety stricken

[AnxietySux]

I will get to the point - event happened in USA.

I am a male - performed Oral on a female sex worker - HIV status unknown. Despite knowing the 'theorthetical risk', I did it anyways. During the act, I made sure that my tongue stayed on the clitoris and did not come into contact with the vaginal opening as much a spossible(if that helps). There was plenty of saliva from me.

The complicating factor is that I was suffering from seasonal allergies and my thorat was irritated - which as I read - increases the risk of transmission.

1. At day 11 post exposure - I elected to perform DNA PCR Qualitative test. Came back negative.
2. At day 16 post exposure, I am experiencing sweaty palms and feet - and sometimes itchy palms.
3. I am also suffering from extreme anxiety

The literature regarding the DNA PCR Qualitative test are not reassuring. Some doctors say that 10-14 day window is sufficient, others state 28 days to be conclusive.

To further complicate my anxiety, advice on this forum given is that cunnilingus is almost a 0 chance of transmission, yet the CDC reports numerous confirmed cases.

Considering the above limited information, what is the expert opinion here? I know that I cannot get diagnosed - but typing this helps to relive my anxiety to some extent.

Thank you all.

[RapidRod]

PCR-DNA Tests
Neither the Abbott RealTime nor the Roche COBAS AmpliPrep/COBAS TaqMan HIV-1 assay is intended to be used as a donor screening test for HIV-1 or as a diagnostic test to confirm the presence of HIV-1 infection.
Richard Klein
HIV/AIDS Program Director
Office of Special Health Issues
Food and Drug Administration

You never had an exposure.

[AnxietySux]

Rapid -

thank you for the prompt reply. I understand what the FDA says. It's not an approved method by THEM. However, it is videly used for early detection.

My further research indicates, that the method (PCR DNA QUALITATIVE, not quantitative) is 38% accurate at 7 days, 97% accurate at 7-41 days and 99% accurate after that.

If I were to wait 6-8 weeks for antibody test, I might as well start digging now, becuase my body would not tolerate the stress or lack of eating for that long.

I will definitely follow up in 8 weeks with antibody and perhaps 12 weeks after that. I needed SOME relief from anxiety to be able to cope NOW - as I am sure - so many members here are posting their concerns for the same reasons.

Your statement that I was not under any risk helps, however like so many other members and readers said before me, it is contradicted by the CDC and some other sources. Yes, you can show me literature supporting your argument and I can show you literature that will support confirmed cases of HIV transmission via cunnillingus (CDC et. al.). The risk is not 'theorhetical' but would appear to be real to the casual reader (as myself).

Ann is my hero - read all her posts - maybe she can chime in for the final nail in my anxiety coffin.

Thank you SO MUCH for your time, patience and understanding.

[RapidRod]

We cannot help that you've read outdated information. Only an uneducated person would be swayed to pay for an expensive test that will not give them a true diagnosis.

[jkinatl2]

IN my ten years on this forum as a member, and in my twenty years living with HIV I have yet to see a reliable statistic, study, or even anecdote that indicates that cunnilingus is in any way a transmission route for HIV.

The quantification we use at AIDSMEDS is based on three distinct and separate studies conducted over the course of two decades with serodiscordasnt couples. We do not rely on anecdotal evidence insofar as HIV transmission is concerned, especially not now, where the current state of the scientific and epidemiological art is as advanced as it is. With more people living longer and healthier lives, a large enough collection of serodiscordant couples has finally emerged to create blind studies where HIV transmission routes can be studied with scientific quantification.

Here are some of the  scientific findings.


No incident HIV infections among MSM who practice exclusively oral sex.
Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WePpC2072)??Balls JE, Evans JL, Dilley J, Osmond D, Shiboski S, Shiboski C, Klausner J, McFarland W, Greenspan D, Page-Shafer K?University of California, San Francisco, San Francisco, United States

Oral transmission of HIV, reality or fiction? An update
J Campo1, MA Perea1, J del Romero2, J Cano1, V Hernando2, A Bascones1
Oral Diseases (2006) 12, 219–228

AIDS:  Volume 16(17)  22 November 2002  pp 2350-2352
Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men

Page-Shafer, Kimberlya,b; Shiboski, Caroline Hb; Osmond, Dennis Hc; Dilley, Jamesd; McFarland, Willie; Shiboski, Steve Cc; Klausner, Jeffrey De; Balls, Joycea; Greenspan, Deborahb; Greenspan

Page-Shafer K, Veugelers PJ, Moss AR, Strathdee S, Kaldor JM, van Griensven GJ. Sexual risk behavior and risk factors for HIV-1 seroconversion in homosexual men participating in the Tricontinental Seroconverter Study, 1982-1994 [published erratum appears in Am J Epidemiol 1997 15 Dec; 146(12):1076]. Am J Epidemiol 1997, 146:531-542.

Studies which show the fallacy of relying on anecdotal evidence as opposed to carefully controlled study insofar as HIV transmission risk is concerned:

Jenicek M. "Clinical Case Reporting" in Evidence-Based Medicine. Oxford: Butterworth–Heinemann; 1999:117

Saltzman SP, Stoddard AM, McCusker J, Moon MW, Mayer KH. Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men. Public Health Rep. 1987 102(6):692–697.Nov–Dec;

Catania JA, Gibson DR, Chitwood DD, Coates TJ. Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull. 1990 Nov;108(3):339–362.

[AnxietySux]

"The quantification we use at AIDSMEDS is based on three distinct and separate studies conducted over the course of two decades with serodiscordasnt couples. "

OK - here's a wrinkle. One of the coples that is HIV+ takes intivaral medication that drives the count to neglible levels.

Not the same as being exposed to someone with high viral load.

Thoughts?

[jkinatl2]

"The quantification we use at AIDSMEDS is based on three distinct and separate studies conducted over the course of two decades with serodiscordasnt couples. "

OK - here's a wrinkle. One of the coples that is HIV+ takes intivaral medication that drives the count to neglible levels.

Not the same as being exposed to someone with high viral load.

Thoughts?

Yes. The couples in the three studies had a wide variety of viral loads during the ten, five and three year run.

Some were on meds, some not. This variable was accounted for.

I am slightly dismayed that you would think me so obtuse as to ignore that possibility.

[Ann]

Anxiety,

First off, the ONLY type of PCR testing that is approved for use in a diagnostic setting is the RNA (not DNA) PCR test. It's only approved for use when there has been a clear risk such as unprotected, receptive intercourse.

Secondly, if you actually had a risk (you did NOT have a risk), any result on the PCR test would have to be confirmed by standard antibody testing at the appropriate time. There are NO shortcuts to hiv testing.

The bottom line here is that you didn't have a risk in the first place. Going down on a woman is not a risk for hiv infection. You say you've read my posts - have you read this one?

Hiv transmission doesn't stand a chance of happening via female genitals to mouth - there are just too many obstacles on the oral route.

The first obstacle is the mouth itself. The mouth is a veritable fortress, standing against all sorts of pathogens we come into contact with every minute of our lives. It's a very hostile environment and saliva has been shown to contain over a dozen different proteins and enzymes that damage hiv.

Hiv is a very fragile virus - literally. Its outer surface doesn't take kindly to changes in its preferred environment; slight changes in temperature, moisture content and pH levels all damage the outer surface. Importantly, it needs this outer surface to be intact before it can latch onto a few, very specific cell types and infect. 

Which leads to the second obstacle. Hiv can only latch onto certain types of cells, cells which are not found in abundance in the mouth.

The third obstacle to transmission this way is having hiv present in the first place. The female secretion where hiv has been shown to be present is the cervicovaginal fluid. This fluid is actually a thick mucus that covers and protects the cervix.

The fluid a woman produces when sexually excited comes from the Bartholin's glands, located on either side of the vaginal opening. I have yet to discover one shred of evidence (and believe me, I've looked) that shows this lubricating fluid to have any more hiv present than other bodily secretions such as saliva, sweat or tears. Saliva, sweat and tears are NOT infectious fluids.

So there you have it. Once the results of the serodiscordant studies started rolling in, what we know about hiv transmission on the cellular level was validated. The only people who were getting infected were those who had unprotected anal or vaginal intercourse. Period. One of the three studies went on for ten years and involved hundreds of couples. That's a lot of nookie.

As an adult, all you need to do in order to remain hiv negative is to use condoms for anal or vaginal intercourse, correctly and consistently, and not share drug injecting equipment. It really is that simple!

Ann

[AnxietySux]

Thank you all for your time and response. I did not mean to be inferring that someone may be obtuse. I have only asked since I do not have time or the stomach right now to read the studies.

One would think that in some study, the HIV+ partner would be on medication which would lower the risk substantially.

I did not get an answer to whether or not a sore throat due to allergies increases the risk or whether Aidsmeds forum experts will still maintain ZERO risk.

Logic dictates that I had zero risk. However my itchy and sweaty hands (going on week now) and intermittent muscle pain in the armpits and chest are really not giving me much comfort in this statistic.

I have read that itchy hands may be indicative of HIV infection. There is very little literature to substantiate if/when such symptom would manifest and to what extent.

Regards ....

[RapidRod]

I suggest you quit reading. Neither of those situation are signs or symptoms of HIV.

[AnxietySux]

I suggest you quit reading. Neither of those situation are signs or symptoms of HIV.

Bless your heart. Now only if the other possibility (fortune coming) came - that would be handy.
I seriously think that 99% of my anxiety is from other forums where people parrot what they hear and read. Possible risk .. maybe ... low risk .. some risk .. ACK! Even doctors there don't seem to agree. Low risk to me calculates to a 100% chance.

People say - you have better chance of getting struck by lighting. Guess what, people get struck all the time. If it's your time, it's time, statistics be damned.

I know what Ann says. It's difficult to belive given the owherwhelming contradictions - especially on THEBODY forum et. al. Seriously, your's and her's synopsis are the only things that are keeping me going for the next few weeks.

My brother tells me to get a grip. Says I'm way overanalysing and doomsdaying the situation. How do people survive this is .. is beyond my compass.

I don't mind spending the money on tests .. even if it may be placebo. I'd pay 10K I don't have for a conclusive result right now. I'm sure many readers would do the same.

This is going to be the most expensive massage the world has ever known, in terms of money and emotional health combined.

To all you readers out there .. hang in there, don't give up, keep it together and try to ingore the symptoms as much as you can. 3 Shots of Vodka before bed seems to do the trick. I live minute to minute - as the rest of the crowd that's waiting. I have become an automaton, executing daily chores like a robot, waiting for the next day to roll in that makes me closer to 8-10 weeks. In the mean time, I pray that my symptoms don't get any worse or any more indicative. Sounds familiar?

Thank God for this forum and it's expert members.

Take care ...

[Ann]

Anxiety,

Cunnilingus is not a risk for hiv infection, even if you had a sore throat due to allergies.

Itching hands have nothing to do with a virus for which you have not been at risk. Neither do your aches and pains. If you feel unwell, see a doctor. It's nothing to do with hiv.

One would think that in some study, the HIV+ partner would be on medication which would lower the risk substantially.

Many of the positive partners in the three serodiscordant couple studies were NOT on meds and therefore had detectable viral loads. Your thinking that they were all on meds is flawed.

I was in a poz/neg relationship for over eight years and unprotected oral sex - both ways - was a feature of our sex life. I was not on meds during this time and always had a detectable viral load, and yet he remained hiv negative and is hiv negative to this day. All we did to protect his negative hiv status was to use condoms for anal or vaginal intercourse. That's all we needed to do.

Ann

[AnxietySux]

Update:
11 day DNA PCR - Negative
17 day DNA PCR - Negative
26 day DNA PCR - Negative
30 day Oraquick - Negative (too early but a good sign)

Ann - my logic tells me that if my aches in the armpits were from enlarged/enlarging nodes, then my body would already be fighting the virus and spitting dead white cells - in which case I should have antibodies. Maybe. Dunno. I have no other symptoms. God willing - none to come either.

Going to get the Abbott Architect p24 antigen today. Will not know result for up to 2 weeks. My additional reading reveals that the regular rapid antibody tests may not encompass all HIV subtypes, nor do they test for HIV-2.

I know that HIV-2 is a long shot, but need to cover ALL the basis - and the Architect will detect most HIV-1/2 ... after 4 weeks. (advertised metrics) Fingers crossed - more sleepless nights and anxiety for sure.

I will report when I get results. I know, I was never at risk - but paranoia is a cruel girlfriend.

[Andy Velez]

You would do yourself a very big favor if you stopped indulging yourself in "reading" about all of this stuff. Continuing with that just feeds your fears and to no good purpose.

You can waste all the money and resources you want to and you are just going to keep testing negative because you did not have a risk to begin with.

[AnxietySux]

OK, my membership is about to run out so I figured I'd post up results.

4 weeks P24 antigen - negative (1&2), 6 weeks Clearview (1&2) negative.
In addition to the 3 negative DNA test, the low risk(NO RISK) and the advice of forum moderators, I am cured of my Anxiety and consider myself free and clear. No further testing will be undertaken.

Despite what the forum experts may or may not believe, the Architect antigen test at 4 weeks is CONCLUSIVE. The DNA PCR - the jury is out on that, but after 30 days, most experts will say CONCLUSIVE.

For the members I had:

1. stiff neck
2. Sore limbic system (armpits, neck, groin, collar bone etc)
3. night sweats
4. peeling skin on fingers, circular and otherwise
5. loss of appetite
6. fast heart beat all the time
7. waking up to racinng heart
8. SORE THROAT
9. rashes
10. bouts of the runs
11. sore muscles, weakness, lethargy etc....

ALL SELF INDUCED PARANOYA AND ANXIETY.

Thank you Ann and others for helping me through this. As I read the other posts now, I realise now what an insane out-of-control paranoied freak I was. Expensive lesson.

Get a grip people and Listen to the moderators. PLEASE!

I'm out.

[Ann]

Anxiety,

Your repeated negative results are no big surprise as you did NOT have a risk to begin with.

You do NOT have hiv.

Ann

[AnxietySux]

Bottom Line:

1. Bleeding gums (found out AFTER the event)
2. Week ago, seen female sex worker, Protected intercourse, light clitoral oral, and rimming. Rimming had little tongue penetration for about 15 seconds.

After about 5 days - developed itchy tongue and what dentist calls either oral lichen, or geographic tongue. I doubt that any autoimmune effects caused by acute HIV infection would flare up 5 days after possible exposure - but that's why I'm asking the experts here. 

Risk?

Thank you so much.

[Jim Allen]

Cunnilingus and rimming are not HIV concerns regardless of how bad your gums are.

To be frank if you fell flat on your face and than went and did it you still would have no risk. Move on with your life.

Here's what you need to know in order to avoid hiv infection:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions.

Keep in mind that some sexual practices which may be described as ‘safe’ in terms of HIV transmission might still pose a risk for transmission of other STI's, so please do get fully tested regularly and at least yearly for all STI's including but not limited to HIV and test more frequently if unprotected intercourse occurs

Also note that it is possible to have an STI and show no signs or symptoms and the only way of knowing is by testing.

More information on HIV Basics, PEP, TaSP and Transmission can be found through the links in my signature to our POZ pages, this includes information on HIV Testing

Kind regards

Jim

Please Note.
As a member of the AM I Infected Forum you are required to only post in this one thread no matter how long between visits or the subject matter. You can find this thread by going to your profile and selecting show own post and it will take you here . It helps us to help you when you keep all your thoughts or questions in one thread and it helps other readers to follow the discussion. Any additional threads will be deleted.

[AnxietySux]

That is a GREAT reply which relieved much stress and needless $$$ for tests. Love coming back here for the reassurance. Hope my post is helpful to other anxiety stricken members.

All the best.

[AnxietySux]

Jim,

I can add peripheral neuropathy in hands and feet.

To sum up:

First week: white spots on tongue
Second week: peripheral neauropathy and sick stomach

I seem to recall reading a similar post from someone else who did deep rimming. Starting to get bit worried.

Thoughts?

[Jim Allen]

My thoughts are stop reading things out of context or stories and confusing the for facts.

Nobody has ever been infected the way you fear.
The acts are not a risk, too many barriers for transmission and finally they lack all the biological conditions needed for transmission

Your symptoms are clearly not hiv related from this incident as this incident could not result in HIV transmission to begin with.

Move on with your life and stop wasting your time on an issue you simply do not have, that is my thoughts. We as in read back the thread have gone over your concerns in the past.

Understand I'm not going to entertain the idea anything HIV related is wrong with you if you had no exposure

Jim

[AnxietySux]

Jim,

Update - if nothing else to other anxitey stricken should they have same circumstance.

Having OCD and possibly PTSD from years of worry, I still did the following:

1. P24 Antigen test at 2 weeks - negative. Antigen spikes at 2 weeks, so good sign. Although I read that some people may not have this trace - still a good sign. Anitbody test negative but at 2 weeks useless.

2. Sent off a PCR DNA after 14 days, test will be done at 16 days. I am told that at 16 days, the modern PCR DNA is conclusive. Hence I have till Friday to report findings.

I am sure you will tell me to expect negative results - and I will gladly take that. I promise to come back by Friday and post result.

Many thanks ....

[AnxietySux]

Final Update to members and Jim:

Thank you Jim for your patience and wisdom. Incredibly important to all of us.

I have the following symptoms:
1. Oral lichen planus - tongue actually stings now
2. What appear to be sore lymph nodes
3. Sweaty hands and feet
4. Very low body temperature - 96+ for 2 weeks now
6. Sore throat and sick stomach

Now, I had an encounter with ZERO chance of acquiring HIV. P24 antigen spikes at 2 weeks and that number will NOT change. That was negative at 2 weeks. HIV RNA (CDC approved) was negative at 16 days post exposure - considered to be conclusive by "some" doctors and specialists.

I will not do a 4-6 week gen4 antibody, because that's another week of needless excruciating anxiety - that most likely caused my symptoms to begin with.

I'm taking Jim's advice and moving on with my life. A good lesson to listen. :-)

[Jim Allen]

 

What a waste of money, time and stress.  You had no reason to test as HIV is not transmitted this way and the test you took are not standalone parts of the testing algorithm (following a risk) for a reason. Seat-belts in cars are approved, so is water filtration i just would not rely on either of them for my HIV testing.

P24 tests the levels can drop quickly and also missed on tests, shit even i tested negative on a P24 test the other year and i've been living with HIV for many many years anyhow hence P24 is not conclusive and not standalone and neither is PCR RNA testing, its still not conclusive and still not a standalone test and nothing has changed and the false result rate from PCR is still too high for it to be considered part of the initial testing algorithm or in the very least not standalone and/or conclusive at all.

Anyhow back to the topic at hand I'm glad you feel okay but you were warned and so you are getting a ban. You had no risk and i wish you well, do look after yourself and seek face to face support with your therapist and learn how to cope with your irrational fears.

Running out and panicking and testing with pointless and expensive tests each time the wind blows is not healthy or a sound coping strategy at all.  Continue to work on your mental health

Jim

P.S

Looking back we have been having the same conversation with you for over 6 years regarding the exactly the same no risk activities /scenario. Get a better therapist -Please!

If you come back with more stories of PCR testing and no risk cunnilingus concerns it will instead be a permanent ban, I mean it.

Jim

 

You would do yourself a very big favor if you stopped indulging yourself in "reading" about all of this stuff. Continuing with that just feeds your fears and to no good purpose.

You can waste all the money and resources you want to and you are just going to keep testing negative because you did not have a risk to begin with.

Anxiety,

Your repeated negative results are no big surprise as you did NOT have a risk to begin with.

You do NOT have hiv.

Ann

Anxiety,

First off, the ONLY type of PCR testing that is approved for use in a diagnostic setting is the RNA (not DNA) PCR test. It's only approved for use when there has been a clear risk such as unprotected, receptive intercourse.

Secondly, if you actually had a risk (you did NOT have a risk), any result on the PCR test would have to be confirmed by standard antibody testing at the appropriate time. There are NO shortcuts to hiv testing.

The bottom line here is that you didn't have a risk in the first place. Going down on a woman is not a risk for hiv infection. You say you've read my posts - have you read this one?

Hiv transmission doesn't stand a chance of happening via female genitals to mouth - there are just too many obstacles on the oral route.

The first obstacle is the mouth itself. The mouth is a veritable fortress, standing against all sorts of pathogens we come into contact with every minute of our lives. It's a very hostile environment and saliva has been shown to contain over a dozen different proteins and enzymes that damage hiv.

Hiv is a very fragile virus - literally. Its outer surface doesn't take kindly to changes in its preferred environment; slight changes in temperature, moisture content and pH levels all damage the outer surface. Importantly, it needs this outer surface to be intact before it can latch onto a few, very specific cell types and infect. 

Which leads to the second obstacle. Hiv can only latch onto certain types of cells, cells which are not found in abundance in the mouth.

The third obstacle to transmission this way is having hiv present in the first place. The female secretion where hiv has been shown to be present is the cervicovaginal fluid. This fluid is actually a thick mucus that covers and protects the cervix.

The fluid a woman produces when sexually excited comes from the Bartholin's glands, located on either side of the vaginal opening. I have yet to discover one shred of evidence (and believe me, I've looked) that shows this lubricating fluid to have any more hiv present than other bodily secretions such as saliva, sweat or tears. Saliva, sweat and tears are NOT infectious fluids.

So there you have it. Once the results of the serodiscordant studies started rolling in, what we know about hiv transmission on the cellular level was validated. The only people who were getting infected were those who had unprotected anal or vaginal intercourse. Period. One of the three studies went on for ten years and involved hundreds of couples. That's a lot of nookie.

As an adult, all you need to do in order to remain hiv negative is to use condoms for anal or vaginal intercourse, correctly and consistently, and not share drug injecting equipment. It really is that simple!

Ann