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Author Topic: The Usual Question  (Read 2183 times)

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Offline whyme415

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The Usual Question
« on: June 12, 2012, 02:49:43 PM »
Hi Everyone,
Mostly this post is to thank everyone for the work you do here. It is very informative and extremely valuable. I'm not sure if you are thanked enough.

I have read your threads extensively and take your advice seriously. I have a feeling I know what your response to my question will be but, nevertheless, thought I would ask it.

Two years ago, I had unprotected oral sex (receiving) and protected vaginal sex with a prostitute. I contracted urethritis from this exposure (clear penile discharge but negative for gonorrhea, chlamydia and trichomonas). I have had only one partner since this and have used condoms every time (even for oral). I have learned my lesson.

Since this exposure, I have had many health problems. Most troubling is the fact that I have had two recurrent  bouts of urethritis (evidence of elevated white blood cells in the urine), a number of upper respitory infections and a series of pink/purple non-itchy lesions on my trunk.

I have seen two STD specialists, a urologist and a dermatoligst about these problems and no one has ever suggested HIV. Universally, they have now shrugged their shoulders and suggested these problems will probably resolve themselves (I have been treated with every antibiotic in the book over the last two years at different points). In fact, I was under the impression that I had been tested for HIV and was negative. My PCP did some blood work and an HSV test last year and I had incorrectly assumed HIV was included. I have just discovered last week that I was not tested despite being tested for every other STD three times over the last two years.

How urgently do I need to get tested based on the exposure and symptoms? Is there any rational cause for concern here? I am particularly concerned about the recurrent urethritis (clear and unexplained discharge from the penis for a few weeks at a time) and the skin marks. The WHO suggests that stage II of HIV is characterized by "minor mucocutaneous manifestations and recurrent upper respiratory tract infections." I'm concerned that my symptoms are consistent with this.

I am reluctant to get tested because I have had a number of false positive tests to other viruses (most notably, HSV II.....which required a Western blot test through the University of Washington to clear up). These have taken a serious toll on me and my personal life (I lost a relationship because of it).

I only ask these questions because the information online is so unbelievably contradictory. Some sites fear monger and others say there is no threat at all from receiving oral. The Public Health Agency of Canada (my native country) suggests very strongly that it is (http://www.phac-aspc.gc.ca/publicat/epiu-aepi/epi_update_may_04/13-eng.php) and the CDC seems to hedge their bets. I guess I am interested in a practioner's perspective rather than government agencies or STD testing compaies.

Thanks again for all of your help. I appreciate it.


Offline Andy Velez

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Re: The Usual Question
« Reply #1 on: June 12, 2012, 03:46:54 PM »
Receiving oral is one of the most common of sexual activities. In the entire history of the epidemic there's never been a confirmed case of transmission to a guy in that manner. It's safe to say you are not going to make history by becoming the first.

As for intercourse, you did exactly what you are supposed to do by wearing a condom. Unprotected intercourse (vaginal and anal) are the only confirmed risks for the sexual transmission of HIV. Properly worn condoms provide very effective protection.

So as far as I can see there's no cause for concern about HIV. Whatever is causing your symptoms has nothing to do with HIV. You should be talking with your doctor about whatever is going on. And you would do yourself a big favor by not surfing the net about HIV as all you will do is find fuel for your fears and to no good purpose.

I don't see any need for HIV testing. HIV is not your problem. Period.
Andy Velez

Offline whyme415

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Re: The Usual Question
« Reply #2 on: June 13, 2012, 01:41:57 AM »
Hi Andy,
Thanks so much for your response. I appreciate your straightforward assessment of my situation. You have correctly identified my illness: Internet addiction. I actually did not self-diagnose with HIV until I started searching the Internet for an explanation of my symptoms. Between government information motivated by a desire to avoid litigation, groups with an abstinence agenda and STD testing companies trying to make a buck, it is almost impossible to find an honest source of information about the risk associated with insertive oral sex. Thank you.

If you (or others) don't mind, I have three (and only three follow up questions) that may be of use to others as well.

1. Does the initial infection with urethritis (diagnosed through elevated WBCs in the urethra) one week following the exposure have any possible connection to HIV transmission? No causative organism was ever discovered and I have become worried that HIV may have been the cause (especially given that the STD doctor noted the strange "clumpiness" of the WBCs). Your advice lessens my concerns considerably but I guess my real question is whether urethritis a plausible first symptom for a new HIV infection (or a plausible later stage symptom)?

2. Is there any symptom (or set of symptoms) that would lead you to recommend a person to get tested for independent of the nature of the exposure? My impression is that the focus on symptoms is not likely to give anyone a good sense of their HIV status but wanted to confirm this impression.

3. My sense after reading your responses to a variety of situations is that one-time exposures rarely lead to transmission and that most infections (particularly among heterosexual males) occurs in the context of ongoing relationships. I will ALWAYS use a condom and 100% believe that everyone else should. But is this assessment more or less accurate?

Thank you all again for the good work you do. I appreciate it a great deal. 

Offline jkinatl2

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Re: The Usual Question
« Reply #3 on: June 13, 2012, 01:54:05 AM »
Hi Andy,
Thanks so much for your response. I appreciate your straightforward assessment of my situation. You have correctly identified my illness: Internet addiction. I actually did not self-diagnose with HIV until I started searching the Internet for an explanation of my symptoms. Between government information motivated by a desire to avoid litigation, groups with an abstinence agenda and STD testing companies trying to make a buck, it is almost impossible to find an honest source of information about the risk associated with insertive oral sex. Thank you.

If you (or others) don't mind, I have three (and only three follow up questions) that may be of use to others as well.

1. Does the initial infection with urethritis (diagnosed through elevated WBCs in the urethra) one week following the exposure have any possible connection to HIV transmission? No causative organism was ever discovered and I have become worried that HIV may have been the cause (especially given that the STD doctor noted the strange "clumpiness" of the WBCs). Your advice lessens my concerns considerably but I guess my real question is whether urethritis a plausible first symptom for a new HIV infection (or a plausible later stage symptom)?

2. Is there any symptom (or set of symptoms) that would lead you to recommend a person to get tested for independent of the nature of the exposure? My impression is that the focus on symptoms is not likely to give anyone a good sense of their HIV status but wanted to confirm this impression.

3. My sense after reading your responses to a variety of situations is that one-time exposures rarely lead to transmission and that most infections (particularly among heterosexual males) occurs in the context of ongoing relationships. I will ALWAYS use a condom and 100% believe that everyone else should. But is this assessment more or less accurate?

Thank you all again for the good work you do. I appreciate it a great deal. 


To answer your queries (and as always, going on your original post where you received oral sex unprotected yet used a condom for penetrative vaginal sex)

1) Absolutely not. There are no caveats in this scenario. You dimply will not get HIV through getting oral sex.

2) Again, absolutely not. There are NO symptoms unique to HIV infection. You must understand that primary HIV infection (ARS) is your own body's immune system reacting to the presence of HIV, and mounting an initial defense. This same defense, in varying degrees, happens when you have an allergy, the flu, a cold, anxiety and stress. It is in no way an HIV specific event. This is why we do not discuss symptoms here. Symptoms alone can not possibly point to an HIV infection.

3) HIV is a lot more difficult to transmit than was generally feared twenty years ago. It really does take an active viral particle encountering a very specific set of cells. It is, to use Ghostbusters vernacular, a keymaster seeking a gate-keeper. It's not going to happen every time an unprotected event occurs.

Given the stark difference between vaginal and anal sex, you can understand why males having vaginal sex are far less likely to acquire HIV through unprotected sex than men who have anal sex. It's not a gay/straight thing, it's a vagina/anus thing.

If you use a condom for penetrative vaginal (or anal -it's not only for gay guys) sex, and use it correctly and consistently, you will avoid HIV. It's difficult, I know, after all these years of fear-mongering and flailing, to believe that it's come to something that simple.

But there we are. And yes it is.

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline whyme415

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  • Posts: 6
Re: The Usual Question
« Reply #4 on: June 13, 2012, 02:41:57 AM »
Jkinatl2 and Andy,
Thank you both for your responses. Really great stuff (especially the Ghost Busters reference). You have really helped me out with your detailed answers. Thanks again for taking the time.

Offline Ann

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    • Num is sum qui mentiar tibi?
Re: The Usual Question
« Reply #5 on: June 13, 2012, 08:53:25 AM »
why,

Have your doctors investigated the possibility that you may have an autoimmune disease? I ask because you mentioned having false positive results to some other viral illnesses - and autoimmune diseases can cause this phenomenon because the immune system is over-active.

Any sexually active adult should be getting tested for hiv at least once a year. It drives me nuts that so few doctors encourage their patients to test regularly.

What you may want to do is to request an hiv test, but don't go for a rapid test, go for a blood test that has to be processed by a lab. Explain to the person who tests you that you have a history of false positive antibody results. Request that they immediately run a Western Blot if the test is positive, before telling you and possibly getting you all worked up over what turns out to be another false positive. 

While you have not had a risk for hiv infection with the sex worker (or have you had unprotected anal or vaginal intercourse - with anyone - that you neglected to tell us about?), a test may be what enables you to put this behind you and continue looking for other things that may be causing your difficulties - like a possible as-of-yet undiagnosed autoimmune condition.

I hope you've been assuming anyone you have anal or vaginal intercourse with is hiv positive and protecting yourself accordingly through condom use. It's not only sex workers who may be hiv positive - anyone can. Even someone you think you know. As you yourself have discovered, doctors often do not test for hiv so many people out there don't know they're positive.

Ann

edited to add... Re-reading your initial post, I remembered that you said you "learned [your] lesson" and have been using condoms for intercourse and oral after the incident with the sex worker, but what about before? Many people never have a single symptom of seroconversion, so don't assume you could not be poz just because you felt ok before. If you've ever had unprotected anal or vaginal intercourse with anyone, then you have been at risk.
« Last Edit: June 13, 2012, 08:58:35 AM by Ann »
Condoms are a girl's best friend

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"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline whyme415

  • Member
  • Posts: 6
Re: The Usual Question
« Reply #6 on: June 13, 2012, 12:33:18 PM »
Hi Ann,
Thanks for your response. I was tested negative for HIV about 3 years ago (prior to the exposure with the prostitute). Since that time, I have used a condom for every single sexual encounter (oral and vaginal....I have never had anal) with the exception of the one time receptive oral sex with the prostitute. I have had only one partner during the last two years and, as a result of my concerns regarding this exposure, I have never had an unprotected encounter with her. My current parnter claims to have been tested for everything two years ago.

You are right about assuming everyone is infected and I have lived most of my life by this rule. The exposure with the sex worker was a moment of weakness and I did not assert myself when she aggressively started the oral sex. I deeply regret it and am paying the price. It was a huge mistake and I beat myself up over it every day.

Thanks for your advice about the testing. Fear of a false positive is really what is keeping me from getting tested. My experience with HSV II, for example, took three months to resolve and I had to fight my doctors on the diagnosis the whole way (I was skeptical of the diagnosis because I had read online about the range of scores, low positives and I had never had any symptoms of herpes). I just don't think I could go through something like that again. This is why I am trying to assess my risk based on this one and only exposure. I know I should be tested but I am trying to find the right way to go about it.

If you don't mind, do you believe the HIV test offered by tstd.org would be a good option for me? I have done some research and it appears they automatically do a Western blot confirmation if the result to the antibody test is positive. Would a PCR test also be in order in my situation?

Has anything I've added changed the assessment of my risk?

Thank you all again. 

Offline RapidRod

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Re: The Usual Question
« Reply #7 on: June 13, 2012, 06:29:45 PM »
No you do not need a PCR-RNA test. Just go get an antibody test and the results will be conclusive.

Offline whyme415

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  • Posts: 6
Re: The Usual Question
« Reply #8 on: June 14, 2012, 02:56:50 AM »
Hi Everyone,
I really appreciate the feedback. It sounds like the consensus is that I should get an antibody test. I'm a little surprised that everyone is recommending testing. I was under the impression that an unprotected oral exposure did not require testing. Is there something in my description that suggests otherwise?

I apologize if I am letting anxiety get the best of me.

Offline jkinatl2

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Re: The Usual Question
« Reply #9 on: June 14, 2012, 03:38:54 AM »
I did not recommend a test. You have read your own thread, right?

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline Ann

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  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: The Usual Question
« Reply #10 on: June 14, 2012, 06:17:21 AM »
why,

I only suggested testing because of a gut feeling that having a negative test result in front of you is the only way you're going to let this go.

Getting a blowjob is absolutely not a risk for hiv infection and neither is protected intercourse. If you can let this go without testing (as you didn't have a risk), then I suggest you do just that.

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline whyme415

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  • Posts: 6
Re: The Usual Question
« Reply #11 on: July 18, 2012, 03:55:23 AM »
Ann, Andy and jkinatl2,
I just wanted to update you all on my situation and thank you, once again, for all of your help and advice. I went and got tested two weeks ago and just received the negative results on Monday. I know this will not come as a surprise to you but I had convinced myself of a different outcome. Thank you all for the effort you put into this site and for showing tremendous patience with crazy people like me. Your work inspires me (in fact, I just attended an AIDS walk and it was one of the best things I have ever done).

If you are someone who is reading this forum and all of its posts, I have two pieces of advice: trust the moderators COMPLETELY and stay off all other sites. These caring people truly know their stuff and they have no agenda other than helping you out. Governments will be excessively cautious in their recommendations, testing companies will dump all sorts of information online to heighten the anxiety that fuels their business and religious and anti-gay groups will use HIV scare tactics in order to pursue advance their moral agenda. If they say oral sex is not a risk, it is not a risk. If they tell you testing is not needed, testing is not needed.

I wish that I could do more to help with the work you do here. When I think of all of the people who needlessly suffer with scares about HIV exposures that are not risky at all, I can't help but feel that there is something very wrong with the way we educate people about HIV (both transmission and the disease itself).

I will be directing everyone I know to this site in the future. Thank you all once again for your work.

Offline Andy Velez

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Re: The Usual Question
« Reply #12 on: July 18, 2012, 06:53:39 AM »
You're welcome.

Now get on with your life and remember to always use condoms properly for intercourse in order to maintain your HIV negative status.

 
Andy Velez

 


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