What are my Risks totally out of my mind with worry and depression

[Danspur]

Hi Guys, last year I engaged at a massage parlor a Titjob in October and 3 handjobs during the period of November and December.
The titjob was unprotected but the handjobs she wore gloves and the last one I wore a condom.
During the last handjob I ejaculated prematurely as I was struggling to get the condom on before she touched me and it caused me some pain, she went on to touch me for around 10 seconds after.
At no point did my penis in all episodes come into contact with any of her private parts.
The next couple of days I went on to get some kind of Prostatis and Epydidimus.
My urine tests came back clear and my blood results normal too.
Reading all the comments on here I know everyone says it’s no risk, but nevertheless I have tested negative at 28 days, 9 weeks, 90 days and 98 days all with 4th generation tests.
I’ve also done loads of Biosure rapid finger prick tests, last one at 108 days.
For the Prostatis I was put on Ciproflaxcin and Tamosulin the muscle relaxant, would these effect my tests?
After I have finished long courses of antibiotics nearly 3 months worth I have got Oral thrush and Acid reflux.
Terrible headaches and a swollen lymph node appeared under my armpit for two weeks.
I’ve been literally unwell for 3 months non stop, I just dunno what to think and have convinced myself it’s HIV.
I hear about people serconverting after 3 months and presume I’m one of those.
I really don’t know where to turn and I’m petrified what I have done, I’ve never slept with anyone apart from my wife and it was a stupid mistake to engage in these handjobs.
Should I do more testing?
Please can somebody give me some advice.

[Jim Allen]

Hiya.

Read your post three times. What you posted over handjobs and titjobs was no HIV risk to you whatsoever, and not testing over these incidents would have been conclusive already.

You tested anyway, and the result was negative. It's not going to change unless you have had more recent sexual encounters that were a real risk.

Sorry to read that you have been feeling unwell. It is not HIV from these events; that much is certain, and it's not HIV specific.  I hope you feel better soon but see your doctor and work with them to diagnose and treat whatever is causing you to feel unwell.

I’ve never slept with anyone apart from my wife

Somewhat obvious but I mention it to anyone who is in a relationship. If you engage in condomless sex with your wife, you are obviously at risk. Often within relationships, condomless sex is based on trust or past test results. However, this does not prevent HIV, and any condomless intercourse is accepting the greater risk of acquiring HIV.

So as you are sexually active test at least yearly for STI's and if you do choose to engage in condomless intercourse, consider testing more frequently for HIV and STI's.

Here's what you need to know to avoid HIV infection:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions. Consider talking to your health care provider about taking PrEP going forward as an additional layer of HIV protection.

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.

Kind regards

Jim

Please Note.
As a member of the "Do I have HIV?" 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.

[Danspur]

Thank you Jim, very kind of you to reply does medication like antibiotics or alpha blockers effect Test results?
And finally Jim if it was Hiv that was making me unwell it would show up on the tests right?
Thank you again mate.

[Jim Allen]

Thank you Jim, very kind of you to reply does medication like antibiotics or alpha blockers effect Test results?

No.

And finally Jim if it was Hiv that was making me unwell it would show up on the tests right?
Thank you again mate.

Symptoms or not if you had HIV it would show on the tests after the window period

I've also already answered that your concerned encounters were no HIV risk whatsoever and these symptoms are not HIV related from those encounters.

[Danspur]

Finally Jim
Regarding the window period, 3 months is sufficient correct or 6 months, there is so much contracting info on this.

[Jim Allen]

6 months would be about 30 years outdated.

Lets recap.

You had no HIV risk from the handjob, no need to test over this as HIV can't be acquired that way and we're not going to pretend it was an HIV risk. It lacks all the biological and environmental conditions needed.

So relax and move on with your life. Regarding your wife, that's your ongoing risk and as you are sexually active make sure to test at least yearly and more frequently if you engage in condomless intercourse.

Finally, I am sorry that you have been stressing about and feeling unwell, I hope you feel better soon. Work with your doctor and treat whatever is making you feel unwell.

[Danspur]

Hi Jim,
Sorry it’s me again, I’ve tried very hard to draw a line under this, but my physical symptoms alongside my mental ones have pushed me lose to the end.
Since we spoke I have had a colonoscopy done and been diagnosed with Diverticulitis as well as LPR Reflux.
Added to my other symptoms of CPPS and Oral thrush, swollen neck and joints, I just can’t believe this is all down to my anxiety.
Added to that I was also worried when I phoned the private STD company Better to Know and the lady said long term antibiotic use can effect testing results.
The guy at the Gum clinic said only Antibiotics that treat TB might do that.
At my last Urologist appointment the Dr said he thinks this is anxiety driven but to do another test just in case.
I had been off the antibiotics at that point for two months.
So Jim looking at my tests can I put this to bed mate, I’m sorry to be back again but I need some clarity.
I’m doing CBT twice a week.
4th Gen lab 27 days negative
4th Gen rapid 31 days negative
4th Gen  rapid 9 weeks negative
Biosure 83 days rapid 2nd Gen negative
Biosure 84 days rapid 2nd Gen negative
Biosure 89 days rapid 2nd Gen negative
4th Gen Rapid 90 days negative
4th Gen finger prick 90 days serum lab test negative
4th Gen rapid 94 days negative
5th Gen Lab test 98 days negative
Biosure rapid finger prick 108 days negative
4th Gen lab test at 112 days negative.
5th Gen lab test 115 days negative.
4th Gen lab test at 140 days Negative

[Jim Allen]

Antibiotics would not change the window period for HIV testing, it also does not matter if it did since you had no HIV exposure, no HIV risk!

Now I am sorry that you are feeling unwell but it has nothing whatsoever to do with HIV from the concerning incident.  Like I said I am not willing to pretend as that would be a disservice.

Instead of the merry go round of pointless testing over nothing, I would recommend instead you consider speaking to a therapist to help you cope with these irrational fears/phobia and guilt prehaps.

Read the below again and if you continue to post about this it will lead to a ban to encourage you to seek professional mental health support.

Lets recap.

You had no HIV risk from the handjob, no need to test over this as HIV can't be acquired that way and we're not going to pretend it was an HIV risk. It lacks all the biological and environmental conditions needed.

So relax and move on with your life. Regarding your wife, that's your ongoing risk and as you are sexually active make sure to test at least yearly and more frequently if you engage in condomless intercourse.

Finally, I am sorry that you have been stressing about and feeling unwell, I hope you feel better soon. Work with your doctor and treat whatever is making you feel unwell.

[Danspur]

Thx Jim
I understand what you are saying but physiological I cannot accept all these physical symptoms.
Also reading the I just turned Poz forum there are example’s of when 4th Gen testing has given false negatives.
I’m going to ask for medication to help me try and get over this.
Jim can you just tell me with the testing I’ve done is there anything that would give so many false negatives, I’m reading people are saying 6 months is conclusive.

Have you ever seen anyone with my testing turn positive after?

I appreciate how tedious I must be so I’m really sorry but I’m in the worst place.
 

[Danspur]

Please don’t ban me, I didn’t see that but until I replied already sorry.
Just regarding my test results are they fully conclusive regardless of my zero risk exposure.
I won’t bother you again until I’ve spoken with a physiologist.
Thx again for you help.

[Jim Allen]

Hiya,

You have had 14 negative HIV tests when Zero where needed and still think you got HIV from a handjob.

You don't understand, as your left testical could drop off and your right arm it would not change that you had no HIV risk to start with from the handjob. Now, let say you tested positive next week it would still not be from the handjob, it would be from your real, recent and ongoing risks like the condomless intercourse!

Now to be very clear there is nobody in the I just tested positive section that has tested positive without having a real exposure or without having ongoing exposures and nobody outside the testing timelines post a risk in the manner that you are suggesting. Let's just be very clear on that.

I do know and have heard wild stories, we all have from time to time, and if you have been reading stories online and mistaking them to be facts, no wonder you can't move on with your life. I've done this for a while and have had people claim to have acquired HIV after contact with Aliens from outer-space, toilet seats, door handles, handshakes, eating food and drink ect https://www.avert.org/news/5-weirdest-hiv-transmission-myths-ever

It's okay I understand they need a story for themselves, it's the old good AIDS vs bad AIDS thinking, but thankfully these stories are just stories, not facts and, there are many reasons why someone would rather not admit to exposure or simply incorrectly dismiss a real risk without realizing it.

Factoring into stories is that being newly diagnosed is difficult enough time on its own. For some, it's a time of struggling with a deep fear of HIV stigma, social judgment, legal concerns, self-stigma and things like sexuality or facing one's sexual orientation, religion, family, etc. 

Finally, as mentioned you are getting a ban, it's out of kindness as this is not helping you move on and neither is the merry go round of testing. Please consider seeking professional support to help you overcome this phobia.

Best, Jim

Asides from my experience & knowledge below is a small collection of data on stories & testing for you to consider.


2018
https://doi.org/10.1016/j.eclinm.2018.08.001

STI Risk Perception in the British Population and How It Relates to Sexual Behaviour and STI Healthcare Use: Findings From a Cross-sectional Survey (Natsal-3)

We have identified falsely optimistic views of personal STI risk among a substantial proportion of those at risk of STIs in the British population, which could have a negative impact on efforts to promote safe sex and STI testing, and the control of STIs.

Among those classed as having ‘unsafe sex’ in the past year (comprising approximately 1 in 5 sexually-active 16–44-year-olds), 39.2% of men and 51.0% of women rated themselves as not at all at risk of STIs

2018
http://journals.sagepub.com/doi/abs/10.1177/0032885517753163

Underreporting in HIV-Related High-Risk Behaviors: Comparing the Results of Multiple Data Collection Methods in a Behavioral Survey of Prisoners in Iran

Participants reported more sexual contact in prison for their friends than they did for themselves. In men, NSU provided lower estimates than direct questioning, whereas in women NSU estimates were higher. Different data collection methods provide different estimates and collectively offer a more comprehensive picture of HIV-related risk behaviors in prisons.

2018
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268760/

Socially desirability response bias and other factors that may influence self-reports of substance use and HIV risk behaviors: A qualitative study of drug users in Vietnam

The accuracy of self-report data may be marred by a range of cognitive and motivational biases, including social desirability response bias

2018
http://emj.bmj.com/content/35/1/46
Self-perceived risk of STIs in a population-based study of Scandinavian women

Subjective perception of risk for STI was associated with women’s current risk-taking behaviours, indicating women generally are able to assess their risks for STIs. However, a considerable proportion of women with multiple new partners in the last 6 months and no condom use still considered themselves at no/low risk for STI.

2018
https://www.tandfonline.com/doi/abs/10.1080/09540121.2017.1384787

Social desirability bias and underreporting of HIV risk behaviors are significant challenges to the accurate evaluation of HIV prevention programs for orphans and vulnerable children (OVC) in sub-Saharan Africa

2018
https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(18)30062-6/fulltext

Non-disclosed men who have sex with men in UK HIV transmission networks: phylogenetic analysis of surveillance data

Jim: In short they analysed the genetic code of the virus from HIV-positive people and came to the conclusion that some of the self-reported heterosexual mens HIV was more than likely actually non-disclosed MSM.

2017
https://www.ncbi.nlm.nih.gov/pubmed/28509997

Social Desirability Bias and Prevalence of Sexual HIV Risk Behaviors Among People Who Use Drugs in Baltimore, Maryland: Implications for Identifying Individuals Prone to Underreporting Sexual Risk Behaviors.

2017 --In regards to STI's
https://journals.lww.com/stdjournal/toc/2017/07000
Sexually Transmitted Diseases: July 2017 - Volume 44 - Issue 7 - p 390–392

Is Patient-Reported Exposure a Reliable Indicator for Anogenital Gonorrhea and Chlamydia Screening in Young Black Men Who Have Sex With Men?

Among 485 young black men who have sex with men recruited in Jackson, MS, 90-day anal sexual exposure significantly predicted rectal infection, but 19.4% of rectal infections would have been missed among men denying receptive anal sex. Reports of consistent condom use were associated with lower infection rates only in men reporting insertive anal sex.

2016
https://www.sciencedirect.com/science/article/pii/S0010782416305418
Could misreporting of condom use explain the observed association between injectable hormonal contraceptives and HIV acquisition risk?

Jim - Not a conclusive or in depth study but under the study participants it did find: 9 out of every 20 sex acts reported with condoms are actually unprotected

2013

Rollins School of Public Health, Emory University, and the Kensington Research Institute, Silver Spring, MD 20910, USA https://www.ncbi.nlm.nih.gov/pubmed/14655794

"At risk" women who think that they have no chance of getting HIV: self-assessed perceived risks.

more than one-half of the "no perceived risk of HIV" sample had engaged in at least one risky practice during the preceding year and more than one-quarter had engaged in at least two such behaviors


2009
The Validity of Teens’ and Young Adults’ Self-reported Condom Use
https://jamanetwork.com/journals/jamapediatrics/articlepdf/380711/poa80067_61_64.pdf

A significant degree of discordance between self-reports of consistent condom use and YcPCR positivity was observed. Several rival explanations for the observed discordance exist, including (1) teens and young adults inaccurately reported condom use; (2) teens and young adults used condoms consistently but
used them incorrectly, resulting in user error; and (3) teens and young adults responded with socially desirable answers

BMC Public Health 2007
https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-7-60

Analyses of data from the Demographic and Health Surveys, Sexual Behaviour Surveys and from other countries show a similar pattern indicating under-reporting
It is probable that as HIV campaigns encouraging delayed sexual debut and abstinence before marriage reach the population, people will report behaviour
assumed to be more socially desirable.

there are some signs of differential reporting bias in our study. We found that controlling for less risky sexual behaviour substantially reduced the association between HIV and survey time among urban men, but less so among women; this may suggest that self-reports from men about sexual behaviour are more reliable. Studies suggest that respondents, especially women, tend to under-report the number of lifetime sexual partners . Therefore, analyses of associations with, and changes in, self-reported sexual behaviour should be interpreted with caution.

2010
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957626/

Self-presentation bias (wishing to be viewed in a positive light) may result in patients underreporting behaviors they perceive to be stigmatizing

Approximately a third of the men in the sample reported that they did not disclose all of their risk behaviors to the HIV counselor during the face-to-face risk assessment. These results echo similar studies of risk disclosure to medical providers



2015
Taylor, D., Durigon, M., Davis, H., Archibald, C., Konrad, B., Coombs, D., et al. (2015). Probability of a false-negative HIV antibody test result during the window period: a tool for pre- and post-test counselling. Int. J. STD AIDS 26, 215–224. doi: 10.1177/0956462414542987

Patients typically want accurate test results as soon as possible while clinicians prefer to wait until the probability of a false-negative is virtually nil. This review summarizes the median window periods for third-generation antibody and fourth-generation HIV tests and provides the probability of a false-negative result for various days post-exposure. Data were extracted from published seroconversion panels. The median (interquartile range) window period for third-generation tests was 22 days (19-25) and 18 days (16-24) for fourth-generation tests. The probability of a false-negative result is 0.01 at 80 days' post-exposure for third-generation tests and at 42 days for fourth-generation tests.

Generation 3 & 4

http://i-base.info/guides/testing/test-accuracy-results-and-further-testing

http://i-base.info/guides/testing/appendix-1-different-types-of-hiv-test

Generation 4

2012
Rosenberg NE, Kamanga G, Phiri S, et al. Detection of acute HIV infection: a field evaluation of the determine(R) HIV-1/2 Ag/Ab combo test. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3318673/

Results. Of the participants 838 were HIV negative, 163 had established HIV infection, and 8 had acute HIV infection. For detecting acute HIV infection, the antigen portion had a sensitivity of 0.000 and a specificity of 0.983. For detecting established HIV infection, the antibody portion had a sensitivity of 0.994 and a specificity of 0.992.

2011
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222669/
Conclusions. Combo RT displayed excellent performance for detecting established HIV infection and poor performance for detecting acute HIV infection. In this setting, Combo RT is no more useful than current algorithms.

In total, 953 people underwent HIV testing. HIV antibody (Ab) prevalence was 1.8% (17/953). Four false positive rapid tests were identified: two antibody and two p24 antigen (Ag) reactions. Of participants diagnosed as HIV Ab positive, 2/17 (12%) were recent seroconverters based on clinical history and HIV antibody avidity test results. However, none of these were detected by the p24 antigen component of the rapid test kit. There were no other true positive p24 Ag tests.

https://www.cdc.gov/hiv/testing/clinical/index.html
2018
CDC recently published research findings that estimate the window period for 20 U.S. Food and Drug Administration (FDA)-approved HIV tests. The study showed that laboratory testing using antigen/antibody tests detects HIV infection sooner than other available tests that detect only antibodies. If a person gets a laboratory-based antigen/antibody test on blood plasma less than 45 days after a possible HIV exposure and the result is negative, follow-up testing can begin 45 days after the possible HIV exposure. For all other tests, CDC recommends testing again at least 90 days after exposure to be sure that a negative test result is accurate.

Bentsen C Performance evaluation of the Bio-Rad Laboratories GS HIV Combo Ag/Ab EIA, a 4th generation HIV assay for the simultaneous detection of HIV p24 antigen and antibodies to HIV-1 (groups M and O) and HIV-2 in human serum or plasma. Journal of Clinical Virology, S57-S61, 2011

Nick S Sensitivities of CE-Marked HIV, HCV, and HBsAg Assays. Journal of Medical Virology, S59-S64, 2007

Eshelman S Detection of Individuals With Acute HIV-1 Infection Using the ARCHITECT HIV Ag/Ab Combo Assay. Journal of Acquired Immune Deficiency Syndromes, 121-4, 2009

Speers D et al. Combination assay detecting both Human Immunodeficiency Virus (HIV) p24 antigen and anti-HIV antibodies opens a second diagnostic window. J Clin Microbiol 43:5397-5399, 2005

Ly TD et al. Evaluation of the sensitivity and specificity of six HIV combined p24 antigen and antibody assays. J Virol Methods 122:185-94, 2004

2020 http://www.bhiva.org/ https://www.bhiva.org/file/5dfceab350819/HIV-Testing-Guidelines.pdf
Recommendations (Grade 1A)

• Clinic policies and patient information regarding the HIV test window period should be based on 99th percentile estimates; where a test is undertaken sooner than this time interval, window period data should be used to counsel patients as to the likelihood of a false-negative result.

• Fourth-generation laboratory tests reliably exclude HIV by 45 days post-exposure, and this should be the window period applied when utilising these tests.

• Third-generation laboratory tests reliably exclude HIV by 2 months post-exposure, and this should be the window period applied when utilising these tests.

• POCTs reliably exclude HIV by 90 days post-exposure, and this should be the window period applied when utilising these tests.

2015 WHO http://apps.who.int/iris/bitstream/handle/10665/179870/9789241508926_eng.pdf;jsessionid=1F192FECF734A0DE7E2520864984AE63?sequence=1
In many settings post-test counselling messages recommend that all people who have a
non-reactive (HIV-negative) test result should return for retesting to rule out acute
infection that is too early for the test to detect. However, retesting is needed only for HIV-negative individuals who report recent or ongoing risk of exposure. For most people who test HIV-negative, additional retesting to rule out being in the window period is not necessary and may waste resources.

Generation 1/2/3

Pilcher CD et al. Performance of Rapid Point-of-Care and Laboratory Tests for Acute and Established HIV Infection in San Francisco. PLOS ONE, 2013.

Branson BM State of the art for diagnosis of HIV infection. Clin Infect Dis 45:S221-225, 2007

Coombs RW Clinical laboratory diagnosis of HIV-1 and use of viral RNA to monitor infection. In Holmes KK (editor), Sexually Transmitted Diseases. New York: McGraw-Hill, 2008

Maldarelli F Diagnosis of Human Immunodeficiency Virus infection. In Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases (sixth edition). Philadelphia: Elsevier Churchill Livingstone, 2004

Parry JV et al. Towards error-free HIV diagnosis: guidelines on laboratory practice. Comm Dis Pub Health 6:334-350, 2003

3rd gen testing accuracy Perry KR et al. Improvement in the performance of HIV screening kits. Transfus Med 18:228-240, 2008

[Danspur]

Morning Jim I hope you are well, I took another subscription out fully being aware you could ban me without any further comments, but life is tough at the moment, every time I feel I’m getting better Something weird happens to my body to bring me back.
I guess I just want some more reassurance or just sombody to talk too, as with lockdown speaking to a GP or a Therapist is impossible and the waiting lists are huge.
I took the Hiv1-2 RNA test at the Wright practice in Harley street for piece of mind at 5 months and it can back Negative, also a rapid insti then and there and was neg.
At 6 months I went to my Gum clinic and had a full Std test and all came back clear.
But my symptoms are just getting stupid now, I still have burning Mouth, maybe candida.
I have either Penile Mordor disease or maybe sclerosing lymphangitis.
I also have this radon swollen lymph nodes under my knee pop up occasionally and the most ridiculously stiff neck.
I have silent reflux as well.
I know you only do risk assessment but just as a favor and to help me get a tiny bit of sleep would you just give me a few brief replies to my questions.

1.If I was unwell due to HIV,the tests would show, as it’s the body antibody response?
2.I know 6 months is way past current guidelines but even at the Uk Gum clinics they are wishy washy about answering if I’m definitely HIV free.
3.mate have you ever heard of somebody doing 17 tests over a 6 month period and still Turing Poz after.

Please if you see fit to answer my questions, worst thing for me if I ever did turn Poz no one would believe me how I got it and people like yourselves would dismiss it as BS and claim I got it another way.
I was a virgin and have only slept with my wife.
I understand I can never guarantee she hasn’t shagged some other dude and will not in the future, but just regarding this and to help a poor sod who is at the end of his mental state please let me know your thoughts.
Those American Doctors who are making thousands of pounds on the backs of people who are petrified on that ask an expert, claim 6 weeks is enough and in 14 years they have never had anyone come back positive blah blah blah, basically what happens if you are positive and they say you were not they just don’t let you post, so basically I know you are a stand up guy and no bullshit, I need some closure.


 

[Jim Allen]

8-week ban.

I've already explained that rubbing against her tits and getting a handjob was zero HIV risk. It lacks all the biological & environmental conditions needed for you to acquire HIV.

No testing was needed to know you don't have HIV from this event! You tested 17 times unnecessarily for an illness you don't have, with predictable negative test results and a deepening fear.

I will not pretend these irrational fears of yours are facts, just like I refuse to entertain people with HIV fears or claims from toilet seats & shaking hands as it would be a gross disservice to both the HIV community and the community as a whole.

You also still don't understand that if your left testical would drop off and your right arm, it would still not change that you did not acquire HIV the way you fear. 

I am sorry to hear you have these irrational thoughts. Please try to seek appropriate help and work with your doctor to treat whatever makes you feel sick instead of googling nonsense to feed your irrational fears.

Anyone who continues to post excessively, questioning a conclusive negative result or no-risk situation, will be subject to a four week Time Out (a temporary ban from the Forums). If you continue to post excessively after one Time Out, you may be given a second Time Out which will last eight weeks. There is no third Time Out - it is a permanent ban. The purpose of a Time Out is to encourage you to seek the face-to-face help we cannot provide on this forum.

P.S

About the wife, I already told you twice to use a condom or accept the greater risks for HIV & STI's that come with condomless intercourse.

If you engage in condomless sex with your wife, you are obviously at risk. Often within relationships, condomless sex is based on trust or past test results. However, this does not prevent HIV, and any condomless intercourse is accepting the greater risk of acquiring HIV.

Regarding your wife, that's your ongoing risk and as you are sexually active make sure to test at least yearly and more frequently if you engage in condomless intercourse.