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Differing HIV expert opinion on window period
Hello,
I'm a male, 39 y.o., circumsized and until recently in very good health.
Had brief protected oral and vaginal sex 04/19/13 with a CSW from Czech Republic, she was extremely careful handling condoms (although she did open the wrapper with her teeth) and she always used her fingers to keep the condom in place and as a barrier from direct contact between our genitals. When finished, condom did not seem broken when I removed it. Other than me fingering her vagina, there was no other form of contact with her genitals (no kissing or cunnilingus).
I didn't think much of it knowing I had protected sex. Two weeks from the encounter I started feeling tired and having some joint pain, but no other symptoms. I have a quite rigorous daily excercise routine and attributed the joint pain to that. However as time passed I kept feeling tired and noticed I had less energy to perform my workouts, my legs felt weak and rubbery, started having muscle cramps and fasciculations in abdomen and legs. I went to my GP who ordered a CBC, blood chemistry and HIV test, all came back normal. These were done exactly 76 days from potential exposure, the HIV test was a 3rd gen chemiluminescence (negative) in a prestigious lab in Mexico City.
As I kept working out I started feeling weaker, arms and legs muscles feeling shaky and feeling sick during intense exercise. I repeated the test at 90 days in the same lab, along with a complete hep B panel, results were negative.
As my leg muscles kept feeling weaker and kept getting sick during excercise, I made an appointment with an endocronologist that after a thourough examination told me I was in excellent health and there was no need to repeat tests.
Because in my mind the encounter with the CSW was the only reason I was feeling ill, I made an appointment with one of Mexico's top HIV specialists. He seemed to be worried I slept with a CSW, but didn't ask for specifics about the encounter other if it was protected or not. He examined me very thoroughly looking for lymph nodes (didn't find any). He ordered another CBC and blood inflammation markers (came back normal), and said he doesn't find any sign of infection and that I should lower my excercise intensity for a week. He never mentioned low risk from using protection and did suggest that I should retest and 6 months to be sure.
This contrasts sharply with the advice given on these boards, that a 90 day 3rd gen test is final and conclusive, that there is no risk with protected sex and that CSWs are not high risk.
I still feel weak, shaky and sick (4 months after encounter), can this be caused by my immune response to the HIV virus?. Do I really need to test at 6 months?.
Many thanks for sharing your experiences and thoughts on this matter.
I'm a male, 39 y.o., circumsized and until recently in very good health.
Had brief protected oral and vaginal sex 04/19/13 with a CSW from Czech Republic, she was extremely careful handling condoms (although she did open the wrapper with her teeth) and she always used her fingers to keep the condom in place and as a barrier from direct contact between our genitals. When finished, condom did not seem broken when I removed it. Other than me fingering her vagina, there was no other form of contact with her genitals (no kissing or cunnilingus).
I didn't think much of it knowing I had protected sex. Two weeks from the encounter I started feeling tired and having some joint pain, but no other symptoms. I have a quite rigorous daily excercise routine and attributed the joint pain to that. However as time passed I kept feeling tired and noticed I had less energy to perform my workouts, my legs felt weak and rubbery, started having muscle cramps and fasciculations in abdomen and legs. I went to my GP who ordered a CBC, blood chemistry and HIV test, all came back normal. These were done exactly 76 days from potential exposure, the HIV test was a 3rd gen chemiluminescence (negative) in a prestigious lab in Mexico City.
As I kept working out I started feeling weaker, arms and legs muscles feeling shaky and feeling sick during intense exercise. I repeated the test at 90 days in the same lab, along with a complete hep B panel, results were negative.
As my leg muscles kept feeling weaker and kept getting sick during excercise, I made an appointment with an endocronologist that after a thourough examination told me I was in excellent health and there was no need to repeat tests.
Because in my mind the encounter with the CSW was the only reason I was feeling ill, I made an appointment with one of Mexico's top HIV specialists. He seemed to be worried I slept with a CSW, but didn't ask for specifics about the encounter other if it was protected or not. He examined me very thoroughly looking for lymph nodes (didn't find any). He ordered another CBC and blood inflammation markers (came back normal), and said he doesn't find any sign of infection and that I should lower my excercise intensity for a week. He never mentioned low risk from using protection and did suggest that I should retest and 6 months to be sure.
This contrasts sharply with the advice given on these boards, that a 90 day 3rd gen test is final and conclusive, that there is no risk with protected sex and that CSWs are not high risk.
I still feel weak, shaky and sick (4 months after encounter), can this be caused by my immune response to the HIV virus?. Do I really need to test at 6 months?.
Many thanks for sharing your experiences and thoughts on this matter.
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.
There is no debate (among experts) about the HIV risks associated with oral sex. The risk is so low that almost nobody who cares for HIV infected patients has ever had a patient believed to have been infected that way. Among experts, it's a semantic issue about using terms like "no risk" and "very low risk". There is no difference between my or Dr. Hook's use of "low risk" and other experts' "no risk".
DR. HANSFIELD
"And oral sex is basically safe sex -- completely safe with respect to HIV and although not zero risk for other STDs, the chance of infection is far lower than for unprotected vaginal or anal sex. Please educate yourself about the real risks. If you stick with oral sex and condom-protected vaginal or anal sex, you have no HIV worries and very little worry about other STDs. " DR HANSFIELD
"I am sure you can find lots of people who believe that HIV is transmitted by oral sex, but you will not find scientific data to support this unrealistic concern..." DR HOOK
"HIV is not spread by touching, masturbation, oral sex or condom protected sex."- DR. HOOK
in the public HIV Prevention forum of MedHelp, TEAK and the other moderators maintain that oral sex in all forms is a zero risk activity. Would you agree with this assessment?
I TOTALLY AGREE / DR GARCIA
"HIV is not spread by masturbation, through oral sex, through kissing or other casual contact." Dr. Hook
"The observation on thousands and thousands of observations is that HIV is not spread by oral sex (of any sort)." DR HOOK
"I would not say your risk ,if he had HIV is "slim to none"- that's too high. I would say they are effectively zero. How much of his ejaculate or other genital secretions you may have swallowed makes no difference. EWH "
"As far as HIV is concerned, there is no known risk of getting HIV from performing oral sex on an infected partner, even if that person's genital secretions get into your eyes or if you swallow." Dr.Hook
HIV is not spread by oral sex, giving or receiving, even if sores, gum disease or blood is present
DR HOOK
The fact is that there are no cases in which HIV has been proven to be transmitted by oral sex, including fellatio.. EWH
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.
There is no debate (among experts) about the HIV risks associated with oral sex. The risk is so low that almost nobody who cares for HIV infected patients has ever had a patient believed to have been infected that way. Among experts, it's a semantic issue about using terms like "no risk" and "very low risk". There is no difference between my or Dr. Hook's use of "low risk" and other experts' "no risk".
DR. HANSFIELD
"And oral sex is basically safe sex -- completely safe with respect to HIV and although not zero risk for other STDs, the chance of infection is far lower than for unprotected vaginal or anal sex. Please educate yourself about the real risks. If you stick with oral sex and condom-protected vaginal or anal sex, you have no HIV worries and very little worry about other STDs. " DR HANSFIELD
"I am sure you can find lots of people who believe that HIV is transmitted by oral sex, but you will not find scientific data to support this unrealistic concern..." DR HOOK
"HIV is not spread by touching, masturbation, oral sex or condom protected sex."- DR. HOOK
in the public HIV Prevention forum of MedHelp, TEAK and the other moderators maintain that oral sex in all forms is a zero risk activity. Would you agree with this assessment?
I TOTALLY AGREE / DR GARCIA
"HIV is not spread by masturbation, through oral sex, through kissing or other casual contact." Dr. Hook
"The observation on thousands and thousands of observations is that HIV is not spread by oral sex (of any sort)." DR HOOK
"I would not say your risk ,if he had HIV is "slim to none"- that's too high. I would say they are effectively zero. How much of his ejaculate or other genital secretions you may have swallowed makes no difference. EWH "
"As far as HIV is concerned, there is no known risk of getting HIV from performing oral sex on an infected partner, even if that person's genital secretions get into your eyes or if you swallow." Dr.Hook
HIV is not spread by oral sex, giving or receiving, even if sores, gum disease or blood is present
DR HOOK
The fact is that there are no cases in which HIV has been proven to be transmitted by oral sex, including fellatio.. EWH
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