anxiety is winning

[mjd83]

Hey Doc, first of all I'd like to thank you alot for providing this service, I am very grateful.

2 weeks ago I met a 34 year old white female in a bar outside of a military post where I was at for some weekend training( I am an ARNG soldier). To make a long story short she ended up back at my place where talking quickly let to other activities. I ended up penetrating her with no protection briefly before realizing how dangerous this was and putting a halt to it telling her we just can't do this. If I had to guess I would say the exposure time was  somewhere in the ballpark of 10 seconds but no more than 30. She then proceeded to grind on me without penetration for approx. a minute before I even put an end to that. She claims that she didn't have anything and that I had nothing to worry about but I am normally very skeptical about this sort of thing as widespread as STDs and HIV are anymore.

1. She claims she has never done any type of drug, only has slept with 6 ppl in her life (she has 3 children by the way), is presently unattached (after divorces) and is not normally promiscuous. Her job is also working in a hospital lab drawing blood but not a nurse. What would you estimate the risk to be here and do hospitals regularly screen their workers for HIV.? I guess it's the person who doesn't know their hiv status that scares me more than the person who lies about it.

2. On day 7 I developed a lot of mucous/scratchinesss in my throat and fatigue. I noticed the occasional cold chill (though no noticeable sweating or hot feeling) so may have a fever but seems to be low grade with lack of other symptoms. This has persisted (minus fatigue) to now (day13). Sound like ARS?

3. How confident are you in 1 in 1000 as statistical risk of transmission? This sounds very optimistic that out of every 1000 unprotected exposures, 1 will be infected. If possible can you please substantiate?

4. Do i need to be tested? As a military pilot I am regularly screened for HIV.

[Edward W Hook, MD]

This has got to end.  Thus, since you are having trouble bringing this to a close, this will be my last response.  My answers are apparently feeding your anxiety and even if they are not, they do not seem to be helping.  After this response, the thread is over.

1.  Sure.  Many of the symptoms you describe are non-specific and can either be perceived or amplified by anxiety.  For instance, we all have"cold sensations" from time to time.
2.  Yes.
3.  Yes, for your symptoms to be coincidental, even with "perfect" timing is still by far the most likely thing.
4.  Personally, once in over 25 years and that was from a truly high risk exposure, not a low risk exposure such as yours.

Over and out.  EWH

[Edward W Hook, MD]

Sorry hosptial workers are not routinely screened. On the other hand, pregant women are so at the very least she was likely to have been tested when she was last pregnant..  Agian, that 25% that you are concerned about are mostly high risk persons- she is not.  Just doing that math aloone, the odds of her being infected and giving it to you are far less than 1 in 100,000.  EWH

[Edward W Hook, MD]

I think your risk is quite  low and you have little to worry about.  Before I answer your questions, let me briefly review and comment on what I got from your comments.

Your partner was actually low risk, despite the brevity of time that you knew her. I say this because: 6 lifetime sex partners is about average for women in the US, she said she was negative- most people tell the truth, few Americans who are not men who have sex with other men (MSM)  or drug users are HIV infected, you had a single, brief exposure.  The grinding does not increase your risk.  Now on to your questions:

1.  Less than 1% of the population of the US has HIV and that includes groups with higher infection rates such as MSM and drug users.  Her likelihood of infection, probably less than 1 in 1000.   See comments above.
2.  You have probably missed our repeated statements that the symptoms of the ARS are TOTALLY non-specific and when people experience "ARS symptoms" they are much more likely to have something else, usually some other, more typical virus infection.  When this has been studied in the US, less than 1% of persons seeking medical care for "ARS symptoms" are found to have HIV, the remainder having symptoms due to other processes.  In addition, it is also important to realize that many person who acquire HIV do not experience the ARS.  For a person to try to judge their HIV risk based on "ARS symptoms" is a waste of time.
3.  Quite confident.  This figure comes from a compilation of multiple high quality medical studies.
4.  You do not need testing. Your flight physicals ware sufficient.  I will bet you a lot of money that you do not have HIV.  At your next physical you will get another negative test result.  In the meantime, you need not worry.  If you cannot keep from worrying, get tested after about 6 weeks and believe the negative result you will get.

Hope this helps.   EWH

[mjd83]

Hey doc, I will try to make this my very last post if you would please indulge me in just a few more questions. I understand that you consider me very low risk but these well timed symptoms are really bugging me. Here goes

1.) Is it possible for anxiety to directly/indirectly induce some of the  "ARS symptoms" or cause you to perceive symptoms? (say cold chills?)

2.) Can constantly checking and feeling your lymph nodes in your neck, arm and groin actually cause them to swell or be painful?

3.) Here is the heart of the issue and my anxiety. The fact that within 2 weeks (perfect timing) I had a "mucous filled" throat and maybe a low grade fever (unverified) with some fatigue and occasionaly a cold chill seems mighty coincedental to me. Would you maintain that there is still a much greater chance of such a well timed coincidence happening then their is of this actually being ARS?

4.) Last question: How often do you see cases like mine (one time, brief, unprotected exposure) result in a new HIV infection. Is it really considered rare and abnormal?

Thanks, after these questions are answered I promise you I will quit worrying and move on with my life.

[mjd83]

Thank you, your response was so helpful and prompt that I almost feel bad taking up more of your time with one follow up question.

I believe you when you say most ppl don't lie but I've read where 25% of those infected with HIV are ignorant of their status and that only 50% of the population has been tested for HIV. It is the unknowing HIV positive individuals that scare me because it seems they would likely (though innocently) continue putting partners at risk and be able to claim they don't have HIV with a straight conscience. That is why i mentioned the part about her working in a hospital... do hospital workers get regularly screened like us in the military do?  This would really put my mind at ease.

Thanks again and sorry about bringing up my "ARS symptoms". I pretty well knew your response before I posted and only brought that up since it is the symptoms that triggered the anxiety the most. I'll try to push them out of my mind now.