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How worried should I be?
Mar 5, 2007

Dear Doctor, I am extremely anxious about the possibility of HIV infection. I had an accident with a condom during anal sex (i was passive) exactly 3 weeks ago. The condom came off, but in the throws of lust we just carried on. I felt very sore and as the guy was well endowed i felt a bit torn inside. He came a lot inside me, and later I noticed a tiny smear of blood on the opening of my anus when in the bathroom. (I did not know about PEP at the time). 3 days later I got flu like sypmtoms and sores around my anus, swollen neck glands and a fever that lasted 2 days (the other symptoms carried on for 2 weeks). I have since been to an sti clinic where I was tested and later diagnosed with herpes and chlamidia. I was diagnosed HIV negative at the time of testing (9 days after the sex). I have taken the anti-virral and anti-biotic drugs prescribed and though the signs of herpes on my skin have vanished I still have night sweats and can feel my pulse/heart beat faster 3 weeks on from sex (although part of that is fear and the night sweats are getting better now). Also I feel oddly tired most of the time and quite ill unless I eat lots. Also I feel a salivia build up in my throat but also a dryness unless I have just eaten or had something to drink. Please can you tell me what are the odds of my having contrating HIV, and are my symptoms indicitative of HIV infection? I know that I have to wait, and that I must sound like a hypocondriac but I just don't feel myself and have never in 30 years felt like this. Prior to this incident I had not had sex for 6 months, and unfortunately this guy was a one night stand, and I can't contact him. I feel so stupid now to have carried on without the condom. I have convinced myself that I have probably cotracted HIV but have to wait 4 weeks to re-test. Is ther anything I can do? The health care workers I saw were nice but not too informative. I can't undestand why I still feel ill as I was told that any Herpes "flu like" symptoms should no longer be evident. Can you clue me up a bit please? Many Thanks, Paul.

Response from Dr. Frascino

Hello Paul,

Even a smart guy can become a dumbass when he's getting some for the first time in six months! Six months? Wow, a dry spell like that could make one's pipes rust! OK, back to your problem. So your little head got the better of your larger head and you decided "in the throws of lust to just carry on" after the condom slipped off. Yes, I agree that was an unfortunate safer sex slipup following the slip-off. The estimated per-episode risk for acquiring HIV from unprotected receptive anal sex with a partner confirmed to be HIV positive is 50 per 10,000 exposures. Your estimated statistical risk would be less, as we don't know the status of your well-hung one-night stand.

Symptoms beginning three days after a potential exposure would not likely be related to HIV, as acute retroviral syndrome-related symptoms generally take weeks, not days, to become manifest. Most likely it was the other STDs that you contracted that accounted for your problems.

Regarding your HIV test at nine days, HIV-antibody tests taken prior to three months are not considered to be definitive or conclusive.

Your symptoms of rapid heartbeat, fatigue, dry mouth, etc. are most likely related to anxiety and stress. They are not suggestive of HIV infection. I suggest you see your doctor if you need help controlling your anxiety during the window period while you wait for a definitive test result. As for anything else you can do, I'd suggest stocking up on latex condoms and water-based lubricant and also reviewing the safer sex techniques so that even in the throws of lust, you remember to throw on a condom!

Good luck!

Dr. Bob



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