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what do you know about mechanics?
Jan 20, 2008

Ok that was a misleading title. I'm not talking about manly, oily men in a garage charging you too much to change a spark-plug, but the mechanincs of HIV.

Doctor Robert, you tick so many of my "I want to date you" boxes... Smart, older, handsome, witty, a Dr... the only minus is you talk to a lot of guys on the Internet (I've been burned there before... sigh!)

Anyway, I was wondering if you could read my story and perhaps provide some info for me.

I'm a 24 year gay guy, I've been sexually active since I was about 15 and have made some serious lapses in judgement over the years. When I was a teen I had unprotected anal sex (twice as the top and twice as the bottom) with 4 guys, 2 of which I was in a relationship (not that THAT affords any protection, I know.) Since then I've always had protected anal sex but unprotected oral (I never let a guy ejaculate in my mouth though.) I'll be honest, I've had a LOT of sex with guys from the net. I've suffered frequently from stress and anxiety, which has always made me to scared to take an HIV test, so I just ignored my past and got on with my life.

Recently, I went to a gay sauna and had oral sex with a guy I didn't know, and I remember having pre cum in my mouth. Usually this wouldn't concern me too much, but when I got home I started to eat a bag of chips and noticed that the salt was making the roof of my mouth sting. I realised then, that I'd burned my mouth on some hot pizza the previous night and the roof, near my front teeth, was slightly swollen. I looked at it as best I could in the mirror, and there was no broken skin, no blood, it was just a little swollen.

It brought back all the fears I had tried to ignore about my devil-may-care past and I knew a test was WELL overdue, since it had been 10 years since I had unsafe sex the first time. Eventually, at exactly 11 weeks after the sauna experience, and after taking a dose of valium enough to knock out a horse, I went for an ELISA HIV test. I think it was perhaps the hardest thing I've had to do in my life. thankfully, perhaps miraculously, the result came back negative. I guess I really dodged some bullets in my past!!! (I'd still like to go back in time and give the younger me a good slap for causing older me so much stress!)

I wasn't aware of the "window period" at the time, or I would probably have waited another 7 days, but now I wonder if I should take another test. I was told that my recent exposure posed a near zero risk, and that all infections attributed to oral sex had been the result of a "significant route of infection", such as deep, bleeding cuts or recent dental surgery, and those people had ejaculate in their mouths. They also told me that the chances I would seroconvert in the last few days of the window period was very unlikely and therefore I didn't need another test.

I would be completely confident with my chances of being negative, were it not for the fact that I've had a painful node in my groin for the last few months. It's now been around 5 months since the sauna-boy incident. The node isn't constantly painful, sometimes it doesn't hurt at all, and to be honest I didn't know it existed until I read online about them, but occasionally it aches. I'm also aware of a slight aching sensation in my armpits sometimes, and perhaps near my elbows, although there are no lumps there. I'm not sure if it's just Mr hypochondriac paying a visit.

Is there any solid information about the mechanisms by which HIV is transmitted orally? Does there have to be a direct route to the bloodstream, or can it somehow get through the cell wall? Were they right in saying that I don't need another test?

Sorry about the essay. I've lived with a lot of these fears for 10 years now. They're pretty ingrained and it would be nice to be able to let go!

Many Thanks

J

Response from Dr. Frascino

Hello J,

I'm very worried about you. No, not because of HIV, you silly goose. I'm worried about your junk food diet. Pizza one night and chips the next? So what's on the menu for tomorrow night, s'mores???

OK on to your questions:

1. Is there any solid information about the mechanisms of oral-HIV transmission? Sure! Lots! HIV can permeate directly across intact mucous membranes (like those in the mouth, urethra and vagina). Cuts or wounds are not necessary! However, I should mention that saliva does contain compounds that can inhibit HIV, thereby decreasing oral HIV transmission somewhat.

2. Were they right in saying you don't need another test? I would agree with the recommendation. However, if you continue to worry and perseverate on the possibility of being HIV infected, go ahead and get a single rapid HIV test at the full three-month mark. The results will undoubtedly be negative and should put any residual fears permanently to rest.

Finally, as for my one "minus" trait of talking to guys on the Internet, well, I'm talking to you via the Internet, aren't I??? So what time are you picking me up, where are we going, do you look like the pics in your online profile and are your "inches" real inches or manhunt/gay.com inches??

Be well.

Dr. Bob



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