|Big weenie guy once again (6 WEEKS VS 3 MONTHS VS 6 MONTHS, 2009)
May 26, 2009
Dr.Bob, hope you remember me. I have a 2 questions for you. 1. I had protected sex with a retired transexual porn actress. Came to find out she also escorts. I don't know if condom broke or not but I did test at 45 days, test came back negative. I have read that New York and State Of Mass have adopted the 6 week test as conclusive. What do you think about this? My next question is this. I had sex with a transexual model who I also found out escorts. Condom was used and this time I did check it, not broken. The only thing is there was blood everywhere. When I washed up I accidently wiped my penis head and under my penis head with the same paper towel that had blood on it. The blood was then on my foreskin and under my penis head, not sure if I actually got the blood on me, but I did rub it all over my penis head. About a month later after this I started getting diarrhea, nausea, cough and I did vomit. I still feel sick after a week of coming down with this. Any risk from that? I'm nervous as hell. Your answer is deeply appreciated. I have sent several donations already and still will. Thanks Dr.Stud
| Response from Dr. Frascino
Welcome back to the forum. I'll bet you think that putting "Big Weenie" in the title of your post would make it more likely that I would respond, right? Well, as you can see, your thinly veiled strategy actually worked.
Were you actually surprised to discover that a retried transsexual porn actress and a transsexual model turned out to be escorts? It seems to me all one would need is a keen sense of the obvious to come to such a conclusion.
Regarding your trannyshacking sexcapade #1, assuming you used a latex (or polyurethane) condom properly and it did not break, your HIV-acquisition risk would be essentially nonexistent. A negative test at 45 days is extremely encouraging but not yet definitive based on the U.S. testing guidelines. Yes, I'm aware of the New York State and Massachusetts guidelines; however, these have not yet been universally (or even nationally) accepted. Also, the specific type of HIV-screening test performed at various locations around the country (and the world) varies considerably. For the time being I continue to support the national guidelines. (See below.)
Turning now to trannyshack sexperience #2, if fresh blood came into contact with your foreskin and/or urethra (pee hole), HIV testing would be warranted at the three-month mark. Symptoms, as your previous experience should have taught you (see below), are notoriously unreliable. The only reason to worry about HIV or to consider HIV testing is HIV-exposure risk!
Thanks for your post and continuing support of the Robert James Frascino AIDS Foundation (www.concertedeffort.org). In return I'm sending you my good-luck karma that your definitive three-month HIV test is negative.
Good luck. Be well.
if Dr. Bob was French... ? (SIX WEEKS VERSUS THREE MONTH HIV TESTS) Feb 10, 2009
suppose for a minute you were French - or just being in doctor in France. The authorities there consider an Antibody/Antigen test conclusive at 6 weeks. (For standard Ab tests, they say 3 months, like CDC). Ok. Now, someone asks you in this forum, is a 6-week Ab/Ag test conclusive? Do you still reply that only a 3-month test is conclusive?
(My exposure: wild making out with another guy - but no penetration of any kind (neither oral nor anal). We did however deep kissed and tight embracing while naked, in the possible presence of cuts on our bodies. Got an 8-week negative Ab/Ag test).
Would French Dr.Bob advise me to retest? What about the real Dr.Bob?!
Thank you. You're an awesome person.
Response from Dr. Frascino
Bonjour Monsieur Dan!
Je parle la langue de Molière. Alors, peut-être je suis français !!!??
My job as "Dr. Bob," whether French, Italian or Zimbabwean, is to provide science-based factual information. I'm really not here to criticize or support one set of guidelines versus another. Also, guidelines are only that: "guide"-lines. They are not absolutes. For instance, if someone decides to calculate three months as 90 days (3 months x 30 days) rather than 84 days (7 days x 12 weeks), does that make his method more accurate or definitive than the other? And of course if someone is comfortable with an 84-day test result, what about a negative test at 83 days? If I were to say 83 days is fine, then someone would write in immediately and ask about 82.5 days, etc., etc., etc.
That was a longwinded introduction to a specific answer to your question. I don't make the guidelines and I have no reason to criticize the French guidelines. Obviously those who devised and approved these guidelines have sufficient data using their specific type of combination HIV-antibody plus HIV p24 antigen tests to support their recommendations. One of the reasons I cannot/do not generalize this recommendation is that all the eyeballs currently reading this response do not reside in France. HIV testing is not exactly the same worldwide. The availability of different generations of HIV tests varies considerably from place to place. So if you and I were both in Paris, I would advise if the French guidelines suggest a six-week "test" is conclusive, then a six-week test is conclusive; however, I would also advise many other published guidelines recommend a three month test for a definitive result. I would then review the level of HIV risk and make a recommendation for the specific situation. The patient, of course, always has the option to retest at three months or six months (old guidelines), if he so desires. That said, if you showed up in my office in Paris, San Francisco or Zimbabwe with a risk of "wild making out with another guy but with no penetration of any kind . . ." I would advise "A l'aise Blaise," (in Paris) "Relax Max" (in San Francisco) or "whatever relax is in Ndebele, the language of Zimbabwe" (in Chitungwiza), your HIV risk is nonexistent and HIV testing of any type is not warranted medically. The only reason to consider testing is a psychological one: to put your unwarranted HIV fears permanently to rest.
Hope that helps.
Ever retracted a WOO HOO? UK HIV advisor (3 MONTHS VERSUS 6 MONTHS) May 2, 2009
I have noticed a bit of an anomaly in the window period advice you give different people. The way I read some of your recent answers is that a 12 week test is 'no way, no how' conclusive if you're not aware that your sleeping partner has HIV. But if he/she does have HIV you always write 'the CDC recommends a follow up at 6 months'. So what of those people who write to you unaware of their partner's status and are given a WOO HOO, then maybe find out a day later that they did in fact have HIV? Is the WOO HOO retracted? Is there any reason you would give them the absolute all clear if you thought that there was any way seroconversion could take up to six months? After all, you have advised in the past that we must all assume our partners are HIV postive, yet your responses don't assume this unless you are told by the questioner that their partner has HIV. As British HIV trust telephone advisors, myself and my colleagues continually field calls from worried people asking about the 'American 6 months window period' which they read about on the net, and immediately freak out about. We are trained to reply that 3 months is absolutely conclusive irrespective of whether the partner is confirmed to be HIV positive; provided a recent generation of test was taken. This is backed up by the observation that in over 12 years of the application of the 3 month rule in the UK and Europe, not once has it been shown to have failed. You have been asked about the 3 month rule in the UK before and replied: 'The CDC is a branch of the U.S. Government. Look at who we currently have at the helm. Do I need to say more? No, I thought not.
BRAVO to the UK HIV guidelines folks for their clear and concise statement. I wholeheartedly agree!
Yet your advice of a 6 month follow up does not 'wholeheartedly agree' with how we are trained to advise callers at all!
Ps apart from the occasional 6 month recommedations you give, which I suspect may be for CYA reasons, I think you do an absolutely fantastic job, and I have learned so much from reading your advice.
Response from Dr. Frascino
Hi British HIV Trust Telephone Advisors,
I receive a number of questions on a nearly continual basis asking for an absolute black-and-white answer to this perennially confusing and often anxiety-provoking question. Unfortunately, like many things in the field of medicine (as in life) the truth has a grayish tinge. I certainly do not fault your guidelines or the consistent message you give to your British callers and I stand by previous statements about those guidelines. Just as I will stand by my statements concerning the eight-week cutoff guideline established in parts of Australia. (See below.) Have you received letters from the former penal colony (Oz) asking why you stick to three months while their data suggest eight weeks is definitive?? How are you going to reply to them when they do begin questioning you (if they haven't already)? I suppose you could state "that's what we are taught". Or you might quote a set of British guidelines that states three months is definitive. But that doesn't really answer the question, right?
Returning to your question I should point out your callers are primarily British citizens and you add the qualifying statement that three months is definitive "provided a recent generation of (the) test was taken." Your response is also going to one person and not the entire cyber universe. Approximately 1.5 million folks read my comments every month. Some of them may not have access to the latest generation of HIV tests. Many of them and presumably at least some of your callers may not know if the test they took was a "recent generation." Would a second generation test in Africa qualify?
It's also important to point out the immune system is not a calendar or a stopwatch. It doesn't tell time or count days. Immune integrity and the robustness of a specific immune response vary considerably from person to person for a whole host of reasons. Add to that variability in viral strains and you may begin to understand the black-and-white model is too inflexible to cover all contingencies when dealing with a worldwide audience.
The potential problem with setting a strict timeframe for a definitive result is that you might miss an infection in someone who takes a bit longer to seroconvert due to some type of extenuating circumstance not immediately identifiable in a format such as a question submitted over the Internet. The consequences of missing a true infection can, of course, be catastrophic. The consequences of someone getting an additional (perhaps unwarranted) test at six months are inconvenience and additional cost. The reason I stipulate that the CDC recommends an additional follow-up test at the six-month mark for individuals who have had a significant exposure to someone confirmed to be HIV positive is that it is exactly what their current guidelines recommend. However, for the extremely common worried-well questioner ("grandma farted in her Barcalounger, could I catch AIDS?") certainly a test at three months is more than sufficient. Testing these folks out to six months is a waste of resources. Many of them, of course, don't need any testing but until they see their negative results they are absolute basket cases. Similarly all the folks who have a paper cut and touched a stripper while cheating on their wife or jacked off a closeted gay Republican in an airport restroom on their way to Bible class demand some type of closure that their minimal to nonexistent exposure isn't going to kill them (often their guilt is the real problem). And although my comments may appear at first glance to be contradictory, in essence they are not. I give my personal opinion based on facts established in large epidemiological studies and also include the CDC's current stance on special circumstances where the potential risk is theoretically somewhat higher (confirmed significant exposure). This six-month recommendation also applies to occupational exposures in healthcare settings.
The important thing to remember here is that because the actual amount of virus circulating in the blood is relatively small, we are not measuring it directly but rather indirectly by assaying for anti-HIV antibodies. These are the immune system's response to being invaded by HIV. It's a more complex concept than most questioners (or even HIV counselors) realize. It would be much easier for me to ascertain the true level of risk and validity of a test result if I had the patient in my office where I could ask questions and see exactly what test assay was performed. Unfortunately that is not the case. Consequently I choose my words carefully and attempt to give the wisest answer to an individual that also won't be misinterpreted by the millions of worried eyeballs scanning for information to apply to their own unique situation.
I hope that helps settle the confusion. Maybe not. But that's my story and I'm sticking to it (at last for now).
Take good care mates and keep up the great work across the pond.
AltaMed Conflicting (3 MONTHS VS 6 MONTHS, 2009) Mar 14, 2009
I recently spoke to 2 altamed hiv counselors, and they both said 6 months is the appropriate time to have a test done. They use OraQuick Advance.
I remember going in the summer time, and they said 3 months. Did standards change recently for that specific test?
I also read a post that you said "An extremely small number of people who are HIV infected will have negative OraQuick Advance test results." Then in another post you said "The OraQuick Advance rapid tests (oral fluid and finger prick) are very accurate."
I'm just a bit confused with that, as well as the window period of being 3 months or 6?
Donation will be sent to The Robert James Franscino AIDS Foundation!! Thanks for your help, you're amazing :)
Response from Dr. Frascino
I realize this topic can be quite confusing. Here's what we know. The majority HIV-infected folks will have detectable levels of anti-HIV antibodies their blood (therefore will test HIV positive) within two to eight weeks after primary HIV infection. Large epidemiological studies have shown at least 97% test positive within three months and virtually 100% within six months. Since these observational studies were done, there have been improvements in the HIV testing techniques, such that many guidelines now consider a negative HIV-antibody test at three months to be "conclusive". Certainly the option of retesting at six months remains open to all and is even recommended in some situations (occupational exposure, for example). I'll reprint some information from the archives that addresses this topic. See below.
the 3 month mark (3 MONTHS VS. 6 MONTHS) Mar 5, 2008
Hello DR...I get mixed answers to my question and was hoping you could help. Is the definitive mark 3 months after possible exposure to get tested or six months? Thanks in advance
Response from Dr. Frascino
I know this seems like a straightforward question, but the answer unfortunately is not always quite so straightforward. See below.
HIV Testing (3 MONTHS VS, 6 MONTHS TESTING ) Jan 17, 2007
Hello to my favorite doctor in the world,
I have a question about HIV testing. In a couple recent posts, such as the one titled "Just Diagnosed - Partner at Risk," you recommended testing at 3 and 6 months.
In most of the other posts, however, you state that a test a 3 months is considered conclusive.
If a test at 3 months is indeed conclusive, shouldn't it be so for everybody, regardless of the situation?
I am sure that you have a good reason for these recommendations. I am just hoping that you will help me to understand it.
Thank you Dr. Bob
Response from Dr. Frascino
This is really a QTND (question that never ideas) and as such has an ATNC (answer that never changes). I'll reprint a post from the archives that addresses your concern.
Again with the 3/6 Months Dec 15, 2006
Dr. Bob -
I have found that although I tested negative at the 3-month mark, my anxiety is creeping back. Part of that for me is the on-and-off diarrhea that I am experiencing; my other "symptoms" have all resolved.
So, I just read your response to the guy who had 4 unprotected encounters and your wishing him well at his 6-month test; this was the first I've ever heard you put so much emphasis on the 6-month follow-up.
My activity was low- risk (receptive oral/no ejac. and frottage), but I'm thinkin', "Hey, Dr. Bob's backing off on his 3-month woo-hoos." It seems to me that either the 3-month test is conclusive or it's not, regardless of the activity that preceded it. Participating in risky activity should not affect whether one is a late seroconverter or not. Reminds me of the term "fuzzy math."
Response from Dr. Frascino
Hello Freaking-Again Mike,
My opinion on testing has not changed, nor is it as black and white as you might have imagined. I'll repost a question from the archives that's several years old that hopefully will clear up any confusion and show you my opinion really hasn't changed.
Regarding your situation, I would consider your negative three-month test definitive and conclusive, OK?
Stop worrying. Return to WOO-HOOing.
Window Period Sep 6, 2006
Dear Dr. Frascino: I just recently made a contribution to your foundation. The only reason I mention it, is to encourage others to do so. Your work on this site and elsewhere is greatly appreciated and should be recognized.
My question is regarding window periods. I had an incident in April that put me at risk for HIV (relatively low). I was tested at three weeks, six weeks, and again after 16 weeks. Why is it that some people reccommend a definitive test after three months and others suggest that you need to wait for six months. Is my test at 4 months conclusive or should I go again at six months.
Also, what is the difference between the blood tests I got the first two times from my doctor, and the oral test I received at a clinic after 16 weeks (I couldn't wait for the blood test to come back, the 20 minute window helped my peace of mind).
Response from Dr. Frascino
Thanks for your donation! (www.concertedeffort.org)
The three-month versus six-month question is definitely a QTND (question that never dies). I have tried to explain this conundrum many times in the past; however, I do realize it continues to be a source of confusion and worry for folks. I'll reprint just one of my attempts at explaining the rationale for the three-month window period below. If you're an avid forum reader, you might have noticed the current controversy has now been focusing on six weeks versus three months! You can catch up on that discussion in the archives, if you're interested.
Regarding the differences between tests, again this has been addressed many times in the archives. Have a look. The FDA-approved rapid tests are both accurate and reliable. We use them at the Frascino Medical Group (650-917-1357) on a daily basis.
Congratulations on your negative 16-week test. It is definitive, conclusive and WOO-HOO-able.
Robert James, this is your Mother talking Jul 26, 2004 okay so I am not your mother, but I do need some advice. You have said over and over if you think you were exposed test at 3 months, but you also say if you know you were exposed test to 6 months??? What gives? Don't quote the CDC. I want you to be straight with me, (there is a joke in there) Why are you not consistent? 3 months if I think and 6 months if I know! What is your opinion? I have had the works when it comes to symptoms and was diagnosed for 1 STD, all are gone except for the PN. This after a 1 time insertive exposure with a female who I fear has HIV. I had a neg elisa at 5 months. Do I need another test or not? And why the 3 or 6 months answers? P.S. and don't be straight the world loves you the way you are!
Response from Dr. Frascino
Hello Not My Mother, I do realize this issue is more than a bit confusing, so let me try once again to explain the rationale behind our advice. The question seems simple enough: three months or six months for a definitive result. The answer, however, is far from "straight" forward. The confusion results from variability in the immune response (time to produce anti-HIV antibodies) which is different from person to person, limitations in the test's sensitivity and specificity (ability of the test to pick up all true positives or eliminate all true negatives), and clinical judgment. In addition, there are special circumstances where our general recommendations for testing might not be applicable. For instance, when folks are simultaneous exposed to hepatitis C and HIV or when folks have previously received experimental HIV vaccines, consultation with an HIV specialist is often required to provide guidance on when to test and how to interpret the test results. Added to his are many very anxious folks who are absolutely certain they have contracted HIV, but in reality, have no identifiable risk. You know the type: "Grandma farted while trying to get out of her Barco-lounger chair. It smelled worse than usual. Now I'm convinced I've got AIDS." Of course, these folks require basic HIV prevention counseling and education, not HIV testing. But that doesn't stop them from getting tested "just to be sure," etc. So what would the answer be to these folks' "three months versus six months" question? In reality, neither, since they didn't need testing in the first place. And what about folks with some degree of potential ongoing exposure? How do we monitor their HIV status? So you can see this is not as straight forward as you might originally think. OK, back to your questions. The best I can do is take all the information provided to me from an individual questioner, apply the information concerning the limitations of HIV testing, the results of large-scale epidemiological studies, and the scientific facts pertaining to how HIV is transmitted, and then give the questioner my expert opinion and advice. Whether that person chooses to accept my advice or follow my recommendations is, of course, totally up to him or her. The reason I quote the CDC's published guidelines is that they are perhaps the most conservative set of published and well-referenced recommendations I have seen. So what can I, in good conscience and backed by science, advise? I can say that following a single possible or known exposure, the vast majority of infected persons will develop detectable HIV antibodies within three months of exposure. If the initial negative HIV test was performed within the first three months after exposure, repeat testing should be done at three or more months to rule out the possibility of a false-negative result within the window period. If the ELISA test is negative at three months or more after an exposure, the individual is extremely likely to be HIV negative. This is all based on statistical risk analysis and large-scale epidemiological studies. Now comes the confusing part. If a person was significantly exposed to a known HIV-infected person, the estimated statistical risks change and a second repeat test "might" be considered at six months or more from the exposure depending on the circumstances. And yes, there are very rare reports of seroconversion 6-12 months after a known exposure. The exact details of these very rare historical cases are a bit sketchy, but the reports do indeed exist in the medical literature. Today, however, extended follow-up testing beyond six months after exposure to rule out the extremely rare possibility of delayed seroconversion is not recommended, except under exceedingly rare circumstances that should be based on the clinical judgment of an HIV specialist. I realize some folks may find this response unsatisfying and perhaps unsettling. However, I'm here to provide you with the best confirmed scientific knowledge that we have, and that's the extent of our knowledge at this time. I'm also here to provide you with an expert opinion about that science. So let's proceed "straight ahead" (or should that be "gaily forward?") to your question. I would consider a negative ELISA test at five months following a "1 time insertive exposure with a female" of unknown HIV status to be definitive. I would not recommend additional testing. However, as always, the choice to follow my advice or not is totally up to you, whether you are my mother or not.
Big Weenie guy again Mar 20, 2008
HI BOB... I just called my for my home access test results. I know it wasn't six months but I took the the test at five months, results were negative... Can I celebrate? or do I have to wait one more month. My exposure was real... Topped an hiv positive tranny with broken condom. I just want to feel better.
I got my sisters to donate to your charity and other HIV charities instead of our usual charities.I want to do all I can to help with this. Volunteer or whatever it takes. I will donate on a monthly basis $20. I know it's not much but the way I see it if 20,000 of us give $20 a month thats quite a large amount. I wish you the best with your health and relationship. You are one a kind you're partner is lucky to have you. I know you are lucky to have him too because of the way you talk about him. Thank you sir and I will continue to have safe sex always. NO matter how horny I am. Your message wont be lost on me. Big hugs from me and my sisters.
Response from Dr. Frascino
Hi Big-Weenie Guy,
Welcome back to the forum. (Big Weenies are always welcome here.) A negative Home Access at five months is extremely, extremely encouraging, but not quite "WOO-HOOable," based on current U.S. testing guidelines. (However it may be worth noting that if you lived in Australia, the guidelines there would advise you are definitively negative.) There is no doubt that the vast majority of those infected with HIV will have detectable levels of anti-HIV antibodies in their blood by four to six weeks. Extremely rarely, seroconversion is delayed out to beyond three months. Improved testing techniques are allowing us to pick up anti-HIV antibodies earlier. However, the guidelines are the guidelines and the U.S. guidelines have not been revised for quite some time. So if you want to be U. S. guideline-certified WOO-HOOable, you'll need to get one additional test at the six-month mark. Can you celebrate now? Sure, I'm quite confident your definitive six-month test will remain negative. So buy the champagne, put it in the ice bucket and start practicing your WOO-HOO yell. Keep the bubbly and your celebratory yell on ice for just a few more weeks, but rest assured you'll be popping that cork and screaming WOO-HOO like a banshee in heat very soon, OK?
Thank you (and your sister) for their donations to the Robert James Frascino AIDS Foundation. Wow, if the foundation received $20 per month from 20,000 of you, we could indeed work miracles!
I'm sending you my very best good-luck/good-health karma. (It's never failed yet!)
Big weenie guy again. Feb 10, 2008
Thank you Doctor for your response. Made my wait a little easier. I just wanted to add other physical symptoms I had during my first 2 to 7 weeks after exposure. I had severe dandruff and dry itchy skin everywhere. My skin was flaky and I even got a flaky dry looking rash on my arm near my shoulder, it was the size of a quarter. Muscle twitching all over and I even had a blood blister looking thing in my mouth which disappeared the next day.Ear ache also. My stress, anxiety and depression were awfully high during those weeks. I never had these things happen to me in my life. Adding these symptoms do you still stand on your first comment about it not being worried some of ARS? Can my stress and depression make me have sudden physical symptoms like these. Skin changes and joint pain that I never had before. Don't worry Doc I will get tested soon so please don't sugar coat your response. I'd like to apologize for the morons that write to you and come out saying insensitive stuff like, I will kill myself if I have HIV. They don't know any better sir. You are one of a kind and I hope you live a long life and keep giving hope and advice to everyone. Keep on smiling...
Response from Dr. Frascino
Hi Big Weenie Guy,
I stand by my initial comments, with or without sugar coating.
My big weenie got me in trouble...I think Feb 1, 2008
I wont start by kissing your ass. You already know how cool you are. This will be my third time I submit this to you, hopefully third time is the charm. About two and half months ago I had insertive anal sex with a hiv positive tranny. I did use the condom but when I finished the condom had a hole right about where my crown starts. Dont know if my urethra was exposed but the hole was close to it. I didn't know his status until like one week after. My symptoms started about 2 weeks after. It all started with several bumps on my butt that itched I think. Followed by joint pain and stiff neck for about 5 days. Never in my life haave I ever had joint paint so this one scares me. I didn't have a fever at all. I had about one or two nights of sweating. When these pains went away I developed an itchy throat. Slight cough came with it. I had nasal congestion and runny nose too. This lasted about one week . After I got over this I started getting headaches for about 4 days. They were in the back of my head. Again no fever at all during these symptoms. When my headaches went away I noticed mouth ulcers, about two. I don't think I ever had a rash through all this but I did have folliculitis. I still do actually. I had several bumps on my arms that itched really bad. They look like goosebumps but itch.Don't think I had swollen lymph nodes either. I did have pains in my armpits and in my abs. About two days of diarrhea. Never had fever. I know symptoms are not a way to tell if I was infected by this person. Just want to know if this sounds like ARS? I don't know if I saw any blood but I was drunk so I can't say. Does having a big member increase my risk. I am not huge but I am big. I model for a living so my looks are kind of important. I hope to hear something from you before I go test. I will get my 3 month test in about two to three weeks. I have not tested yet at all. I didn't even know of PEP before this. Thank you kind sir. Looking forward to your response Doc. A donation will come soon. Hope that you live many more years of happiness with your man. One of your biggest fans saying thanks y sigue tenendio ese sexo tan bueno de que tanto hablas.
Response from Dr. Frascino
Hi Big Weenie Guy,
Say, you wouldn't happen to be the 2xist underwear hottie, would you? Or perhaps one of those amazing "International Male" catalogue guys??? (The catalogue that everyone gets, but from which no one would every purchase anything. Great looking models, but anyone else wearing those fashions would have to be gay enough to bottom for Liberace.) OK, back to your question. Insertive anal sex with a positive tranny and broken condom does put you at some degree of risk for STDs, including HIV. The array of symptoms you describe ("several bumps on my butt that itched I think," etc.) are not worrisome for HIV ARS (acute retroviral syndrome). However, because the condom failed, HIV testing is definitely warranted. Symptoms in and of themselves are notoriously unreliable in determining who is and is not HIV infected. The reason to worry and/or test is HIV risk. Your broken-condom, poz-tranny, backdoor-action sexcapade does have risk associated with it, so testing is certainly recommended.
Does having a big member increase your risk? Well, would that be big as in "big as a beer can" or big as in "needs its own zip code?" Having an Italian-sized salami may certainly increase your odds of getting laid, but it does not increase your odds of getting HIV relative to those of your average small-dicked Republican.
Thank you for your donation to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). In return I'm sending you my best good-luck/good-health karma that your definitive HIV tests are negative. Also you might want to try Magnum condoms in the gold foil wrap. They're made for Italians and those with Italian-sized equipment.
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