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False Negative on PCR Test? (GLORYHOLE ANAL SEX, 2010)
Nov 18, 2010

Hi Dr. Bob - thanks so much for your terrific site. You are an inspiration to so many. It is an incredible resource.

I recently had an "unexpected" MSM encounter in an adult bookstore. I say "unexpected" because I got onion rings when I thought I had ordered fries. While in a booth and masturbating, I realized there was a guy watching next door. He told me he'd finish the job and jerk me off if I put my penis through the hole. Being unfamiliar with the gloryhole routine and without thinking through the risks involved, I naively complied. Only I didn't feel a hand or even a mouth - but something else, pressure at the tip of my penis, his anus, I assumed, that he was positioning for penetration (though can't be entirely sure, since I didn't see him). Once I felt the pressure/ sensation that was not what I was expecting, I withdrew my penis from the hole immediately (not wanting to have unprotected sex) and left.

Several days later, I had swollen lymph nodes under the jaw, which went away after a few days. In week two, I started having dysuria and some itching at the tip of my penis. I also some anorectal soreness (after bowel movements and sometimes without), a frequent need to urinate, some itching and swelling in my eyes, and these symptoms generally continued through weeks three and four and then subsided. In week five, I noticed a small but swollen inguinal node on my right side that lasted a couple of weeks and now has largely gone away. In week six, I had another swollen node under jaw on the right side for a week (that may have corresponded with a tooth infection - the tooth was also sensitive), followed by the appearance of another large node on my left collar bone that went down after 24 hours, and one large one under my right arm that is still there after four days (I'm now in week 7 post-possible exposure).

So, here is my question. First, from reading your site, it would seem that my exposure risk was somewhat low (no penetration, urethral exposure, and I do not use drugs and have not had sex with men), but I also know thanks to your site that anal secretions have a high viral load and my exposure was very high risk (in terms of setting). Furthermore, the timing of some of the symptoms seem consistent with acute/ primary HIV infection, particularly the general lymphadenopathy and flu-like symptoms.

Second, and even more curious, I had a full STD panel at 28 days. Syphilis, Gonorrhea, Chlamydia, Herpes II (early test), Hep B&C, and HIV I&II anti-body test, all of which came back negative (much to my surprise, especially since the dysuria, etc. seemed consistent with UTI/STDs).

Third, knowing that the anti-body test could bring back a false negative during the window period, I had a PCR test at 37 days, which from what I read should be fairly reliable (after 28 days) to detect the virus directly. Yesterday, I found out it had also come back negative.

So . . . what are your thoughts? Is the PCR in fact reliable, and can you think of any other cause for the symptoms I've described? It would seem long odds to think that these symptoms weren't caused by my ill-advised gloryhole decision, but is there any chance my viral load was somehow suppressed or still below PCR detection at six weeks post-exposure? What else am I missing? What else should I be looking for?

Thanks so much for your thoughts and for all the work you and others do! You guys are incredible.

Response from Dr. Frascino

Hello,

1. I agree your HIV-acquisition risk is exceedingly low.

2. You didn't actually ask a question here. Rather, you just stated your lab results.

3. PCR testing is generally not recommended for routine HIV screening. An HIV-antibody test outside the window period remains the gold standard for HIV-diagnostic testing.

4. Symptoms are notoriously unreliable in predicting who is and is not HIV infected. Your symptoms are not worrisome for HIV acute retroviral syndrome (ARS). Follow up with your general internal medicine doctor for any persistent or worrisome symptoms.

I'll repost below a few similar questions from the archives just to show you that you are not alone in getting "onion rings" while in an adult bookstore.

Dr. Bob

Unconsenting Anal Top Needs PLEASE HELP Oct 3, 2010

I was feeling horny, and stressed (moving across the country this week). I've always been safe. And never had sex with a stranger.

After over two years of only loving my hand, I went to a porn store and thought I would get my rocks off through a glory hole... which btw I've never done. Walking around I saw an older man (late 40's early 50's) go into booths next to two other guys and get them off. He really wasn't my type, but I wasn't going to be seeing him while he was blowing me. So I went for it. He started and stopped a few times. Then was still and I pounded away at what I thought was his mouth. When I cummed, I pulled out and looked down and saw I was in his ass... WITHOUT a condom. I freaked and ran out of the store, across the street to a gas station and bought hydrogen peroxide and covered my penis in it in their bathroom. I am uncircumcised, but used it under the skin and on the opening. I saw no blood, but there was feces.

I assume he had pulled the same trick on the other guys. And their (and who knows who else) loads where up there, and because of already being penetrated he was so loose that I didn't know I was going into an ass.

You've said that the chance of infection of HIV per encounter as the top is 6.5:10,000. I know this should calm me down but it hasn't. I've just passed the 72hr PEP deadline and am freaking out more.

I know I could have gotten other STI's and plan to get checked. I plan to get tested for HIV, I've already marked my calendar for the 45 day test.

SO!!! On a scale of "There is a risk, you should get tested, but you're chances are low you shouldn't worry about it" (one) and "You've most likely got HIV"(10)... where do I stand? How reliable is the 45 day test? I also shot hydrogen peroxide in my urethra when I got home an hour later. It burned, but did this help? Hurt?

Please Answer... I'm so very scared.

Response from Dr. Frascino

Hello,

You shot hydrogen peroxide up your urethra??? OUCHAMAGOUCHA!!! That was not a good idea. Such actions will not abort an HIV infection and in fact might increase the risk, because hydrogen peroxide could irritate the delicate mucous membrane lining the urethra. There is no doubt your glory hole snafu places you at risk for STDs, including HIV. I can't give you a relative risk rating as there are may variables, but I definitely agree you need HIV testing. I would wait until the three-month mark, as HIV-antibody tests taken prior to three months are not considered to be conclusive. Finally, if you can't tell the difference between an ass and a hole in the wall, I'd suggest you forego the wall between you and your paramour!

Good luck.

Dr. Bob

Yet another ridiculous question for you... Sep 19, 2010

So here we go again Dr. Bob. If you're not amused by some of these questions you must be frustrated by now...lol

My question is this...I was at a gloryhole last night and I'm worried that the guy on the other side might have 'slipped it in' without me noticing. Do you think it's possible to be getting a bj, then the guy 'slip it in' and you not notice the difference?

I try to stick to oral because of the reduced risk but I seem to be freaking out for some reason.

Thanks in advance,

Response from Dr. Frascino

Hello,

Welcome back to the forum with another amusing (not frustrating) question! You ask, "Is it possible to be getting a blow job (through a glory hole) and then the guy 'slip it in' and not notice the difference?" Taking your question literally, you asked if I would notice the difference. I can absolutely assure you I would! Those who wouldn't notice probably don't know their ass from a hole in the ground (or wall)!

Relax Max. As always, if you're worried and feel you've placed yourself at risk for HIV, get a single HIV-antibody test at the three-month mark. For future reference, it's definitely easier to keep track of what's happening sexually if you do it without a wall in the way.

Until next time, be well. Keep smiling. Stay safe.

Dr. Bob



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