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Safe Sex/Confused/Symptoms/Home Access
Mar 9, 2011

Dr. Bob,

I recently had anal sex where I was the bottom. This was a 1st time experience. A condom was used at all times and put on immediately when my partner got hard. This was a person I met through an on line site. He said he was negative and had tested recently although I am not convinced he was entirely honest about being certain of his status now based on a follow up conversation.

The condom did not break, slip off he remained hard the whole time and he did not ejaculate. I am sure he had pre cum as just before we put the condom on there was a tiny drop. He did have a drop of the precum on his finger which he wiped off and subsequently inserted that finger during sex. We did have sex for 1/2 hour or more in some different ways.

The experience was about 4 weeks ago. About 1.5 weeks later I started getting headaches that have been persistent since. I also have a swollen lymph node behind my right ear which has been small and hard and also enlarged and soft at different times. I thought it was a pimple and have been poking at it not knowing there was a lymph node back there. It has been there for 2 weeks. I have had stomach cramps and some diarrhea but only for a few days. No temperature. I don't seem to have any other swollen lymph nodes but don't know how to really check properly.

I am going to take the Home Access at week 4 in 4 days. I have searched very thoroughly on the site and although there are answers I can't seem to find the ones that will help me be less confused:

1. Other forums say safe sex is safe as long as the condom is used properly as does yours with the qualifier of "properly". I am pretty sure all was done right and don't know how to do it any better or differently, but does pre cum often leak out the back and what is my risk. Does changing positions and removing and reinserting change the definition of a condom being used properly (penis always stayed hard). Does it have to be one continuous act to meet the definition or is their greater risk when you change positions several times. My research here indicates I would not have qualified for PEP.

2. Are my symptoms anything to be concerned about as I am very stressed and anxiety ridden. I know symptoms do not tell a story and testing is the only answer, but it would help to hear what you have to say.

3. Will poking at a lymph node "irritate it" and make it swollen etc.

4. I can't find info on the home access accuracy and testing at 4, 6 or 8 weeks. I know 3 months is the full time, but I need to get some piece of mind on an interim basis. What is the accuracy of a home access test at 4 weeks? 0%, 50% etc. Does the accuracy go up at 6 weeks or 8 weeks etc? know this is not a precise answer but something indicative would help.

I know it does not influence your answers but did want you to know I donate to your charity.

Lastly, should I be worried during this window testing period because I am and as with many here it is making it difficult for me to concentrate and be productive with all the anxiety.

Thanks is advance for your time.

Response from Dr. Frascino

Hi,

1. No, precum does not leak out of a properly used condom. Changing positions (removing and reinserting) does not alter the level of risk as long as the latex condom remains intact and in place. I agree PEP would not be warranted.

2. No. Symptoms are notoriously unreliable in predicting who is and is not HIV infected.

3. Yes.

4. As HIV-antibody testing is not recommended prior to the three-month mark (and not considered conclusive), there are no accuracy statistics! The best I can say is that any negative HIV-antibody test can be considered "encouraging." I can also advise that the vast majority (but not all!) of HIVers will have detectable levels of anti-HIV antibodies in their blood within four to six weeks of primary infection (exposure).

5. Anxiety during the window period is common, particularly when someone has had a significant HIV exposure. You, however, followed all the safer-sex guidelines and consequently you have significantly less to worry about. Based on what you've written, I'm quite confident your definitive three-month HIV test will be negative.

Thank you for your support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's very warmly appreciated. In return I'm sending my good-luck/good-health karma that your conclusive HIV tests will be negative.

Good luck!

Dr. Bob



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