pregnancy , HIV fear and nightmare in kuwait

Question

Hello Dr. Bob,

First off, a huge thankyou for your work and inspriational committment to life! I'll try to be brief. My name is Majid, 32 yrs old, living in Kuwait. I'm a Kuwaiti and my wife, who I love very much, is Italian. We've been married 3 years and I've been faithful throughout. But six weeks ago, on a business trip to Stockholm I got horribly drunk in a bar, and ended up having unprotected vaginal intercourse with a woman who I'd never met before- or since. After intercourse I realised there was menstrual blood on the sheets. I got back, felt notedly rough for a few days- pain in my lower back, kidney region, burning sensation when passing water, something like a bruised feeling on the side of my chest and arms, diorrehea- and put it down to overnight flights and general exhaustion. Stupidly, I had unprotected intercourse with my wife during this time- we had been apart for some time and were trying for a baby.

During that first week, I got myself checked out by a urologist who told me I had strains of Streptochoccus and gave me Antibiotics. My wife did a urtheral swab and nothing was found so I went on anti-biotics for a week and that was that. A week later, my wife and I had intercourse again.

One week later and since then - to my terror- I've been having all the symptoms of sero-conversion sickness that I can find on the internet. Swollen lymph glands (groin and armpits only), extreme fatigue, dizziness, and coming up now for a month of diorehheaa.

Two weeks ago, my wife found out she was pregnant with what we hope will be our first child. The concoction of joy and fear that filled me on that day has gradually- as my symptoms persist- turned into days and nights of unmitigated horror. My sense of guilt and fear are driving me insane. I've abstained from all sexual contact with my wife since my symptoms began- too late, one might say. I know. I know. I did an HIV antibody test at 3.5 weeks and result was negative. I've been to lymph doctors about the swelling and they bat me off with platitudes- no doctor I've seen in this country takes my fears seriously even when I present them with my history and they all tell me its stress etc. As my wife enters her 5th week of pregnancy, she's begun suffering from nausea and fatigue which I have hoped to be pregnancy related. But for two days now she has diaorhhea also! I can no longer bare to sit at a table with my wife without breaking out in a cold guilt and fear-ridden sweat. I can speak to no one here- specialist or layman- about my anxiety- it's all too tabboo. There are no viral load tests in this country, and it seems, nothing I can do, but sit and wait for this nightmare to unfold. Finally, I should add that i have mentioned nothing to my wife about my symptoms or my encounter in Stockholm for fear of what it would do to our marriage and in the hope that- perhaps- I am not infected with HIV. If, somehow, I am not HIV +, Ill have learnt a stiff lesson. For life.

My questions are related to the worst case scenario: 1). Let's say I am infected, let's also say I infected my wife, let's say that her symptoms are not pregnancy related and that in fact she is sero-converting now. Is there any medication that can help her at this stage? If so what is it? 2). Is there any medication that should be taken now to try to prevent the HIV from infecting the foetus?

Your answer to these questions will decide whether I tell my wife everything now and face the consequences, rather than wait till I can do another ELISA test at 12 weeks and see what is in store for me and my family then. I know there are thousands of people out there sharing similar fear and I don't want your time from others more in need, but the sooner you can answer me the sooner some relief will come into these, my darkest days. I'm sending your foundation a contribution whether you are able to respond or not. What you do is really important.

Thanks and keep well, Yours, Majid- Kuwait

Oh, one more thing: Can someone call the Disease Control Hotline from outside the US?

Answer

Hello Majid,

It is true that unprotected sex does place you at risk for STDs, including HIV, and that you'll need appropriate HIV testing to definitively confirm your HIV-negative status. It's also worth pointing out the statistical odds remain very much in your favor that you did not contract HIV from this single episode of unprotected insertive vaginal sex with a woman of unknown HIV status, even with "menstrual blood on the sheets."

Your "terror" appears to be related to developing "all the symptoms of seroconversion that I find on the internet." Most likely these "symptoms" are psychologically induced by your guilt and fear, not true HIV. Why would you believe that symptoms "found" on Internet are threatening your health, but not believe the physicians who have actually evaluated your problems?

I believe you may well be correct in identifying your problem when you write: "No doctor I've seen in this country takes my fears seriously." That's the problem your fears! The physicians should indeed "take your fears seriously" and offer you help confronting those very real fears and your anxiety.

Undoubtedly guilt is the main problem ("I can no longer bear to sit at a table with my wife without breaking out in a cold guilt and fear-ridden sweat.") Waiting for the "nightmare to unfold" is not really a desirable option. I suggest you confront your guilt by leveling with your wife. It won't be easy, but it really is the best way to begin coping with your fears and anxiety. We all make mistakes. Admitting those mistakes, accepting the consequences of our actions and learning from our mistakes are all part of being human.

To answer your specific questions:

  1. Your wife should not consider HIV meds without confirmation that she is HIV positive, and even then, only under the care of an HIV specialist familiar with treating HIV-positive pregnant women.

  2. Medications are available to decrease the risk of mother-to-fetus HIV transmission; however, they should only be considered if your wife is confirmed to be HIV positive.

Finally, what to do? First, you should level with your wife. If you have trouble finding the words to do so, why not show her this post and my response? Your love for her and concern for her health and that of your future family comes shining through in your comments.

Next, because of your wife's pregnancy and your deteriorating mental condition, a definitive determination of your (and her) HIV status needs to be made as soon as possible. My understanding is that viral load tests are available, albeit expensive, in Kuwait. In general, PCR testing is not warranted for routine HIV screening; however, quantitative HIV RNA is useful for diagnosing acute HIV infection. The sensitivity of the test approaches 100% with true acute HIV infection. The specificity of the test is 97%, but approaches 100% if the viral load is greater than 10,000, which would be likely if indeed you or your wife were seroconverting which I strongly doubt, by the way. The statistical probabilities would all be in your favor for not being infected. Either way, counseling may well be helpful for you as you confront your guilt and fears.

Whether you've learned a "stiff lesson for life" or a "life lesson about being stiff", you still need to confront your current situation to bring the sunshine back into your "darkest days."

Thank you for your contribution. I'm sending you and your wife my very best karma for health and happiness as you prepare to welcome a new life into this wonderful world.

Good luck.

Dr. Bob