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Brief encounter - unprotected insertive anal
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sweetfunkystuff posted:
Hey, y'all.
On April 1st, in the heat of the moment, I inserted about two inches of my penis into the anus of a man of unkown status. In less than five seconds, my senses caught up with me, and I got the heck out of there. Nothing else happened, and there was no thrusting (apart from what was required to enter him) and no ejaculation. Also, there were no cuts or sores on my penis. I cannot speak to the condition of his anus or rectum, i.e., whether he was bleeding inside or whether he still had sperm inside from a possible previous encounter the same evening.
I wasn't too concerned until exactly one week post-incident, when I began to feel ill—muscle/joint aches, a couple of bouts of diarrhea, a swollen lymph node on the right side of my neck, slight fatigue, and some unattributable sweating (I have no thermometer, so I couldn't take my temperature), all of which was staggered and which lasted 2-3 days. Now, here it is, 3.5 weeks post-incident, and I'm experiencing lingering joint/muscle pain (fingers, wrists, knees, calves, and ankles—and in my feet, too), and just today I started experiencing pain in my upper arms and underneath my left underarm, and in my thigh, close to the groin area. (No, as far as I can tell, no lymph nodes are swollen.) I am also experiencing some minor nasal congestion (enough that I have to go up there and clear things out from time to time). As you might imagine, I am very, very concerned, especially with this latest talk about anal secretions and how they contain more HIV than blood and semen.
I have already been told that while this was indeed a risk for acquisition of HIV, it was a diminished risk since the insertion was brief and shallow, and that the odds of testing negative are in my favor. Of course, however, diminished risk doesn't equal no risk, and to my knowledge, no studies have been conducted that take depth of penetration and length of time into account. And, again, there is the fact that I haven't been feeling well these past couple of weeks.
I know that it's impossible to diagnose HIV from symptoms, and of course I'll get tested in a few weeks, but I'd still very much appreciate your input. Could what I've described be symptomatic of HIV infection? And what do you think of my risk for HIV acquisition?
Thank you very much.
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Nieciedo responded:
I think you've pretty much stated everything that I would have told you.

The average estimated risk of infection for a man having penetrative anal intercourse with another man known to be HIV-positive is about 1 in 1500. This is an average, so your risk is significantly less not just due to the brevity of the penetration but also because you don't know that your partner had HIV.

It's not possible to diagnose HIV by symptoms so it's not really worth it to go into those.

I once had a similar experience with a partner who turned out to be definitely HIV-positive and nothing happened. It is scary, but the risk is really not that great and I don't think you have any reason to be concerned. HIV is not an easy virus to catch. You're coming up on 30 days since the encounter, so plan on getting tested at that time. It will give you an excellent indication of your status (the majority of people who get infected will test positive by that time).

Dan
 
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sweetfunkystuff replied to Nieciedo's response:
Hey, there.

Thank you very much for your response.

Logically, what you say makes sense--the penetration was brief and shallow, so it's not likely that I've contracted HIV (assuming the worst possibility, that the bottom was positive). The thing is, though, there's this emotional component that won't allow itself to be ignored.

I'm certainly not a self-hating gay man, and I absolutely don't think that HIV/AIDS is some kind of punishment, but--and maybe it's because of the fact that I came of age during the really big, bad days of AIDS (I'm 42 years old)--there's a part of me that can't help but feel that HIV is just lurking in the shadows waiting for its opportunity to pounce on me, y'know?

Also, in addition to being gay, I'm black, and you're always hearing this stuff these days about how HIV is still a serious problem in the gay community (though generally not in my age demographic, but younger) and how it's on the rise in the black community, with particular focus on African-American MSMs. And the thing is, I love defying people's ignorant and hateful stereotypes, and I don't want to be anyone's prison/drug dealer/uneducated/dead/HIV/teenage father/whatever else statistic. Not, mind you, that I care what the haters think--because they're certainly not worth it--but I'd certainly hate to be deprived of the pleasure that I derive from turning idiots' pre-conceived notions upside-down.

Anyway, I was planning on holding out on getting tested until my semester ends in a couple of weeks because, the randomness of the universe forbid that I should turn out to be positive, I wouldn't want that messing with my head while I try to write my term paper. The thing is, though, just the not knowing and the fear are already messing with my head, so I might as well just get tested as soon as possible and get it over with. And, good or bad, at least I'll know, and I'll be able to deal with facts and not fears.

Here's to hoping for the best.
 
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David J Malebranche, MD, MPH replied to sweetfunkystuff's response:
Sir,

I applaud you on several levels, and can empathize with the stress you are under, especially with school and having to deal with this as well. Best advice I can give you is get tested after all your exams and such, as this will be a good time after the potential exposure occurred, if it was about 4 weeks ago. A negative test now will give you temporary peace of mind, but to be truly sure you should get tested 6 weeks to 3 months after exposure. I had a similar situation happen to me when I was in medical school with someone who told me they were positive after we had sex, and it was during a hard semester. I waited actually 3 months to get tested, and things were fine, but it was stressful. So when I say I understand where you are at, I do. And if you already got tested, and everything is fine now, I would say get tested again in 2 months to give you a total of 3 months to really make sure all is good.


You're right, you are at small risk from what you described, but you sound like you are very vigilant with your health and I definitely encourage that.

Also, your symptoms could be acute HIV, yes, but they also could be a million other things, like the flu, allergies, etc. We tend to go straight to HIV with any symptoms we have as Black gay men, but the truth is, it could be anything else, so we just feed into these stereotypes you describe by internalizing them to the point where we think any little symptom we have is HIV.

I know your situation is tough, hang in there and I wish you the best. Hope our comments have been helpful and please give us updates as you go through this and if you have any other questions let us know.

David
 
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sweetfunkystuff replied to David J Malebranche, MD, MPH's response:
Hi, David, and thank you so much for your words.

I understand that a negative result right now would givfe me temporary relief, but I'm still not feeling well (now it's just the pain and the nasal congestion), and while I am growing more concerned, I really think that, if worse comes to worst and I am indeed positive, at least I can deal with that instead of this constant anxiety over the unknown. I have therefor decided that I am going to get tested tomorrow--not just for HIV, but for other STDs as well. I am frightened (for one thing, I don't have any allergies, and for another, can the flue possibly last 3 weeks?), but I need to know something.

And I think you're absolutely right about internalizing stereotypes as Black gay men (though I'm sure that many gay men who are not Black experience the same thing) with regard to thinking that any little symptom is HIV. Lord knows I've been there before, even when I engaged in sexual activity that DIDN'T put me at risk. Crazy, isn't it?

And yes, both your and Nieciedo's comments have been helpful, so thank you both. Unfortunately, none of you could say "No, you don't have HIV" (which I knew when I posted my question), but I do appreciate your efforts at trying to alleviate my stress and my fear by confirming that my risk was lowered. Like I said, though, I am not feeling well, and lowered risk =/= no risk, and so I am trying to prepare myself to hear the worst when I get tested tomorrow (if one can actually prepare to hear that kind of news). And, hey, if I've prepared for the worst, and it turns out that I'm negative, then I'll enjoy the sense of relief that I'll surely feel.

I'll come back and lete you know what happens.
 
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David J Malebranche, MD, MPH replied to sweetfunkystuff's response:
Please do. And remember, feeling sick doesn't automatically mean HIV, and I think you're doing the right thing by getting checked out regardless, as it may be something else. Smart move, and please let us know what happens, I'm sorry you're not feeling any better...

David
 
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sweetfunkystuff replied to David J Malebranche, MD, MPH's response:
Hey, y'all.

Okay, so, as I told you, I was going out of my mind, and I couldn't wait for a six-week test, so yesterday, May 1st, 30 days post-incident, I got tested, and the result was non-reactive.
I am, as you might imagine, relieved. But not so fast, because of course the very cute counselor told me that I would need to retest at the 3-month mark, which I already knew. Having said that, from what I've read and from what I've been told by various sources, and from what the counselor told me, I stand a good chance of my 3-month test coming back negative.


What are your thoughts?

At any rate, I do want to thank the both of you for taking the time to share your expertise and for making efforts to allieviate, as best you could and all things considered, my anxiety. So, thank you very much.

Oh, yes, I also took the opportunity to get tested for other STDs. They took both a blood and a piss sample, and the guy told me that they would contact me within two weeks ONLY if any of those test came back positive. Otherwise, he said, I'd be okay.
 
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Nieciedo replied to sweetfunkystuff's response:
That's very good. I think the 3-month test is a formality now to confirm your negative result.

Dan


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