Sexually Transmitted Diseases/help for OCD or genuine risk?

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Question
Hi Mark,

I am a 25 year old male living in America and I suffer from OCD regarding HIV transmission. Over the past few years I have gotten myself tested for HIV many times (with always a negative result). None of the previous situations involved unprotected anal/vaginal sex or iv drug use. Most of the situations were "low risk" situations. Worrying over all these situations and getting tested has caused me a lot of stress. So I want to break the pattern and not go get tested over just any scare. Now recently a situation happened that has gotten me worried again about any possible risk for HIV transmission. I know that this might be a classic "what if" scenario. Please be patient with me and maybe talk some sense/advise into me.

This Halloween I was with a couple of friends at some bars near my apartment. I ended up drinking quite a lot and got separated from my friends. I don't usually drink that much and would definitely not do this in the future. I may have blacked out for a bit - basically I do not have any memories of what happened between 1:00 am and 4:30 am. The next thing that I remember is walking to my apartment alone at 4:30 am in the morning. All my personal belongings (cellphone/wallet) were with me and I could account for all the money (except for $10). My jeans were a bit dirty around the back pocket (maybe I had fallen somewhere) and one belt loop on my jeans was torn (I don't know how that happened).

Now I am worried that I may have been exposed to HIV during the time I was drunk and alone? Am I crazy in thinking that? Would I have remembered in the morning if I was involved in unprotected anal/vaginal sex of any kind, iv drug use or any other risk for HIV transmission? I am not trying to waste anyone's time but am genuinely concerned about this situation. Please help me with your advice. How should I deal/think about this situation?

Doug.

Answer
Hello Doug,
OCD and anxiety are best addressed by health care providers or behavioral health specialists who can consider medications or talk therapy. Are you at risk? It seems unusual that you have absolutely no recollection of anything that happened to you.  Sounds like the lesson to be learned is never to experience such helplessness in the future, and avoidance of over-drinking is a good idea. What I would do, is get periodically HIV tested every 3-6 months to ease one's sense of "could it be possible?" And of course, see, care for your anxiety disorder, which is disabling and getting you into some degree of trouble, including your "blackout."

Good luck!
--mark  

Sexually Transmitted Diseases

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Mark P. Behar

Expertise

Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!

Experience

Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Organizations
Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Publications
Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Education/Credentials
Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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