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Fatigue and AnemiaFatigue and Anemia
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May 8, 2002

Dr Bob I have sent a question quite a while ago and no one repliedI have been having anxiety attacks since I didnt have any response from you. LETS TRY AGAIN PLEASE TRY TO ANSWRE THIS TIME!

This is my story. I had unprotected sex about 6 years ago with a guy I went out with approx. two years. He never ejaculated inside me. I did however perform oral sex on him. He told me that he was fine and of course I believed him I MEAN I TRUSTED HIMAfter we broke up I had unprotected oral sex with two men thereafter and also had unprotected sex (no ejaculation inside me) with a guy I went out with for four months. (This all happened approx two years ago)

Its only now that I am starting to get worried about the fact that I could have contracted the virus since it is also present in pre-cum. I am terrified have been having anxiety attacks and very bad depression. When I read your forum I have been developing almost all the signs these people are describing. I think my one lymphnode has been swollen for almost three months, had a white tongue, had thrush three times already and also feel very fatigued.

Worst of all the first boyfriend I was with died last year of colon cancer and now I am thinking that he might have had AIDS and his mom and dad are covering it up by saying he had cancer!!!!!!!! I also found out that he slept around while we were going outIm going mad. I cannot remember if I even showed any signs of flu after exposure since it was sooo long ago? I must say that I get the flu very often (at least every 2 months) and I am anaemic.

Im sure I am positive but cannot get myself to get tested. How big is the risk for me if they never ejaculated inside me??? HELP HELP HELP!!!!!!!!!!!

Response from Dr. Frascino


Just a reminder to all our readers: I would love to answer everyone's questions, but we get hundreds of questions every week. Also remember, my forum is dedicated to questions pertaining to HIV-related fatigue and anemia. "Am I infected" and "worried well" questions should be sent to our forum on HIV prevention and safe sex. So please don't have "anxiety attacks" if I'm unable to specifically answer every question.

OK, questioner, you mentioned you were anemic, so let me start there. One of the hallmark signs of anemia is fatigue, which you are also experiencing. So, these two things may be related. To determine if you are really anemic or not, as well as the severity of your anemia, you need to measure your hemoglobin level. The normal range for men is 14-18 g/dL and, for women, 12-16 g/dL. If you are anemic, then the next step is to determine why. Is it related to iron deficiency, vitamin deficiency, blood loss, medications, HIV, etc.? Once the cause is determined, then specific treatment can be prescribed, such as vitamin or iron supplements or Procrit, a medication that stimulates the body to make additional new red blood cells.

Second, you mention you are experiencing very bad depression and anxiety attacks. Anxiety, stress, and depression are very frequently associated with fatigue, as well as with insomnia loss of appetite, and difficulty concentrating. There is no doubt you are under considerable psychological stresses over this issue, and I would strongly recommend that you see a therapist or psychiatrist to help you with this aspect of the problem. Creating worst-case scenarios, like your ex-boyfriend's parents are covering up an AIDS diagnosis, are not healthy.

Finally, what about your HIV risk? The risk of contracting HIV from oral sex is relatively low. Please read the detailed response I gave to this subject in a previous question titled, "Anemia and oral sex." Regarding the other "unprotected sex - (no ejaculation inside-me)," anal receptive sex carries the highest risk, but certainly not every exposure leads to infection. And I'm assuming you really don't know the status of your partner. Do I think you are positive? Probably not. The odds are in your favor for not having been infected. That said, however, the only way to be absolutely certain is to get an HIV test. You say you "cannot" get tested, but are "sure" you are positive. I'm quite convinced that the psychological stress surrounding this entire issue is the basis for many of your current symptoms. So what should you do? Ask your doctor for a referral to a psychiatrist. The psychiatrist will help you with your depression and anxiety. Hopefully, s/he will also help you confront your irrational fears about HIV and HIV testing. I sincerely hope you will soon find the strength to get tested. It will be negative, and your symptoms will melt away like a bad dream. Isn't it time to wake up from this nightmare?

Stay well. I wish you nothing but pleasant dreams.

Dr. Bob

Excessive need for sleep
anemia and oral sex

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