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PTB and HIV: How likely?
Mar 5, 2001

Dear Doctor,

This is my question.

In April 1999 I was diagnosed to have pulmonary tuberculosis (PTB). I have undergone the 6-month quadruple drug therapy and repeat chest x-rays after one year and then this January (2001) showed that my lungs are OK.

6 months before the PTB diagnosis, I have engaged into unprotected oral sex. I gave and received. Then in July 2000, I went to a gay sauna bath and have engaged in into oral sex (both giving and receiving) and and prolonged kissing with I dont know how many men. I cannot remember though if they had precum while I was servicing them but definitely no semen in my mouth. No anal sex was performed.

I am afraid that there seems to be something wrong with me now, almost 6 months after possible exposure. I know exposure is not equivalent to infection. Anyway, I have some difficulty breathing and I feel something painful in my lung area, dorsal and otherwise. I also easily get tired. I am losing weight (I think), and experience headache even as soon as I wake up. I also feel like an "upwelling of cold air" in my back. My heart beats faster. It palpitates. I have difficulty swallowing and afraid that my throat has swelled such that it appears to me that my Adam's apple is not so prominent as it used to be. Now I feel like I am catching fever or so. I am afraid these are symptoms of HIV infection. I am in a panic mood and cannot sleep well at night. I am afraid.

How likely is it that I get infected with precum, assuming that, on the worst case scenario, that they are (or some are) HIV+? I am worried. I have a girlfriend. We have a healthy sexlife although we NEVER had penetration. I know that PTB can be transmitted by air. If I still have PTB, if I contracted HIV virus, and yet, still, engage into "close-to-sexual-act" with my gf, I am afraid that I am exposing her to danger as well... I am worried.

What is your prognosis? Also, I would appreciate if you can tell me where to get HIV home test kits. I am in Italy. Sorry for not checking all the entries... I have been reading them in the past 2 hours.

HELP! Thanks.

Response from Dr. Frascino

Hello, Your potential exposure 6 months ago was unprotected oral sex with multiple partners whose HIV status is unknown. Your sypmtoms apparently began recently (6 months after the potential exposures) and include fatigue, rapid heart rate with palpitations, painful lungs with some difficulty breathing, headache, difficulty swallowing, possible weight loss and feeling feverish. In addition you state that you are in a "panic mood." There is a risk of HIV transmission with unprotected oral sex however that risk is much lower than anal/vaginal sex. You state that you had no semen in your mouth - this also decreases your potential risk somewhat although not completely. The group of symptoms you are now experiencing is not characteristic for an acute seroconversion type reaction and are most likely related to another cause. For instance stress/anxiety can cause fatigue, headache, sensations of throat constriction and breathing problems, as well as feelings of panic. Anemia can cause fatigue, intolerance to cold, rapid hear rate, headache, and a variety of other symptoms. The fact hat you had pulmonary tuberculosis last year also needs to be taken into consideration. So what to do . . . You need to be evaluated by a physician to see what is the cause or causes of your recent symptoms. Simple blood tests will let you know if you are anemic or have several other potential problems. The only way to determine for sure if you have contracted HIV is to have an HIV test. I'm not sure what the status of HIV home test kits in Italy. You may need to check with local AIDS service organizations to get the latest information confirmed with a blood test. As for risk to your girlfriend, you'll need to determine if your TB is still active. This would be unlikely considering the therapy you had and the recent negative chest x-ray. HIV risk would depend on your sexual activities. Penetration, which you state you have not practiced, would be the riskiest activity, particularly for the receptive partner. The best way to calm your fears would be for both of you to get tested. You are both sexually active and consequently having this information would be helpful for both of you. Hopefully that helps clarify the situation. Good luck. I love Italy. Have a bowl of gnocchi for me - RJF


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