Doc,

I am sorry for flooding your inbox. Truly, I am only seeking your professional opinion as I am struggling to get one in my local community. As mentioned in previous posts, I had protected (though condom could have ripped) sex with a commercial sex worker in las vegas on 10/26/07. I was tested with blood antibody tests with full STD screenings 3 days and 1 month post exposure, all negative. I was then tested again at 4 months for HIV using rapid test and separate antibody test all negative. In month five my girlfriend (only partner post exposure in October) developed some hivesand sore throat, prompting me to get further testing a rapid test at 5 weeks (with onset on symptoms) and a full STD screening including HIV with blood antibody test at 5 months 3 weeks (174 days). All negative. A CBC that day also came back clear. It was at this time (5 months) my stomach began having burning pains. My family doctor insisted it was a simple ulcer due to my severe stress. He gave me some nexium. However, the pain has not left and now I have been diagnosed with Chrons disease and I even have an anal abcess that was diagnosed months ago by a dermatologist as a cyst. It was present prior to my exposure to CSW. I has a NAAT test taken at the 5 month 3 week mark, and I just received the results negative. My question is this can my Chrons disease prolong the window period? I have read that these abcesses are common in HIV and Chrons and it has me worried. Do I need to keep getting tested? My anxiety is through the roof and I am hoping you can help me please Doctor.

Much appreciation.

Hello,

Sending your 4th question actually is not flooding my inbox. There are some anxious wrecks that send four posts within a day and even a few that manage to crank out four in an hour! Now those dudes qualify as inbox flooders.

To specifically address your new circumstances and present concern, no, Crohn's disease, while literally being a royal "pain in the ass," would not affect the HIV-test window period. Your multiple negative HIV tests using a wide array of testing techniques (ELISA, rapid tests, NAAT) out to five months and three weeks are absolutely definitive and conclusive. You report your "anxiety is through the roof" and I really don't understand why. Your HIV risk (protected sex, assuming the latex condom was used properly and didn't break) is essentially nonexistent; your symptoms have been linked to a definitive disease entity (Crohn's disease with rectal abscess); and numerous (excessive) HIV tests, both antibody-dependent (ELISA, rapid test) and antibody-independent (NAAT) have been negative out to almost six months. Gosh, you just can't get any more negative than that! Frevinsakes!

I would strongly advise you stop perseverating on a disease you could not possibly have (HIV) and begin focusing on your medical problems that require attention. These would include not only Crohn's disease, but also anxiety and irrational fears of being HIV infected. Psychological counseling could be very helpful in decreasing your stress and anxiety levels as well as helping you believe the truly wonderful news that you are HIV negative.

Good luck.

Dr. Bob

NEED EXPERT - ASHAMED - and seeing a therapist May 8, 2008

Dr. Bob, I had protected oral and vaginal intercourse with a CSW in Las Vegas late on 10/26/08. I do not recall the condom breaking, but I was a mess and do not recall everything perfectly. I know it was not completely broken, but I guess small break is possible. I asked the CSW after sex if she were clean and she assured me I had nothing to worry about as she always used protection. She was an older (and unfortunately, very unattractive and hygiene lacking lady). The sex was brief, a few minutes with her on top and me from behind. Afterwards, I showered off.

I tested with my GP with blood antibody tests for all stds 3 days after exposure and GP gave me doxycyclinjust in caseto kill what he considered the more common CSW diseases. All tests came back negative, though he DID say I had whatever causes canker sores and fever blistershsv-1 maybe? I have had a few canker sores in my life, so was not surprised by this. I repeated testing at 1 monthall tests negative. No symptoms ever presented themselves, except for some tingling/burning in my genitals that subsided with good test results.

My fears subsided until I entered a long relationship and moved in with girlfriend. My fear of hurting her really made me research further and then when the spitzer news broke, my research turned in to an obsession. I was constantly reading how some people could convert after 3 months, etc. My GP led me to believe I had nothing to worry abouteven after the 3 day testso I took on the challenge of educating myself.

I repeated HIV test with GP using antibody test (chemoimmunoassay by Bayer) at 4 months 3 weeks. I also took a rapid test that weekboth negative. The CDC guideline had me scared, so I tested again at 5 months 2 weeks and then again at 5 months 3 weeks with rapid tests. I also tested with blood again for ALL STDS at 5 months 3 weeks (174 days) and all were negative.even my hsv-1 was negative this time.which scares me. Why would I be positive at one point and then negative 6 months later? While at the AHF wellness center (amazing service they provide), I was recommended to a NAAT test because my fear was not being subsided by the antibody tests because they were prior to 6 month (barely). I am awaiting my NAAT results ANY DAYand now read they have a high rate of false positives. I am a MORON. In the meantime, I have been diagnosed with a stomach ulcer and put on nexium. My girlfriend and I both had small rashes on our backs and arms start around month 5 as well (hence the additional testing). I have been negative for everything thus far do you think I am in the clear? I really am struggling to find an expert opinion (obviously my GP does not have a clue with his testing me at 2-3 days post exposure). Does my ulcer or rash warrant further testing? I am otherwise healthy.26 (as of last Sunday!), monogamous for 6 months post exposure, athletic (training for your SF marathon in August)but scared. I started seeing a therapist two weeks ago and after two sessions, I am starting to calm down and realize I am really just disappointed in myself. To hear from an expert that I have reason to woooohoooo would be amazing. Please pray for good NAAT results and know how much I appreciate you. Please let me know where to donate (I already have significantly to AHF).

Thank you truly

Scared and ashamed

Response from Dr. Frascino

Hello Scared and Ashamed,

You're repeatedly negative HIV tests out to 174 days are definitive, conclusive and WOO-HOOable! Dude, this is definitely a case of what happened in Vegas stayed in Vegas!

Sure, I can see feeling a bit scared and ashamed. After all you did give it up for a "very unattractive and hygiene lacking" Vegas hooker. But dude, you did use a condom and that's something to be very proud of! BRAVO!

Your "symptoms" are not worrisome for or suggestive of HIV acute retroviral syndrome (ARS).

No further HIV testing is warranted. I'm delighted you are seeing a therapist and starting to calm down (with only two sessions!).

Continue your therapy sessions and marathon training and I'm confident all will turn out "well" (including you).

Thanks for your willingness to make a tax-deductible contribution to the Robert James Frascino AIDS Foundation. Donation information can be found on the foundation's Web site at www.concertedeffort.org. In return I'll send you my good-luck/good-health karma that your HIV NAT results are undetectable and that your unwarranted HIV fears continue to evaporate. I may also cheer you on (from the sidelines) during your S.F. marathon!

Be well! Run fast.

Dr. Bob