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Medical Student Scared sleepless
Mar 23, 2003

Hey Bob.

I am so scared that I have not been to a physician for the last year ,I know what you'll say to that .Hers a timeline:Have protected sex with gal ,don't know well,wash off and possibly clean off with soap and water rubbing over penis fluid that may have been infected.One month down beginto have itching over pubis and periorally,bad sinus infection and tiny bumps over glans and recurrent bumps over thigh as well as really bad itching in perineum over ensuing two months.Start to have tingling over both hands and entire right harm all the way upto right shoulder (??brachial neuritis ) that comes on with chills and eventually resolves only to recur.This has now become virtually constant .Had episodic night sweats and recurrent cold sores that I never had before ,now have burning tingling sensations in my feet as well and feel fatigued all the time.Skin over my hands and arms has recuurent episodes of what seems like blanchable red spots that leave a mark(??vasculitis).Iam sure I had relatively asymptomatic herpes that reactivated(itching in perineum that has now improved a lot...immune reconstitution??).A wart appeard on my thumb and I had a Beaus line on my thumbnail as well,suggesting significant pathology.I think I have HIV,women in question denies everything ,am having a hard time trying to get her to get tested ,found out she uses cocaine.....

Please PLEASE help me gauge these symptoms....

Response from Dr. Frascino

Dear Scared Sleepless Medical Student,

Help you "gauge" your symptoms? OK, let's start with your anxiety, which is significant. Your other symptoms are not.

Thanks for your detailed history (they are going to love you on morning rounds); however, I hope your attending physicians soon teach you not to jump to illogical unlikely diagnoses just because you happened to have recently read about them in a physical diagnosis textbook. Tingling over both hands and entire right arm is not suggestive of "brachial neuritis", which is usually unilateral and not even associated with HIV anyway. Blanchable red spots that leave a mark? Vasculitis? Most likely not. Vasculitis is not all that common and frequently has other associated symptoms. (Go back and re-read that chapter in your textbook.) Immune reconstitution because you had recurrent cold sores? No, no, no. Herpes is an intermittent chronic infection that frequently behaves this way. Immune reconstitution has absolutely nothing to do with it. As for "Beaus line" on your thumbnail, well I haven't heard that term since I finished medical school. (these transverse corrugations on the fingernails are seen after typhoid fever and a few other systemic diseases). Save your brain capacity kid. Beaus line is not something you'll be including in your physical examination chart notes.

Now let's get to the crux of the matter, shall we? What's the most important thing that you told me in your excessively detailed history? Give up? OK, it's the phrase, "protected sex." What do you suppose that means? That's right. You were "protected" from getting HIV, because you wore a condom. So what's your worry? Could you get infected while cleaning off the sticky stuff with soap and water? The chances of this are so miniscule as to be non-existent. In other words - no.

Next up, you say, "I think I have HIV." I disagree. Neither your story, your risk level, nor your symptoms suggest HIV infection.

Last, who cares if you're having a hard time trying to get her to get tested? You're the one who's all freaked out about this, not her. If you had protected sex, she doesn't need to be tested. If you're worried, get yourself tested! You're a medical student. You need to start acting like one.

If everyone behaved as you - "so scared that I haven't been to a physician for the last year" - what would that do to your future career? No one would come to see you; you'd never be able to pay off your medical school student loans; and then you'd really have something to be scared and sleepless about!!! Med student, you have a lot to learn, and I suggest you get started right away. Good luck.

Dr. Bob



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