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Re: HIGH RISK EXPOSURE IN THAILAND -- FOLLOW-UP
Jul 7, 2003

HIGH RISK EXPOSURE IN THAI--PROPHYLACTIC TX OPTIONS

AS AN RN IN A COMMITTED RELATIONSHIP WHERE THERE IS LOVE, HONOR, RESPECT AND TRUTH I MUST SAY THAT I DEEPLY RESENT AND AM OFFENDED BY YOUR FLIPPANT REPLY.I WAS RAISED BY AN MD AND HAVE BEEN A NURSE FOR 25 YRS--I CANNOT BELIEVE THAT YOU WOULD ANSWER ANYONE IN SUCH A WAY--NOW--IF YOU WANT TO BE ENLIGHTENED--GO TO THE US CONSULATE SITE AND READ ABOUT THIS SORT OF THING--BEC IT IS REAL AND IT DID HAPPEN TO XXXX--HIS DRINK WAS DRUGGED AND HE WOKE UP IN BANGKOK--AN HOUR AWAY FRROM HIS HOME IN XXXX. AND THE FIRST THING THIS "DISHONEST" MAN DID WAS EMAIL ME AND TELL ME THAT HE THOUGHT HE HAD HAD UNPROTECTED SEX--HE HAD HAD SO MUCH TO DRINK --SINGHA BEER--6 ALCOHOL--THAT HE HAD A BLACKOUT. SO THINK WHAT YOU LIKE--IF HE DOES HAVE SEX--BELIEVE ME IT IS W/ MY KNOWLEDGE AND HE USES A CONDOM. AS FOR THE "SNAKE" SHEDDING IT'S SKIN--DEFINE THE WORD SLOUGHED--THAT IS WHAT HAPPENED--IT CLEARED UP W/ LOTRISONE CREAM AND HAS NOT RECURRED. I REALLY THINK YOU OWE ME--A MEDICAL PROFESSIONAL ASKING FOR ADVICE--AN APOLOGY. I THINK YOUR BEDSIDE MANNER MUST BE ATROCIOUS--I WOULD HATE TO BE A NURSE WHO HAS TO WORK W/ YOU--AND MY EXPERIENCE IS 25 YRS IN ICU AND ER PRIMARILY AT LEVEL ONE AND TWO TRAUMA CENTERS IN SOUTHERN CALIFORNIA.

I KNOW WHAT GOOD MEDICINE IS--THIS IS NOT IT BE ASHAMED OF YOURSELF. I CANNOT BELIEVE YOU WOULD EVEN WRITE SUCH A LOATHSOME LETTER. OBVIOUSLY YOU HAVE NO RESPECT FOR ME OR FOR XXX IN COMPLETE DISBELIEF, RN,XXXXXX

Response from Dr. Frascino

Hello RN,

First off, I certainly hope you realize I was not specifically trying to offend you or your husband. Please note this and other expert forums on this site serve the purpose of providing accurate scientifically sound medical advice on HIV and related topics. We maintain the anonymity of our questioners by not posting e-mail addresses or family names. As you can see, your e-mail address was not published and your name was deleted from your question -- you were referred to as "RN-Colorado."

You state you are a "medical professional asking for advice." I hope you found the medical advice I provided helpful. As you will recall, I advised PEP (post-exposure prophylaxis) would not be appropriate for your husbands situation, since he was 2 months post-possible exposure. In order to be effective, PEP should be started within 72 hours. I also mentioned his skin symptoms could be handled by a dermatologist, if they persisted. Ill stand by my advice as appropriate and sound.

Along with advice, I try to make my replies palatable and even entertaining for the vast number of readers we have around the world who log onto this site. Perhaps not everyone appreciates my slightly twisted sense of humor, but then again, this site is voluntary, the advice is free, and Im not forcing anyone to read it. You seem particularly upset that I found your husbands tale implausible. Please note its not important for me to believe him. The circumstances surrounding his possible exposure had no direct bearing on the medical advice I was giving. So, whether his story is a slight exaggeration of the truth or whether he gets kidnapped on a regular basis is of no consequence to our readers or me. After all, hes not my husband.

"Ashamed of myself?" No, I cant say that I am. But, I am sorry if you found my remarks disparaging, and hope that now you realize that was not my intention.

So, I hope you can start typing in lower case letters once again and that we are now friends. Per our policy, Ill continue to keep your name, e-mail address, and other personal information censored from this post.

Finally, Id like to leave you with a quote from Paul Rudnick: "Only money, rage, and science can conquer AIDS, but only laughter can make the nightmare bearable." As a person living with HIV, I have found this philosophy a breath of fresh air. So maybe try those 3 deep cleansing breaths one more time and this time smile!

Dr. Bob

Your original question and my reply listed below:

HIGH RISK EXPOSURE IN THAI--PROPHYLACTIC TX OPTIONS Posted: Jun 30, 2003 I AM AN RN WHOSE HUSB HAD HAD WAY TO MUCH TO DRINK AND WAS DRUGGED AND KIDNAPPED IN BANGKOK IN LATE MARCH/APRIL. 2 WEEKS LATER THE SKIN OF HIS PENIS SLOUGHED OFF. NO URETHRAL DRNG--DID NOT TEST FOR SYPHILIS--LONGSTANDING HX HERPES AS A YOUNG 20'S--NOW 49 AND HEALTHY. 2 MO POST EXPOSURE NEG FOR HIV, HEPC, ETC--KNOW THERE IS SEROCONVERSION TIME AND WILL RETEST IN SEPT--QUESTIONS WHETHER HE SHOULD BE ON SOME DRUG TX NOW DURING THIS UNCERTAIN TIME AND IS HAVING HIGH ANXIETY--NO MEMORY OF EVENT. VAGUELY REMEMBERS MAN AND 2 WOMEN. OUR FAMILY MD AND I HAVE READ UP, BUT I FEEL I NEED TO GO DEEPER. CAN YOU HELP US??? SINCERELY, , RN--COLORADO

Hello RN, So your "49 year old healthy" husband was in Thailand and had a few too many drinks (OK). Then he was drugged (a bit unlikely but if you say so OK). And then he was kidnapped (now its beginning to sound a bit weird). And then he has vague sexual memories of a man and two women (now it sounds like a bad flashback sequence from an even worse porno flick). But thats his story and if you want to believe it its your choice. So.on to your question.. The skin on his penis sloughed off? You mean like a snake shedding its skin? I dont suppose it was just one of those "almost invisible" condoms left behind by the phantom kidnappers was it? No, I suppose not. Testing negative for STDs at two months is encouraging. Yes, I would agree a three month test after the night he may have "banged cock" in Bangkok is warranted. PEP (post exposure prophylaxis for HIV) is recommended only for significant HIV exposures and must be started within 72 hours to be most effective so it wouldnt apply to your hubbys situation. Besides that whole drunk-drugged-kidnapped and used as a sex toy scenario seems more than a bit far fetched to me. Could it be hes not telling you "the truth, the whole truth, and nothing but the truth?" Have him see a dermatologist if his "snake" continues to shed (slough). And tell him to come up with a more plausible story time he decides to take a walk on the wild side. Has he ever told you he was abducted by space aliens and anally probed? Good luck, Dr. Bob



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