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up for a challenge dr. bob???... answer this one
Feb 21, 2004

Hello Dr. Bob,

This is my second attempt at writing you and hopefully one that will be answered regardless of how optimistic what you have to say makes me. As an incentive to answering me I will entice you with a guaranteed sizeable donation now (or at least as sizeable as somebody with tens of thousands of dollars of student loans can afford V which Im sure you understand seeing as you have those two little letters after your name) and my promise of continued donations annually for as long as the foundation exists. Like so many that write you I am terrified at the thought of having contracted HIV and consider you to be the most knowledgeable source of information available on the entire World Wide Web V and believe me, theres a lot of conflicting evidence. Not that your sometimes humorous attitude isnt refreshing when dealing with the thought of such a serious condition but it is definitely your expertise that has me promising annual donations (which hopefully will be for many years).

Before I begin on what has caused me to write, I feel I should give you a brief background on myself and my general health. I am a twenty-six year old grad-student at a large Big Ten university with a few months left before graduation. As a college student I admit that my health is not as good as many of those my age that lead more traditional lifestyles. I am at least borderline insomniac, I smoke roughly a little more than a pack of cigarettes a day, I drink almost nightly (although not as much recently due to my spending most of my late nights on the computer reading your site and others covering STDs), I dont wear a coat until the temperature drops to the point I have to in order to avoid frostbite, I eat unreal amounts of food and despite losing forty pounds from dieting this summer am usually overweight, and seeing as how I still live in a fraternity house am constantly around general illness that seems to get spread from person to person on a continuous wheel. Like so many others that have written you I also suffer from OCD but have not had to seek treatment to control it for roughly ten years. I realize that this lifestyle is not good for my health regardless of HIV status and do plan on taking control of it upon graduation (when I have more resources available and less exposure to contributing factors to bad habits). Basically I know Im messed up as Im sure youll probably understand more after realizing how much time Ive put into this submission.

That being said, let me get to why I am writing. I am a completely heterosexual male (although if it increases the odds that youll respond to this Ill say I think youre cute) that has had sex with twenty-five women in my lifetime. I realize that this is a large number by some standards but what can I say, God has blessed me with the kind of looks women go for . And unlike most of my friends with that sort of a number I can recall the names and situations and timeframe of all twenty-five from memory V I can honestly say that in almost all cases they were females that I honestly thought something could develop with rather than the typical college one-night stands. I wear protection religiously with women I am less familiar with but admit that I have had unprotected sex with a handful that I was dating seriously and had little reason to doubt the status of. I have not had unprotected sex in roughly a year and if I can come out of my current situation may never again. I do both receive and give oral sex without protection often but did neither with either of the girls I will mention later as possible sources of HIV.

In late last August I had a serious relationship end and went on a self-proclaimed stage of bitterness towards women in which I had several (eight) sexual partners within a short period of time. It was also during this time that I was masturbating frequently enough without lubrication that I rubbed skin off my penis near the head (to the best of my recollection this occurred in late October or early November). Shortly thereafter I had bumps begin to appear on my penis (the cauliflower type out of where I had worn the skin off as well as other bumps elsewhere on the shaft). The warts/bumps/whatever were slightly itchy but did not hurt and have not gone away. There are also sores that I think have evolved from where I tried to remove bumps and keep picking at before they can heal properly but am not sure and do get scared to death when I pick at them and they bleed. I have seen several pictures of HPV/ Molluscum Contagiosumon the internet and they are all consistent with what I developed. When these did not go away within a week or two (although I did try to cut them off myself which was a big mistakeK they bled) I began to do research on the internet and through friends I know to have had similar conditions (if you live in a fraternity house for the better part of seven years theres more than you think). This wouldve been in the middle of December as I remember it interfering with my studying for finals. Anyway, as I started studying the symptoms of HIV (I knowK symptoms dont equal disease) I became terrified. I had had a severe sore throat/fever/very swollen lymph nodes the week before to the point that I missed class one day but will note that it was the Monday morning following a Saturday night of sitting in a hot tub for a couple of hours in roughly twenty-five degree F weather. Additionally, I had had one morning where my chest itched terribly for an hour or so but am not sure whether this was before other symptoms started or not. I had also been feeling generally crappy lately and had had a long lasting sore throat/cough for quite sometime (which I had always attributed to being in bad general health and smoking). The following weekend I had one morning of extremely sore muscles in my legs which I contributed to a night of heavy drinking. During this stage of a few weeks that I am afraid was ARS I had a toothache one night which I treated by flossing and using mouthwash which I never do on a regular basis (for the next few weeks I felt a clean feeling in my teeth which I dont know whether it was due to the use of mouthwash or if it was a possible symptom as I have read that receding gums are a symptom and what I was feeling couldve very well been just that). I asked friends to let me compare my tongue to theirs and all the other paranoid symptoms of the worried well despite them telling me my fears were irrational. It was also during this time that I noticed a purple blister on the inside of my cheek one morning that I removed easily with a fingernail and also a couple of long extensions on the underside of my tongue that may have always been there but I had not noticed (which of course freaked me out so I removed them with tweezers and they have not returned). Finally, during this span of a couple weeks and during finals I found myself with a decreased appetite and not being able to put on weight despite forcing myself to eat. After finals I returned home (same general geographic location) and at about ten days after the severe sore throat/fever noticed a handful (5-10) small red bumps on my chest which disappeared a few days later. I should also mention that during December when all this was going on I did have a few nights of night sweats with one night actually soaking through my clothing slightly as well as general sweating which may or may not be contributable to temperature/stress/etc and headaches which may have been stress related or from going a long time without seeing my chiropractor... For the next few weeks I still had the sore throat/cough but nothing else too dramatic for me to handle.

On January 2 of this year I left for a study experience in Brazil. On the plane ride down I was overcome with chills and on a trip to the restroom noticed some bumps on the very back lateral edge of my tongue V I have since written these off as being normal and that I have probably had them my entire life as they are still there now. While in Brazil and still checking my tongue twenty times a day I found myself sweating more than other people in the group and did have a few nights of night sweats despite having the air-conditioning on at night. I also had three non-consecutive days of diarrhea within a week which I have hopefully correctly attributed to the food as there were other members of my group having it too.

Since returning home in mid-January, I have still had the sore throat and have lately been experiencing sore muscles and continued crappy feeling as well as being warm to the touch and sweating as well as chilling cold spells. My stools have been somewhat looser than I think they usually are (and have also had frequent gas V dont know if thats ever been considered a symptom or not) and I had a couple of clusters of red dots appear on my upper legs a few days ago which is also where I have been noticing the sore muscles. I have also noticed that Im scratching my head a lot lately and I have read that itchy scalp is a symptom of HIV (although I believe it not to be during ARS). Lastly, I could feel a bump on the roof of my mouth (which granted I do get occasionally) that lasted for longer than a week and a cold sore (which I get very frequently) that began while I was in Brazil and has just completely cleared up in the last few days (probably due to my constantly picking at it.

OkK so how do I think I couldve gotten HIV??? I had three sexual encounters with two different women that I believe to have been somewhat risky in late October/early November. Two of them were with a friend of mine that I have known for several months who is a stripper. On my two encounters with her I was extremely careful by using a condom and not giving or receiving oral sex. I am still worried though because of the sores on my penis that despite having the condom on couldve still gotten something in them off of my hand or something and because during one of the encounters she insisted on lubrication and the only thing I had was hand lotion which I have read is not the best to use. The second situation involved the daughter of a friend of mine (alright, my friend is the lady who owns the bar I go to the most) that was living here with her mother after leaving her husband (separated/divorced/not sure) in Texas. There was no oral sex involved and a Condom was used for the entire intercourse process. So why am I worried? At one point I was fingering her and she slipped my finger in her anus. Upon removing my hand I noticed blood on it and on my sheets. I dont know that I had any open wounds but do bite my fingernails to the point of blood and sometimes have a wound/sore on my knuckle from playing golden tee (arcade golf game found in bars). I do not know the HIV status of either of these women but will say that I was not worried about the encounters until the symptoms started to appear (I knowK symptoms dont equal disease).

As I send you this post after writing it over the course of a week I am at the three-month mark of the risky encounters and still having many symptoms. Everything Ive read however says that symptoms are not long-lasting in most cases and not Im almost afraid that theyre going away and that Ive sero-converted. My swollen lymph nodes have returned and my throat is still extremely sore but Im fairly sure this is something I have caught from my girlfriend as she is experiencing the same symptoms. I also noticed the same type of red bumps on my chest the other day that have since disappeared. I also think that the bumps on my penis are decreasing and am afraid that this is another sign that my body has fought off the initial infection and I am entering the asymptomatic phase.

Dr. Bob!!! Im sure you can tell from the length of this email that I am very concerned about having contracted HIV. I have honestly read just about every submission on your site as well as the HIV/AIDS statistics for my state/by transmission type (heterosexual)/for rural areas/etc. and realize that the odds are in my favor but if youre familiar with OCD you know that it is not a rational disorder. I just keep imagining the devastation to my family, having wasted all this education on a life that wont get to mature as normal, and to make things worse I have met a woman that Im very much in love with and have been very faithful to since the night I met her (Thanksgiving) and could very well marry V although I admit I was tempted by those beaches of Rio. I also realize that I need to be checked out for whatever I have growing down there but dont feel that I can until I get some sort of indication of how the tests will go from you (and yes, I know that a proper positive diagnosis happens only 25 of the time even with a Dr.s consultation).

One response on the message board would suggest that I dont even need to be tested for HIV but if thats really the case why am I feeling so crazy (not suicidal just yet but who knows where my anxiety is leading):K

Trying to determine your HIV status based on symptoms you are experiencing is unwise, anxiety provoking, and unreliable. Recent HIV infection (acute HIV infection, acute retroviral syndrome) should only be considered if ALL of the following are true: 1) You had unprotected vaginal or anal sex (inserting or receiving a penis without a condom) within the past three months. 2) Your partner was known to be HIV infected, or is a person who is in a "high-risk" category (a man who has sex with men, an injection drug user, or a person who has sexual contact with others in an area of high HIV incidence or prevalence, like sub-Saharan Africa). 3) Your symptoms are indicative of acute HIV infection (febrile illness, sometimes compared to flu or mono). The specific symptoms can vary from person to person, but acute infection most often manifests in this "flu-like" manner. If all of the above are true for you, see a doctor to have your symptoms evaluated. If all of the above are not true, you should still have your symptoms evaluated by a doctor, but it is not likely that they are related to HIV infection.

I wish you could tell me that my symptoms are not symptomatic of ARS and that Im just a worrier like everybody else, but I dont think you can so Im asking these questionsK

1. What are the likelihood of transmission from the incidents I described when I had open sores and the incident when I had blood on my hand??? What is your overall feeling about my chances of having been infected with HIV based on everything I have written (I realize you cannot diagnose over the internet and that a test is the only way to know for sure but you are an expert and as far as I can tell one of the best so your opinion is very valuable to me on this matter). Basically, would I be one of these hopefully not 25 youd correctly diagnose positive (I mean I think Ive given you more information than most people would at a doctors visit).

The main symptoms that extremely freak me out that I can not really attribute to other causes like I can the sore throat/fever/headache were the sore in my mouth, the extensions on the underside of my tongue, and the itchy chest (all happening at about the six-week mark of the risky encounters). I am also very scared that I had the sore gums but am not sure whether or not this feeling for a few weeks is indicative of HIV or not. The bumps on my genitals obviously scare me too but I think its safe to say that they would be more likely to be HPV or MC.

2. These symptoms seem to be going for a longer period of time than what seems to be the normK are ARS and Sero-Conversion the same thing happening at the same time with the same symptoms (the internet is confusing on this). Does ARS happen and then a few months later Sero-Conversion happens or are they the same thing. I realize that I pick a different symptom to worry about every day (for the third time, I knowK symptoms do not equal disease) but I wish there could be more normalized symptoms with more normalized timeframes (and of course the confusing internet on an OCD sufferer is devastating).

3. Do my symptoms strongly indicate another STD???K Ive read all about them but am still confused as my grad-studies are business related and I am an idiot when it comes to the wonders of the medical field. Could I have perhaps gotten any bacteria or something else in my system from masturbating with dirty hands and open sores that caused the bumps??? Could I have gotten it from poor hygiene as far as using the same shower towel for several weeks without washing it or living in a generally dirty environment? I have read posts on your page that link ARS and Molluscum Contagiosum to the point of saying that the bumps indicate ARS (to which you replied that the lady at the CDC didnt know what she was talking about). If MC and ARS or Sero-Conversion are related, how so?

4. The week before finals is what I consider to be the most likely time I would have been going through symptoms of ARS (severe sore throat/fever/swollen lymph nodes in the neck) but at the same time the guy in the room next to me and my girlfriend were experiencing similar symptomsK if mine were being caused by HIV they wouldnt have gotten the symptoms by being around me like they would if what I was going through was just a normal cold or the flu, would they? I also had similar symptoms following a weekend trip to Memphis in mid-November, but the timing of this was only a day or two after my at-risk encounters and dont consider them to be likely of ARS.

5. FinallyK do all states require that couples getting married get tested as Im pretty sure they do in my state? If so, I think there would be a better chance of the recently separated female that I had the encounter with knowing that she did/did not have it and I cant see her being involved with me if she knew she did (hope that makes sense).

Dr. BobK I realize this email is lengthy and would take time to look at the timeline and different symptoms and that is why I am promising a lifetime of annual donations in addition to one upon your answer. Im a man of my word and will probably be making a lot of money in the near future so I will definitely be able to make your time worth it to the foundation V which judging by the emails you choose to answer is very important to you. If you would rather not post a response for some reason just let me know a way to get you my personal email address as I do want to remain anonymous to the general public. Whatever it takes to get a response let me knowK I just want to be able to halfway enjoy my final semester of college and not go off the deep-end.

Finally, to all the other worried well out thereK I think Im your new leader and I just wanted to say that I am very comforted reading your submissions as I realize others are experiencing the same anxiety that I amK its good to know youre not alone.

Response from Dr. Frascino

Hello,

O.K., you win. Yours is the longest post I have ever seen. Is there a Cliff Notes version available? I really do think with just a bit of fine-tuning and lots of meaningless footnotes, you could turn it in as a doctoral thesis case study on the devastating consequences of high anxiety.

Delving deeply into each of your myriad questions would be quite impossible (it would rival War and Peace in length and boredom), and it would be about as feasible as trying to get Bush to pronounce the word "nuclear" properly (i.e. impossible). So, if you truly believe I'm "the most knowledgeable source of information available on the entire Worldwide Web," I'm going to ask you to accept my response.

I agree you have OCD. You need help with this, and the sooner the better.

I agree you are living an unhealthy life being overweight, not getting adequate rest, smoking, drinking, and most alarming, you used the same shower towel for several weeks (kidding about the last one being significant).

You are being hypervigilant. That means you are perseverating on things you shouldn't be. Comparing body parts with your friends and frat brothers? Are you sure you're not gay? Checking your tongue 20 times per day??? Searching for symptoms on the Net and on your body? None of this is helpful.

You've done some really dumb stuff picking at your penis bumps until they bleed? Trying to cut them off? What are you, a frustrated moyl??? Oucha-ma-goucha. Stop abusing your Mr. Happy! You "removed" a couple of "long extensions on the underside of your tongue" with a tweezers??? I'm also afraid to ask what you've done with the nail clippers in your manicure set. A frontal lobotomy perhaps?

Next, having "unprotected sex with a handful" is not "wearing protection religiously." (Unless maybe your religion is like Jim Bakker's or the over 4,000 celibate Catholic priests now accused of sex abuse.) Unprotected sex places you at some degree of risk for STD's, including HIV. Your risk is the same as everyone else's. The fingering episode does not sound all that worrisome to me, despite the "golden-Tee" induced wounds.

You repeat three times correctly that HIV-related symptoms do not equal HIV disease, yet you don't seem to believe it. Why not? You can see for yourself from the gazillions of testimonies in the archives how true it is!

Your "main symptoms that extremely freak you out" "sore in mouth, extensions on the underside of your tongue, and itchy chest" are not suggestive of HIV-ARS or HIV disease.

Seroconversion means going form HIV-negative to HIV-positive. ARS is a constellation of symptoms that can be related to HIV seroconversion. However, seroconversion-related symptoms can be so mild as to go essentially unnoticed. So no, these two terms are not identical or interchangeable.

Genital warts (HPV), molluscum contagiosum, or other cause for your bumps, do not indicate ARS. You are correct that I cannot diagnose these over the Internet. (No, don't send digital photos!) Diagnosing and treating this kind of stuff is what God created dermatologists for!

Next, why are you second-guessing whether a recently separated female would or would not have had a mandatory HIV test? This is not her problem. It's yours. Stop mentally masturbating over questions you cannot answer.

O.K., my little excessively wordy, excessively worried OCD frat boy, here's what you need to do:

1. Get psychiatric help for your OCD.

2. Get dermatological help for your Mr. Happy.

3. Stop smoking, excessively drinking, overeating, and not getting enough sleep.

4. Stop trying to perform medical procedures on yourself.

5. Get HIV tested.

6. Floss daily.

7. Wash your shower towel.

Thank you for your donation. But please note, my advice here is free. Donations to my foundation are desperately needed and sincerely appreciated, but please, those donations should be made out of altruism, compassion, and a desire to help those less fortunate than us, O.K.? Providing crucial services to men, women, and children with HIV and promoting awareness of the HIV/AIDS epidemic through education and advocacy is the mission of The Foundation. If you wish to help me in that cause, please accept my heartfelt thanks!

Dr. Bob



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