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Crazed Canuck... Please Help!!
Aug 1, 2004

Hello Dr. Bob,

First, I must confess a rather unhealthy obsession with your forum. I cannot tell you how much I enjoy reading your witticisms and disparaging remarks about your "esteemed" president, George W. Bush, whom the majority of Canadians (myself included)greatly despise!

The main reason I devote a disproportionate amount of time to your forum, however, is that I am absolutely convinced (despite some "evidence" to the contrary) that I am infected with HIV. I know you have heard this a million times before, so I apologize in advance for making it a million and one.

Here is my story: About 4 months ago, I engaged in unprotected receptive and insertive oral sex (no ejaculation) with someone I have been friends with for several years. Although I did NOT want to have sexual relations with this individual, I felt oddly compelled to do so, being at that moment both physically and mentally weak. Ever since that day, I have been absolutely consumed by feelings of anger, guilt, and utter terror. I have become obsessed (literally) with weighing the evidence for and against a possible infection with HIV.

On the plus side, I know from reading this forum that the chance of contracting HIV through oral sex is extremely low; in addition, from what I know about the sexual history of my friend, the chance of his having HIV is negligible. Also, as far as I know, I did not experience any of the typical symptoms of ARS (ie - high grade fever) and I tested negative on ELISA at 69 days (10 weeks) post exposure.

On the negative side, I have experienced a number of strange afflictions since that evening for which I have been unable to find a plausible explanation, other than anxiety. Most notably is the presence of what I can only assume to be genital warts. About 3-4 days after the sexual encounter, I felt intense itching in my genital region; upon closer inspection, I noticed a series of small wart-like growths. I was shocked and somewhat horrified at the prospect of having contracted an STD, as I had not been sexually active for many years (and had only been intimate with one other person, a long-time boyfriend, prior to my abstinence.) My sexual history (what little there is!) led me to believe that I had most likely contracted HPV from this one sexual encounter. I further deduced, being the worry wart that I am (no pun intended), that since this condition developed so rapidly after exposure (instead of the normal incubation period of several weeks to months) that I had been simultaneously infected with HIV which impaired my immune system to the point that HPV was able to flourish so quickly. (I have heard that symptomatic HPV infections are much more common in HIV+ women than in HIV- women.)

Another one of my physical symptoms resembles peripheral neuropathy. For about 3 weeks, I have felt intermittent numbness, tingling, burning, and pain in my hands, feet, arms, and legs. There have also been a few recent occasions on which my entire body (spinal region, neck, legs, face, etc.) has, without warning, gone completely numb. Other symptoms include: sore muscles and joints (esp. those in my hands), frequent dizzy spells, abdominal swelling and pain, pimple-like rashes on my upper arms, and - for the first time - irregular menstrual cycles.

Please, Dr. Bob, tell me your honest assessment of my situation. I have resisted the urge to write to you for several weeks, but my paranoia is getting the better of me. I fear I am one step away from utter insanity. When I muster some much-needed courage, I will get re-tested now that my window period has elapsed. However, due to a backlog in the local health care system, it will be at least another month before I receive any conclusive results. Until then, I would really appreciate your advice.

I guess my questions could be summarized as follows:

1. In your best estimation, what percentage of HIV+ individuals would test positive by 10 weeks on the ELISA? I know that the results are not definitive until 12 weeks, but I have also read in the forum that a 10-week test is considered "highly accurate" and that the "vast majority" of people will seroconvert prior to that time. What percentage (approximately)would seroconvert between 10 and 12 weeks?

2. Do you think it's possible and/or likely that my "warts" (or bumps) are related to an HIV infection, or would it take several years for immuno-suppression to excelerate the incubation period from several weeks to a few days? Since the "warts" do not fit into the normal timeframe for HPV infection, could they possibly have been contracted by non-sexual means?

3. Could I be experiencing peripheral neuropathy so soon after exposure, or would it only develop during the later stages of infection? (I have read much conflicting data on this point, even within thebody.com)

4. You noted in a recent post that there have been no documented cases of "oral-pre-cum" transmission. Do you know how many reported cases there have been of such an occurance? (Would it be in the tens, hundreds, or thousands?)

I could ask you questions all day, but I know you are a popular man! Thank you very much for taking the time to read this lengthy email and, if you have a few more minutes to spare, I would REALLY appreciate your feedback. If it is clear to you that I do not have HIV, then I am obviously suffering from a serious case of hypochondria for which I need extensive professional help. In either case, a proper diagnosis would put my mind at ease.

Dr. Bob, you are providing an invaluable service to the global community and it's reassuring to know that there is someone like you out there. (I know that sounds cheesy, but I really do mean it!) Best of luck defeating that moronic president of yours! I'll be rooting for ya...

Response from Dr. Frascino

Hello Crazed,

Now let me get this straight . . . .

1. You've had a very minimal sexual history two episodes, to be exact. (How are things in the nunnery these days???)

2. You are concerned about the second episode, an episode of oral sex, -- which you state you know carries "an extremely low" risk for HIV transmission.

3. Your oral sex buddy has, at best, a "negligible chance" of being HIV-positive.

4. You did not experience any ARS symptoms.

5. You tested negative on an ELISA at 10 weeks.

And with the above information, you are "absolutely convinced despite evidence to the contrary that you are infected with HIV." Yup! That would make you "a million and one" alright. In fact, since your question is so lengthy and has four sub-questions, perhaps we should make you "a million one, two, three, and four!!!

OK, so let's talk about your worries, as irrational as they may be. You've experienced "strange afflictions since that evening" for which you have been "unable to find a plausible explanation, other than anxiety!" Bingo! There's your most plausible explanation. After all, you state, "Ever since that day, I have been absolutely consumed by feelings of anger, guilt, and utter terror!"

What about the "genital warts?" Well, for one thing, you shouldn't try to diagnose yourself. After all, that's why God made dermatologists! If you've got some bumps in the nether regions, get them checked out. If they showed up only three-four days after your oral sex-capade, they are not HPV. The time course would be way, way too brief. And your other assumption of simultaneously getting HIV, which impaired your immune system, allowing the HPV to "flourish so quickly" is utter nonsense. Even if you had contracted HIV,-- which you didn't-- , immune deterioration takes years and years, not hours or days!

Next, what you described doesn't even vaguely sound like HIV distal sensory neuropathy. Again, you see the dangers in trying to self-diagnose! These, and in fact almost all your symptoms, are quite commonly seen with anxiety.

So is your paranoia getting the better of you? Yep!

Now for your four specific questions:

1. There is no exact percentage estimate for seroconversion at 10 vs. 12 weeks. You are correct that the "vast majority" seroconvert within weeks.

2. Warts related to HPV? Nope! HPV is transmitted by skin-to-skin contact. This does not necessarily have to be sexual.

3. Peripheral neuropathy? Nope!

4. No, none that I am personally aware of.

In summary:

Hypochondria Yes!

Need for counseling to treat irrational fears? Yes!

OK, let's hope a future Mr. or Ms. "a million and five" can learn from these comments.

Good luck.

Feel better. OK?

Dr. Bob



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