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Possible meningitis == ARS?
Oct 23, 2004

Dr. Rob,

First of all, I would like to thank you for providing help and advice to those of us who suffer the window pain and the disease. Your web site has been the comfort I seek every day in the past three months. I do not know how I can live through those days without your humor, optimism and expertise. I know you got thousands of emails every day and I have searched through the web site similar to my case and did not see much. Hope you can answer my questions.

Here is my story. On 7/27/04 I went to a massage parlor and had protected oral and anal sex with the masseuse (status unknown). Also there was an unprotected masturbation by her on my genital and anal area. I know the oral part carries no risk however I was very worried about the anal and masturbation part. The anal sex lasted about only 10-15 seconds at most since I was very tired. I checked the condom after withdrawal and found the condom was intake. When she masturbated me, she did not get into my anus with her fingers. She just touched with massage oil as lubricant.

So my first question is : Since I have a little blind piles near the anus and wonder if this can be a route for infection.

On 9/17 in the evening, 7.5 weeks after the encounter, I started having fever (98-100.5) and headaches mostly on the top of the head but it seemed to move around. I felt a little bit chilly and my heartbeat was about 120. I called the on-call doctor at my hospital and he said it should be all right. I should stay home and relax. Since my heart beat was so high my wife took me to the hospital to see if I am going to suffer heart attack. Basically I am a very healthy person (33 years old) and only sick a couple of times a year mostly flu or cold.

When we arrived at the hospital 4 am in the morning (12 hours after symptoms started), the ER doctor performed EKG on my heart and CT scan on my brain. Every thing seemed to be normal. But he also performed spinal tap and check if I had inflammation in my CSF. Later he found there was trace of that and did not know if it was bacterial or virus that caused this. I was so nervous and thought this would be it. I was over with the virus. The doctor wanted to keep me at the hospital to make sure the bacteria was not there. I was on IV (saline and antibiotics) for two days and left the hospital on the morning of the 3rd day (9/19). My headache and fever actually disappeared about 24 hours after they appeared. So basically I stayed two more days in the hospital just like a normal person. The release form from the hospital said I had possible viral meningitis. I talked to my resident doctor and he said he would not even admit me to the hospital if he saw my symptoms. I had no other symptoms then. I tested for HIV about one day after the symptoms appeared. It turned out to be negative. I had another one at 2 weeks from my primary care physician it was also negative. My PCP was suspicious that I had viral meningitis since the duration was so short. Usually people with this disease would not recover that soon (he said should be at least 5, 6 days).

My PCP used to work at a SF clinic and had treated 100+ positive patients. He said he never seen any positive patient with viral meningitis as the only sign of acute infection. He said most meningitis was not caused by HIV. I learned from WebMd that 80-92 percent was caused by intestine virus. I was out on BarBQ and picnic about three days in a row a week before the incident. Also I was preparing a lot of raw chicken meat the day before.

Here is my second question. Do you think these have some thing to do with that? I remember the day before I was very busy with housework and was a little bit stressed. Also is it like stomach virus type flu?

Now my symptoms come after coming back from the hospital. I had night sweat a few times (5-6) but mostly the sweat was around my neck and upper back area. Only one time I have sweat to my lower back, but never on my thigh or legs. My wife and dad-in-law also told me they felt it was hot during that week. They had to avoid the comfort during the first few hours of the sleep. Then around 3 or 4 am they put the comfort back. I had one night sweat at the hospital and I figured out I put too much blankets on me. The second day I did not have the same problem at the hospital. My PCP said it was environmental, not likely to be ARS related.

Here is my third question, is what he said true?

So after one week the sweat stops, now I felt tension around my front head area about 1-2 inches above the eyes. Every time it happened it lasted about few seconds or minutes. It some how moves a little bit. On a scale 1 to 10 I would say it was 1. I never felt it at sleep and usually the condition is more obvious when the evening and night come. I was a little bit sensitive to lights for some nights when I went to supermarkets and drive on the street. One time I tried to put on my contact lens the pain started right away so I had to take them off and ever since I am wearing glasses only. Recently I went to an acupuncture clinic and it seemed to sooth the condition a lot. The tension or head tingling problem almost disappeared. I had a big cold sore between my nose and mouth one week after the hospitalization. One day sore throat 4 weeks later. I had no other symptoms.

The 4th question is, do you think these are ARS related symptoms? Is ARS/seroconversion at 7.5 week a little bit late for most people? I learned from you it should be 2-4 weeks. WebMd said 3-6 weeks. Since I have been depressed for the first two weeks after the encounter, from 3 to 7.5 I felt ok, would my immune system be depressed to delay seroconversion?

My PCP did not believe I have acute infection and he thought my two HIV tests cover pretty much the bell shape distribution of the vast majority of infected people (9-41 days 95% confidence interval according to CDC). He only suggested me to go back at six months to double check. He did not think I belong to the type of people that would have depressed immune systems such that it delays the production of antibody.

The 5th question is: it seems my immune system is doing well since my possible meningitis symptoms disappeared within one day. Do you agree with that?

Ever since the encounter, I felt very guilty, anxious, and worried. I told my wife the whole story and she forgave my mistake totally. We went to my PCP together when we have questions and concerns. But I still cannot get over with all these bad ideas that I might have contracted the virus. I could not sleep at night and keep thinking the bad thing that will happen.

Dr. Rob, what do you think about my chance? I learned from you that a protected sex is protected. I do not believe the infection did happen but the idea just cannot get out of my mind. It is going to be 13 weeks next Tuesday and I will go for the test even though my PCP recommended 6 moths.

I am an Engineer who works and lives in Silicon Valley. I wish some day I could meet you in person. Before writing this email I was thinking giving you a call and pay a visit to you. After thinking that you probably are too busy so I quit the idea. My company has a donation program. I had asked them to add your organization as one of the charities so when we donate one dollar the company will match one. I will start contribution regularly to your foundation to help those people who are fighting with the disease. Before I only donate to church and cancer organization and did not know the severity and importance of the disease. I hope I will get a Woo-hoo on 13 weeks and get back my life again. I will cherish more what I have and enjoy my life and family as much as I can like Dr. Rob you do.

Thank you for always being with us.

Sincerely, sy

Response from Dr. Frascino

Hello Sy,

Let me see if I can shatter your "window pain."

"Protected" sex is indeed protected assuming the latex condom was used properly and did not fail. Masturbation is not a risk for HIV transmission; consequently, from what you have told me, HIV infection would not even be a significant consideration.

So on to your questions:

1."Little blind piles???" I'm not exactly sure I know what you mean. Hemorrhoids? Rectal warts? At any rate, merely having the masseuse touch you with massage oil would not be a risk for HIV transmission.

2. Although I haven't seen the actual results of your spinal tap with "trace" inflammation, I would tend to agree with your resident doctor and would not have admitted you to hospital. Your final diagnosis, "possible viral meningitis" clearly indicates the diagnosis remains in question. I don't believe your Bar BQ activities had anything to do with it either.

3. Yes, I agree with your PCP.

4. No, absolutely not.

5. I believe your immune system is fine.

6. I believe you are HIV negative, based on essentially negligible risk, symptoms not consistent with ARS and negative HIV tests to date. Your real problem is just as you stated in your question: "I still cannot get over with all these bad ideas that I might have contracted the virus. I could not sleep at night and keep thinking the bad thing that will happen . . .. the idea just cannot get out of my mind." You are clearly suffering form anxiety related to this entire event. I suggest you ask your PCP for a referral to a therapist who can help you work through your irrational fears and accept your HIV-negative status. Hopefully your 13-week result will help in this regard. I do not feel a six-month test is necessary, but as always, the decision to retest is up to you.

Thank you for signing up for the donor-matching program at your work. Silicon Valley is a wonderful place to work and live. I sincerely hope the silver lining to this entire frightening experience is that you can now indeed "cherish and enjoy your life and family!"

Stay well, Sy!

Dr. Bob



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