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doggy style risky encounter + how long do I have to live
May 20, 2005

Hi Dr Bob. Firstly, your life's achievements to date are a wonderful inspiration to everyone - HIV + or not! The fact that you provide such inspirational advice to essentially strangers on the net is amazing and demonstrates your obvious passion for what you do. OK, here's my case. I broke up with my g/f of two years, got depressed and decided to indulge in a hooker of asian origin. The sex was vaginal, completely protected with me wearing a condom and her using water - based lube (I insisted). I asked her HIV status and she said 'negative' in somewhat broken english but I don't trust that for a second since I don't think she had a clue what I asked her. It lasted for only about 3 minutes in total about half for missionary and half for doggie style. After I withdrew I checked thoroughly for breaks in the condom and found none. I slipped it off with a glove I brought (she thought that was weird!). I then washed my whole genital area thoroughly with soap. The shaft of my penis was kind of sore and redenned which I suspect was due to friction and a tight fitting condom. About 5 minutes later what looked like an abrasion started to bleed moderately which stopped after I applied tissue paper. At that point I was somewhat concerned. Is doggie style more risky than misionary or with her on top? 6 weeks later I developed what I suspect was a wart in the same place as the bleed which grew, became puss filled then dried up and receeded then disappeared leaving only a slightly red patch in its place. Is this herpes or HPV? 2 weeks after that I had a 24hr bug which included severe fever, vomiting, diarrhoea, severe fatigue but this I think could be linked to some dodgy chinese food I ate. 4 weeks later the same symptoms appeared again for no reason. So we are now at 12 weeks post possible exposure and I am still too afraid to get tested. It has been a year now since then and the other symptoms I have had are two more outbreaks of the herpes and more recently some light oral thrush (my own diagnosis) and a fungal infection in my groin which I treated successfully with kenacomb antibiotic. I am still too afraid to be tested for HIV even though I have got tested all negative for syphillis and gonorrhoea (bad spelling I think) OK now for my questions: since I have never had genital herpes before, could this be indicative of HIV? Do you think I have seroconverted since I have some signs of early HIV infection and ARS? I know I was stupid. I now have a new g/f (virgin) who wants to do it but I keep putting it off and she is getting frustrated cause I can't tell her why. I read on the forum that if you do test positive in 2005 and you have continual access to and follow religiously HAART then you will probably not die of AIDS? How true is this statement? How available is HAART in Australia and what is your estimate of cost? You said that you spend 20000US dollars annually - is this the same in Australia? As a third year medical student I have been exposed to end stage AIDS patients (in the hospital sense!) and I am extremely scared. Thank you for you time. You have inspired me to specialise in HIV treatment once I'm through med. What are the chances I have contracted HIV? If I don't have it then why the herpes. You're a champ Dr Bob and may you live a long and happy life! Your paranoid understudy. David.

Response from Dr. Frascino

Hi paranoid Understudy David,

So you had "completely protected" vaginal sex, using a latex condom and water-based lubricant. And after 1.5 minutes of missionary and 1.5 minutes of doggie style, you withdrew and checked thoroughly for breaks in the condom, and found none. So far so good. That all qualifies as very safe sex. Next, you slipped off the condom with a glove you brought with you? Dude, I agree with the hooker. That's weird! But on the other hand (so to speak), it's certainly safe.

OK, on to your questions:

1. Is doggy style more risky? No.

2. The "wart" is probably not a wart, because it became "puss filled then dried up, receded and disappeared." Is it HPV? No, not from your description. Is it herpes? Possibly, although herpes usually presents as a cluster of fluid-filled vesicles.

3. Since you never had genital herpes before, could this be indicative of HIV? No. First off, we aren't even sure it was herpes. Next, even if it was herpes, this is a completely different STD than HIV.

4. Do I think you seroconverted? No. Your exposure risk is essentially nonexistent and your symptoms are not consistent with HIV ARS.

5. Don't you think it's a bit premature to worry about when you might die of AIDS, considering that, at this point, we have no indication that you are even HIV positive?

6. HAART is readily available in Australia. Costs are probably similar to those in the U.S.; however, your health insurance should cover most or all of the cost. But again, isn't this premature, considering you haven't even had an HIV test yet?

7. As a medical student, you will be exposed to many end-of-life situations. If you are inordinately frightened by death or illness, perhaps becoming a physician might not be a wise career choice. As a third year medical student, I'm also concerned by your irrational fear to even get tested! This does not show good medical judgment. Self diagnosis ("light oral thrush") is also something I would strongly advise against.

8. What are the chances you have contracted HIV? Essentially nil from the episode you described. But why ask me to hypothesize when you can have a definitive answer within 20 minutes by getting a rapid test?

I realize you are "extremely scared," but if I really have the ability to "inspire" you, I would encourage you to act more rationally. Herpes and HIV are two very different STDs. You may well have herpes (recurrent outbreaks), but I strongly doubt you have HIV. I strongly advise you to formally consult a physician for an evaluation and, if needed, treatment. If you don't know how to act responsibly as a patient on one side of the examination table, I doubt you'll be able to function effectively on the other side of the examination table as a physician. Paranoia is not one of the qualities one looks for in their physicians.

Good luck!

Dr. Bob



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