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Low exp. risk vs. ARS symptoms

Apr 15, 2006

Dear Doctor Bob, I didn't see this question answered elsewhere, tho I'm sure others have had similar.

I'm concerned -- freaking out, to be exact -- over recent signs of ARS/seroconversion. I didn't even know what those things were until I started looking into a recent spell of unwellness. A few weeks ago, I awoke feeling very fatigued, a bit achy, as if coming down with flu. This lasted a day or two, culminating with a searing headache (something I rarely have), which at the time I blamed on bad eyeglass prescription. No flu erupted, but for the next couple weeks, I had a fluctuating sore throat with slightly swollen lymph nodes in throat. (I smoke a lot.) Very slight cough for a few days, but no runny nose. (Healthy appetite, no thrush or rash, no vomiting, slept very well and felt well except for lingering sore throat.) I thought little of any of this until my partner, a woman with whom I began having unprotected sex (resuming a longtime partnership), said a couple weeks later she was feeling tired and had a sore throat, things that set off alarm bells in my head, and I went looking for some information and found ARS symptom list, which sent me into a tailspin. I would have chalked up my brief period of feeling unwell to other factors -- had been traveling a lot and had just arrived in a destitute African country with all sorts of unhealthy things floating around, I guess -- but the fact that her complaints echoed my own made me think twice. (She has not had any partner for a long time, I know. I'm the jerk here.)

Just prior to this, I was traveling and had a number of encounters with "pros" in a high risk region (SE Asia). All of these encounters were conducted with very conscientious safety, on my part and theirs -- covered oral, covered vaginal, no breakage tho one occassion it was dry. Otherwise only mutual masturbation, tit-fucking, slight anal fingering. To the best of my knowledge, everything was well within the bounds of safe, caution to the max, shower before and after, etc. Except for that dry condom, changed once or twice carefully, always heavily lubed, and I can't see where there was any exchange of fluids, other than a few kisses. At no time did I sense I had ventured anywhere near "unsafe", I had no "scares," "accidents," whatever, and I consider myself pretty well versed on the chart. As I said, I honestly believe I played very safe, aside from the stupidity of banging strangers.

What horrifies me is that those symptoms I had seemed to show up in my partner, tho less prominently, within two weeks after we had sex. Aside from my own health, I am now mortified at the possible criminal act I may have inflicted on another, having been convinced I had played safe, safe, safe -- all condom, all the time!

I know the only answer is to get tested. My questions, though, are about how quickly results will show up. Anytime after seroconversion? In two days (traveling again) I will have access to a good US clinic, and I will get tested, probably peeing in my pants all the way. The coincidence of ARS symptoms and my own fits pretty well -- 4 out of 7, I would say. And the timing, 2 to 3 weeks, fits as well. I did not have the courage to reveal my fears to my partner, but I was paying close attention to her comments about how she felt.

There are other emotional/anxiety factors feeding into this, I guess, but not to bore you. I am absolutely mortified, and will happily make a generous donation for any dose of rationalism you can provide.

Many thanks, Doctor Bob.

--Sleepless in 3 Continents

Response from Dr. Frascino

Hello Sleepless in 3 Continents,

From your description of your foreign affairs (so to speak), I would agree your mattress mambos followed all safer sex guidelines. I agree: you did not venture anywhere near "unsafe!" And since you "had no scares, accidents or whatever," why are you so worried now? Banging strangers or Mother Theresa doesn't matter so long as you're dressed for the occasion.

Symptoms, no matter what they are, do not equal HIV disease. The "symptoms" you described could be (and almost certainly are) related to any of a number of ailments. Jumping to HIV is a quantum leap unwarranted by the evidence, particularly because your risk is essentially nonexistent! That your partner has some similar, very nonspecific symptoms is not at all worrisome for HIV. I absolutely agree: "there are other emotional/anxiety factors feeding into this . . . ." In fact, I'm willing to bet these emotional/anxiety factors are actually the main problem here!

Sure, if you are worried, get HIV tested three months after your last stranger-banging. The results will be negative. It may well be the most efficient and effective way to calm your fears. You have not committed a "possible criminal act." You have no cause to feel "horrified."

The only potentially risky thing you mention in your post is having "unprotected sex" with your current partner. If guilt and anxiety are a problem, I suggest you level with her. You are not a "jerk" for acting responsibly when having sex. In fact, quite the opposite.

I do see one very worrisome fact in your post that could lead to disastrous health consequences: "I smoke a lot." Statistically speaking, your illness is much more likely to be related to smoking than HIV. I strongly advise you to quit immediately. My brother is currently struggling with the challenges of stage IV lung cancer with brain metastases as a consequence of his smoking habit. His prognosis and current medical problems are far worse than mine as an HIV-infected person. I have absolutely no doubt the biggest risk to your good health at this moment is smoking, not HIV.

Thank you for your donation. Contributions are urgently needed and warmly appreciated. On behalf of all those whose lives will be touched by your generosity, please accept my heartfelt thanks. I'm also sending you my very best good-luck/good-health karma that your HIV test will be negative (as I strongly suspect it will) and that you quit smoking (as I strongly hope you do!).

Good luck. Good health.

Dr. Bob

prophylactic circumcision

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