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Thank you, please, please help!
May 29, 2006

Thank you Dr. Bob for answering everyone's questions. My email can be accessed by my family so can you please respond to my questions on this forum. I provided you with an account that has been inactive for some time so I don't know if you responded. I sent several questions in a posting earlier today (about two dumb encounters with two different escorts of non-US origin). The first encounter was 4 months ago (involved vaginal intercourse with a condom that broke and oral ejaculation). The second encounter involved oral on me with a condom BUT the woman licked her fingers a few times and rubbed my anus (I can't remember if there was penetration of my anus...). I was tested at a private clinic with an HIV 1, HIV 2 and p24 test, 32 days after the second encounter and a little over 4 months after the first encounter. All of the tests turned out to be negative, including a screen of all STDs. 2 weeks after the second encounter I noticed a flat red-ish rash all over my legs (just under my legs -- all ranging from small marks to two large marks the size of a quarter). The rash was also found near my waste line (larger marks) and I had a few spots near my armpits on both sides, on my butt, and on the back portion of my thighs. I have never had a rash of any sort so I am so very scared. Was my body going through seroconversion based on the second experience with the saliva on my anus? Is the p24 test negative because the occurrence was nearly 5 weeks before the test? I have read on your board that HIV can not live in saliva (but what if she had open sores in her mouth) and what if she rubbed directly from her mouth to my anus? I also read on your forum that 95% of all HIV 1 and HIV 2 tests will be positive if infected over 3 months prior to getting tested, and that 99% will read positive if infected 6 months prior to getting tested. I'm scared for a number of reasons. I can't sleep and it's hard for me to eat. I am forcing myself to eat a lot and my weight is still dropping. My body has been sore and achy for a week and my legs, arms and back have never felt so tight and achy. Is my body reacting to an infection? The rash is going away after using steroid creams for about a week, but I also read on your site that the seroconversion rash goes away on its own. I also had general blood work done and my white blood cell count is normal. I originally thought that my white blood cell count should be high because of "any" infection, but I read on your forum that it actually drops in the case of HIV infection. My lymphocyte reading was also at the lowest end of the "normal" range -- which I read on your site could infer the seroconversion period. Please help. My life is a mess. I am thinking about this every hour and even though I plan to get tested again in 2 months (following the 3 month window after the second occurrence and the 6 month window following the first occurrence), I don't know if I can make it until then. I mean, I am making myself so sick because of these serious mistakes. Please give me your views on what I have written. Do you think I have been infected? What else could have caused an internal rash like the one that I had/have? Could bacteria passed from the woman's finger and saliva near my anus have resulted in such a flat rash? I will see my doctor this next week to check on the rash. What other tests should I do if my Red Cell count was in the middle of the normal range and my white cell count was above 7. Again, lymphocytes (and monocytes) are at the low end of the normal range. How do I check on my CD4 count? Please give me some advice and peace of mind so I can get on with my life, and wait for my next testing. I also read that it's important to detect the HIV infection during the acute stage. The private clinic I went to said that they would only administer an HIV test (p24 and other) if the testing date was at least 28 days after possible infection. I didn't wait until 32 days but I started to read about rashes being related to HIV infection and it worked out that way. Is my negative p24 test after the second occurrence with the saliva a good sign? Are my HIV 1 and HIV 2 negative tests a good sign after the first occurrence? Is it too early after the second occurrence for them to mean anything? Please, please respond on the forum so I can read your response. Thank you.

please answer my earlier question

Dr. Bob, please answer my earlier question about the two incidents with two escorts (one 4 months ago and one 32 days before getting tested). I am planning to make a donation to your foundation! Please just answer my question...I can't sleep! And I can't access my personal email because it's a family account. I am checking the forum every few hours but can't find answers about the rash on my legs and the testing that I just did...I know you write that you can't answerer every question, but this is so important to me...please. I just woke up in a hot sweat and my back and the back of my neck are very achy. I read a recent posting from a disgruntled person who wrote that you may not respond to people who seem like they have contracted HIV...is that true? It doesn't seem that way to me. Signed, planning to make a large donation

Response from Dr. Frascino

Hello,

I've combined just two of your many posts over the past few days.

I'll be brief:

Your first episode vaginal intercourse with condom failure and oral ejaculation does place you at some degree of risk for STDs, including HIV. However, your negative HIV-1, HIV-2 and p24 antigen four months after this episode is definitive and conclusive. You did not acquire HIV. You are HIV negative.

Your second sexcapade protected oral and licked fingers on your backdoor is not considered a risk for HIV transmission.

Your rash is not worrisome for HIV ARS. I cannot diagnose the cause over the Internet, but I can assure you it's not HIV, because you do not have HIV.

The option of doing additional HIV testing is always open to you, but I do not personally feel additional testing is warranted. I would also counsel against getting a CD4 cell count, as you have no indication for that test.

My advice:

1. Ratchet down the anxiety levels! HIV is not your problem. No way. No how.

2. If you can't stop worrying, get psychological counseling to help you cope with your irrational HIV fears.

3. Thanks for your offers to make a donation to The Robert James Frascino AIDS Foundation. (www.concertedeffort.org) However, I should also mention that donations should be given in the spirit of compassion and generosity and not as a bribe to get my attention. My advice is free and available to all. You have the response you so desperately and repeatedly requested. Please don't feel obligated to make a donation or feel guilty if you don't, OK?

4. Yell WOO-HOO as you realize HIV is not your problem!

Dr. Bob



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