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Med Student Confused

Sep 7, 2006

Hey Doc, First of all I would like to say you are providing one heck of a service to everyone out there! I am astounded by your kindness truth and generosity. I really enjoy your forum and always refer to it when HIV comes up in our studies. I am studying to be a medical doctor in NY, 1st year in college I have a long way to go!! Anyways recently I have been reading that infected breast milk can only cause HIV in infants because of the amount they induce. This also depends on the viral load of the breast milk is this correct? You wonder why I asked my teacher these questions huh? Sex worker incident, dont ask. No sex, No oral, just sucking milk from her breast (fetish), and licked one of her breast that was cut and had a scab on it. I know I am stupid, a med student should know better but I was drunk and it was 3 am. Ha-ha. She confirmed it was breast milk because she just had a baby. My professor announced to me that even adults can be infected with HIV through exposure to infected breast milk. He stated that especially if the infected person is still in the 3-6 month window period in which they are highly infectious, he said that this will definitely affect a non-infected person. Whether they drink a little or a lot, he also stated that infected breast milk that gets into the eyes of non-infected person can infect that person with HIV. I was grilling him with questions and this is what I got. We almost argued about the issue because I was opposing his statements, all my readings on this website kind of state that there is no risk. So what is it? I kept telling him and the class about your forum and the website, but he said he stands by his statements. The sex worker had a bunch of bruises on her arms and legs, I didnt see any sign of anything else this led to me to think she might be positive. Now I am confused and need some assistance so I can shut my professor up! His statements got me really worried because 2-3 weeks after the exposure I suffered heavy diarrhea, fatigue, didnt want to get out of bed, heavy sweating day and night, and a rash on my anus that hurt like hell!!! This lasted for like 5-6 days. I washed my anus and put some ointment on it and it went away, but it returned a few days later and kept returning for a week or two. After that I was nauseated for two weeks straight and had abdominal pain, as if GERD and heavy Acid reflux for about 2 and a half weeks feeling like vomiting all the time. I couldnt eat because of this nausea. I noticed little lymph nodes in crotch area between my thigh and penis, the area in between. My armpits still hurt and I feel some swelling in my neck with a little pain. All this happened about 3 weeks ago and I still feel lymph nodes in my neck, and armpit, and some twitching where groin lymph nodes are located. I try to keep a cool head but it is hard to stay calm and avoid anxiety when introduced to this. I am in the 7th week after exposure. What do you think Doc; I know youre a pro thats why I am asking!

Youre a BraveHEART!!!!


Response from Dr. Frascino

Hello Med Stud from NYC,

You want my assistance to shut your professor up??? Hmmm . . . that could be quite a challenge. Most professors never ever shut up.

I can advise you that there is no scientific documentation to validate his claims that (1) adults will definitely be infected by ingesting breast milk from a lactating HIVer "still in the 3-6 month window period" whether they drink a little or a lot and (2) infected breast milk can transmit HIV by getting into the eyes of an uninfected individual.

In fact, there are no reported cases of adult HIV transmission via breast milk. However, since this clearly does happen in newborn infants, it remains at least a theoretical risk for adults as well. I'll reprint one of my archival posts below.

Your "symptoms" are not suggestive of or worrisome for HIV disease.

If you're worried, get a single HIV rapid test at the three-month mark to put any residual fears permanently to rest.

As for your professor, he can "stand by his statements," but that doesn't make them scientifically accurate or valid. You might ask him to produce some documentation to back up his claims.

Stay well. Study hard.

Dr. Bob

Breast milk adult transmission

May 19, 2006

Dear Dr. Bob, I am the guy who had protected vaginal sex with 3 condoms and then checked the outermost condom for leaks until it burst..Your answer really made a big difference in my life. Remember me? I sincerely express my most heartfelt thanks to you. I have seriously started addressing my OCD and gained some ground in my fight against OCD.

However, one incident about breast milk adult transmission is putting a spike in my OCD recovery. I sucked a girl's right nipple and 1-2 drops of white breast-milk entered my mouth..She was not pregnant, but she was lactating due to a breast surgery which she had done 1 or 2 weeks before this episode of nipple-sucking to increase her boobs. Two months have passed since the incident, and I have encountered no ARS symptoms. I have researched your archives, and you have mentioned that the HIV risk of nipple-sucking is "essentially non-existent" and "no testing is needed". My questions are as follows: 1) Does nipple-sucking remain no-risk, even if 1-2 very small drops of breast-milk enter my mouth? 2) How likely is it to get HIV-infected during breast surgery in a developed country (Japan)? 3) Assuming she got infected during her breast surgery, her viral load would be sky-high. In such a situation, could 1-2 small drops of breast milk transmit HIV? or would it still remain no-risk? 4) From a medical standpoint, would you recommend HIV testing for this exposure? I have had no other risks and I always play safe to the point of obsession. 5) I could not find any statistics on breast milk transmission among adults, but I estimate that the risk should be less than 0.5 in 10000 exposures (oral sex risk) since semen quantity in oral sex is much more and semen contains higher concentration of HIV than breast milk. Can you give me some statistics about adult breast milk transmission via nipple-sucking?

Dr. Bob, please help me to bounce back in my fight against OCD. If Elvis was alive, he would have sung the song "You are the ANGEL in disguise" for you! From a nipple-sucker (now an OCD warrior)

Response from Dr. Frascino


Three-Condom-Guy! How could I forget you?

OK, on to your questions:

1. Breast milk from an HIV-positive woman can transmit the virus while breastfeeding infants. There are no recorded cases of HIV transmission via breast milk in adults. However, there is at least a small hypothetical risk. Do I think you should worry about 1-2 drops? No. Absolutely not.

2. Not at all likely.

3. This hypothetical situation is so hypothetical as to make the question unanswerable.

4. From a medical standpoint, no, I do not feel HIV testing is warranted. From a mental health standpoint, if you are worried, get tested! A simple 20-minute rapid test three months after your titty nosh will calm all your residual or lingering fears.

5. There are no statistics, because there are no reported cases. Consequently the risk remains only theoretical.

Dr. Bob

again non seroconverters

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