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dysplasia, molluscum, please reply!
Sep 9, 2006

Dear Dr. Bob,

Please, please respond to my inquiry, Dr. Bob! I had 2 unprotected sexual encounters almost 3 years ago with a man of unknown hiv status. Both encounters were what I would consider "soft" sex -vaginal only and he also performed oral sex on me only. He did not wear a condom either time but also he did not ejaculate inside of me. I was quite tipsy both times and on vacation with a girlfriend. This man was from Germany and here in the US studying English. I don't know how many other women he may have slept with before me. I did later find out that this man was actually married. I also kept in touch with him via email up until recently when I married. If he does have HIV he seems to be doing well and does not know he has it. - (I have been very tempted to ask him if he has been tested but I have not).

This is why I am very worried now Dr. Bob:

1. After this incident I did test for everything except for hiv and all came out negative. Then, several months ago my OBGYN told me I have both mild & moderate dypslasia. This was not a huge surprise to me as I was diagnosed with mild dysplasia & a high risk strand of HPV 6 years ago at which time I had it frozen and tested for all STDs including HIV. All tests were negative. HIV never even crossed my mind until I began reading about dysplasia and found that hiv+ women have a higher risk of developing it.

2. Next, I became increasingly alarmed as I read about ARS and recalled falling ill about 6 weeks after this incident with this man. I remember suddenly becoming very tired for a couple of days, I believe I had a slight fever (I never felt hot enough to take my temperature though), I also got a very sore throat. The tiredness only lasted for a couple of days but the sore throat turned into a really bad cough which prompted me to go to the doctor - because I was coughing so badly. He didn't mention swollen lymph nodes or anything and checked me for strep - didn't have it. He gave me some antibiotics which took care of whatever I had. I didn't have a rash or any of the other symptoms but could the symptoms that I did have and the timing of them be a sign of hiv infection? I was working crazy hours during this time, smoking, and sleeping in front of a very chilly window (I ended up moving my bed).

3. This is the last and most recent thing which has me TOTALLY freaked out!!!!! 5 months after I slept with this man (about 2 and 1/2 years ago) I developed a acne/rash-like problem on my chest. I thought it was hormonal acne as I had just turned 30 and went to several dermatologists who all said it was acne and gave me medicine which seemed to help but never really got rid of it. Recently, I got really fed up - it is not nearly as bad as it was when I first got it but still there and ofcourse it is unattractive. My husband and I moved cities recently and I went to a dermatologist here who visually diagnosed it as molluscum! She took a biopsy of it which will confirm it (I don't have the results back yet) but she is pretty sure that it is molluscum. It is strictly on my chest - she checked my legs and everything. I was upset in the office when she gave me this diagnosis as I have read so much info about HIV I know this is one of the symptoms of the illness. I asked her if it is common to catch molluscum and she said it is very common. She said I could have gotten it from a swimming pool, a towel, or from a child. She gave me some Retin-A which she said treats this and acne to use until we get the final result back. So, my question is would it be unusual to develop hiv related molluscum only 5 months after an initial infection?

4. My final question is 3 years after infection would it be unusual for me to demonstrate no additional signs of hiv. I have read that most people at least become unusually tired in this time period. Is this true?

5. What do you think my chances are of having contracted this illness?

I know the only way to know for sure is to get tested but I am absolutely TERRIFIED of the possibility of having it. I honestly don't know if I could handle it. At the same time, if I had it I would be exposing my husband to it by not knowing.

Dr. Bob, it seems I am in a very low-risk group. The man I slept with was not a drug user, he was heterosexual, but, I guess I really don't know much about his sexual history as I barely knew him. I do know that he was not concerned enough to use protection with me. I am very, very worried, Dr. Bob. Please, please write back to me.

ps I go back next week to see if the dysplasia has regressed on it's own. I was on BC pills and smoking at the time. I have quit both - heard that both things can trigger dysplasia. On the internet though, all info frequently associated moluscum with immunosurpressed individuals. I feel totally healthy otherwise however.

Dr. Bob, I know you are positive. Can I ask what your symptoms were at 3 years after infection? Were you already on medicine at this time? You know so much about this illness and you have helped so many people. You are really making a difference in people's lives by educating us with this site. I would like to make a donation. Please let me know where to send the check?

Thank you so much for your time and please, please reply Dr. Bob!

Response from Dr. Frascino

Hello,

Your HIV risk is two unprotected "soft"-sex encounters with a German dude of unknown HIV status. Your "chances of having contracted HIV" are exactly the same as those of anyone else who had a similar level of exposure. To put things in perspective, I can advise you that the estimated per-act risk for acquiring HIV from unprotected receptive penile-vaginal sex with a partner confirmed to be HIV positive is 1 in 1,000 exposures.

Symptoms, no matter what they are, are notoriously unreliable in predicting who has contracted the illness. The reason to get tested is that you placed yourself at risk, not that you've developed this or that symptom. Consequently, you need to get an HIV test and stop driving yourself nuts worrying about symptoms that most likely have absolutely nothing to do with HIV.

I agree having an HPV strain that is associated with dysplasia is the cause of your abnormal Pap. Follow up with your OB-GYN for this problem.

Your other "symptoms" the sore throat/cough and your chest rash (acne vs. molluscum) most likely have nothing to do with HIV. These are extremely common ailments and the vast majority of cases yes, even the molluscum, if that's what you have have absolutely nothing to do with immunodeficiency or HIV disease.

Can someone three years after HIV infection be asymptomatic? Yes. As a matter of fact, I was asymptomatic three years after my seroconversion in January of 1991. (I didn't start antiretrovirals until October 1995.)

You are correct: the only way to know for sure whether or not you've contracted HIV is to get an HIV test. And that is exactly what you need to do. As for your comment about not knowing if you could handle "knowing," it seems to me you're having considerable difficulty handling "not knowing." I anticipate that will only get worse with time and additional worry, anxiety and guilt about possibly exposing your husband.

You already know exactly what you need to do. Terrified or not, it's the only way.

1. Level with your husband. Let him help you cope with your anxiety and fears. You can use condoms until your negative HIV status is confirmed (as I strongly suspect it will be) just to take him out of harm's way and decrease your guilt/stress levels.

2. Get an HIV rapid test. The results are available in as little as 20 minutes! The odds are all in your favor that you did not contract HIV from your German fling. Your WOO-HOO is waiting for you just 20 minutes away!!!

Thanks for your willingness to make a tax-deductible gift to The Robert James Frascino AIDS Foundation. The Foundation's address is:

The Robert James Frascino AIDS Foundation 1000 Fremont Ave., Suite 145 Los Altos, CA 94024

In return, I'm sending you my best good-luck karma that your HIV test will be negative. I am quite confident it will indeed be negative, OK? I'll be waiting for your WOO-HOO! And would love to get that news in say 20 minutes or so . . . OK?

Good luck!

Dr. Bob



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