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Need Your Opinion-The "Whole Story" Guy

Oct 20, 2006

Dr. Frascino,

Thank you for your previous responses to my Whole Story. Things have gradually been getting back to normal since my 16.5 week negative HIV test. My wife and I have been doing well and have become intimate again. I am lucky and happy my wife has allowed me to put this behind us.

Undeniably, I still have minor concerns about my HIV status. Mainly because of my persistent symptoms of swollen neck lymph nodes, anomalies of the tongue, mouth and lips, that often burn or become sensitive, periodic sore throat and difficulty swallowing. I have had my GP, ENT, and Dentist look into these. They all agree that I have apthous ulcers. My GP thinks the tiny cluster of blister like bumps on my lips are fordyce spots and my dentist thinks it is a fungal infection (thrush). My GP prescribed me Kenalog throat paste for inside my mouth and my dentist prescribed me Nystatin cream for what he thinks is thrush on my lips. Anyway, I know you cant diagnose this over the internet, but my question is

My wife and I started having unprotected sex again. I felt comfortable doing this with my excessive negative tests out to 16.5 weeks. However, with these frickin symptoms (especially my dentist suspecting thrush!), I am confused about this. I would really like to know your opinion about unprotected (monogamous) sex with my wife at this point. I do plan on having an HIV test again after six months.

Thanks and my second donation to the concerted effort is on its way!

Mark

P.S.- You should think about bringing a concert event to the Ann Arbor Art Fair in the summer. It would be a great place to showcase your talents and bring awareness to the concerted effort. Let me know, Id love to offer assistance here for you.

Response from Dr. Frascino

Hey Mark,

Well things may be heading in the right direction, but I wouldn't say they are "back to normal" yet, if you are still worried about possible HIV disease, despite "excessive negative tests out to 16.5 weeks!"

Mark, please note that the vast majority of cases of aphthous ulcers, Fordyce spots and even documented cases of thrush have absolutely nothing to do with HIV/AIDS. This certainly applies to your case, as you have incontrovertible evidence that HIV is not your problem. No way. No how.

Do I think it's safe from an HIV perspective for you to resume unprotected monogamous sex with your wife? Absofrickinlutely! Go get her you stud you!

I agree the Ann Arbor Art Fair would be a fine venue for a Concerted Effort event one of these years!

I'll reprint your original questions below.

Stay safe. Stay well. Be well.

Dr. Bob

The Whole Story Aug 19, 2006

Dr. Frascino,

I have written a few times before about my situation. I am a 32 year old male. I am married with a two year old daughter. I love both of them with all my heart and would never want to intentionally bring fright to them (Although it seems I managed too). My wife is a loving, caring women and I may have destroyed the most promising life I could imagine.

I know many people have vices. Some do drugs, smoke and some drink alcohol. While I have sampled some recreational drugs, tobacco and alcohol, my main vice is sex. About the time my birthday comes around every other year I would get antsy to try someone different than my wife. Terrible, huh! I have had about five of these experiences over the course of about ten years. I happen to have found a self-described prestigious dating service on-line. I am not sure if $300 an hour is considered upscale but the photos of the woman were pretty exact to what I saw. 34DD(enhanced)-24-34 hot-looking-redhead. I guess the excitement of doing something deviant had its stimulation as well. But how long could I expect to go on doing it without an incident like this.

On May 31, 2006, I recieved 10 to 15 min. of unprotected oral sex from the female sex worker and brief protected vaginal intercourse. I pulled out and remember pulling off what I believe to be an intact condom and ejaculated on her breasts. Rested for a little while and then received another session of unprotected oral sex and sex with her breast to which I ejaculated on again. After the second orgasm I took a shower. From this encounter I contracted gonorrhea, which I can only assume came from her throat. A little over a month after I was diagnosed with mono by a + mono spot. (The prostitute and I did do some brief light French kissing. Is that enough to pass mono or can it be sexually transmitted?). I asked the Dr. if it was EBV or CMV and she thought the mono spot only detected EBV. So who knows about CMV. Also I have experienced every symptom in the book. Swollen glands, sore throat (+ strep), mouth ulcers and sores, lip ulcers and herpe like small blisters in the corners, sharp pains everywhere, numb toe, limbs falling asleep more often, a period of night sweats and diarrhea, AST/ALT elevated (has gone down on last test), over-all ill feeling. Of course the mono can be blamed for everything as well as the stress and anxiety. My tests were as follows:

1. Friday, June 9, 2006 One Week +2 Days after possible exposure. HIV antibody w/reflex (my Doctor). NEGATIVE HEP A,B,C. NEGATIVE

2. Friday, June 16, 2006 - Two Weeks +2 Days after possible exposure. HIV PCR DNA (On-line site through Labcorp). NEGATIVE

3. Monday, June 26, 2006 Three Weeks +5 Days after possible exposure. HIV PCR DNA (On-Line site through Labcorp). NEGATIIVE

4. Thursday, July 6, 2006-Five Weeks +1 Day after possible exposure. HIV PCR DNA and ELISA (On-Line site through Labcorp). NEGATIVE

5. Monday, July 24, 2006-Seven Weeks +5 Days after possible exposure. HIV antibody w/reflex (my Doctor). NEGATIVE HEP A,B,C. NEGATIVE

6. Thusrday July 27, 2006-Eight Weeks +1 Day after possible exposure. HIV PCR DNA and ELISA (On-Line site through Labcorp). NEGATIVE

I know this is classic worried well syndrome, but I can barely stand this anxiety and stress over what I have done and how this would affect our life. I have read through these archives continuously looking for situations similar to mine. I can expect the usual three month waiting period, and the HIV PCR DNA not-recommended response, but honestly, what do you make of these test results? I am still going to go to my doctor for a three month test (and 6 mos). Should I go in at exactly the twelve week mark, in-between 12-13 weeks or exactly thirteen weeks? I know I am crazy. My doctor did prescribe me lexapro and niravam for the depression and anxiety. Your thoughts on this are greatly appreciated and youre probably thinking what a waste of money on the HIV PCR DNA test. I read so many different opinions on this test, pros and cons. Each time I read cons I freak. I promise to donate the amount I spent on the tests to your foundation (over time, I do need to recoup). You are a great guy and caring doctor, I am sorry that HIV has inflicted your life. As one of your previous forum writers put it Do we really need another disease, isnt cancer and all the others enough. Especially when you can get this-a life ending disease, from something as great as sex. Gonnorhea would have been good enough for me to change my life. Your thoughts and karma are greatly appreciated, and I will update you on my outcomes. Thank you.

Mark

Response from Dr. Frascino

Hey Mark,

OK, so you are not a saint. Who the hell is? Yes, you've "sampled some recreational drugs, tobacco, and alcohol" and OK, your "main vice is sex." Just as an aside, tell me about " . . . my birthday comes around every other year . . . ."! That sounds great. How can I get mine to do that? Gosh, if I knew how to do that trick, I'd still be in my twenties (instead of just acting like I'm in my twenties). OK, back to your problem . . . . Your every-other-year-birthday sexcapades followed safer sexual practices for which you should be commended! (No points for stepping out on the Mrs., but at least you tried to do it safely.)

It's unfortunate that 34DD-redhead turned out to be a high-priced germ factory. Yes, indeed, I agree you contracted gonorrhea from her throat and mono from the "brief light French kissing." (Mono is frequently referred to as "the kissing disease.") You are also correct that your "every symptom in the book" can be attributed to these two illnesses. One point to stress is that both gonorrhea and mono are much more easily contracted than HIV.

Turning now to your numerous HIV tests (yes, I would call it excessive), you've had three negative HIV-antibody tests out to eight weeks and four negative DNA PCR tests out to eight weeks. Since you obviously have already thoroughly mastered my advice pertaining to (1) the three-month waiting period to get a definitive ELISA result and (2) PCR testing not being recommended for routine HIV screening, I won't bother to reiterate it again in detail here other than to say those tenets still hold, so consider them said, OK? As for HIV DNA PCR testing, it's a qualitative test used to detect cell-associated proviral DNA. It is not considered to be sufficiently accurate for HIV diagnosis without confirmation.

Regarding your question about 12-, 12.5- or 13-week tests, it really makes no difference in this case. Your HIV risk unprotected oral sex- is extremely low and your myriad of tests to date is extraordinarily encouraging that you did not contract HIV from Miss Redhead Double D.

It does appear you are experiencing considerable anxiety, depression and guilt over this entire issue. I'd recommend some counseling to help you confront these very real medical problems. I'm assuming you've leveled with your wife. If not, I'd recommend that as well for multiple reasons: (1) she may need to be checked for gonorrhea and mono and (2) it's the right thing to do.

Depending on how she's handling this situation, couples counseling may help to patch things up between you, as you obviously love your wife and your family very much.

Thank you for your kind comments and donation. In return I'm sending you my very best good-luck/good-health karma (it hasn't failed yet!) that your definitive HIV test at three months confirms what I very strongly suspect: that you are HIV negative. I'll look forward to officially WOO-HOO-ing with you soon. OK?

Good luck.

Dr. Bob



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