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Resubmitted form the Fatigue and Anemia Forum: My odds & HIV
Oct 30, 2006

Heya Dr Bob,

I've been reading thebody.com for a while now and really do appreciate the constant replying you do (dont you ever get a little tired of it all?) =)

I'm a 22 year old heterosexual male from Sydney (but a really horny one). I had a one time exposure with a transvestite prostitute (male). The condom broke and I dont know how long my whole penis was exposed but it wouldn't have been no longer than 2 minutes, I mean a sex worked would notice early right? I reapplied a new condom and did not ejaculate.

I asked the sex worker if they had anything and they said no, but of course you really never can be sure about these things.

At 5 weeks post exposure I got a really sore throat (new girlfriend was sick with same thing at the time I got it of course!), enlarged lymph nodes under jaw and one side of neck, some red bumps here and there (could count them on one and a half hands), small rashes on back of hands, perhaps a low grade fever for a half a day(37.4C armpit temp on a 40C degree day after bball game). It all went away in about two weeks but then I started getting joint aches and nightsweats, now gone. You know... the standard stuff all WW's get!

At 5.5 weeks I tested negative (p24 antigen and antibody sandwhich ELISA), at 8 weeks I also tested negative and have now taken a test at 11 weeks, results pending.

How do you rate my risk factor, odds of contracting HIV from such an exposure and would you recommend that I take my 13 weeks results as conclusive?

Also would I have started seroconverting at the time I experienced these symptoms (5 weeks post exposure)? And if I had started seroconverting at that time would my 8 week test detect sufficient antibodies?

Much appreciated!! In peace and love, Your #1 Aussie fan. =D

Response from Dr. Frascino

Hello "Really Horny" #1 Aussie Fan,

"Number 1 Aussie Fan?????" Hmmmm . . . I'm not sure about that. I've heard you have some "stiff" competition on Oxford Street, Paddington.

Your HIV risk broken-condom sex with tranny of unknown HIV status. I'm assuming this was backdoor action, right? The estimated risk of unprotected (including broken-condom) insertive anal sex with a partner confirmed to be HIV positive is 6.5 per 10,000 exposures. Your estimated risk would be somewhat less, as we don't know your tranny's status.

Could you experience seroconversion symptoms five weeks post-exposure? Yes, it's possible.

If you were "seroconverting" at five weeks, would you have detectable anti-HIV antibodies by week eight? The immune response, including the development of antibodies, varies from person to person. It is possible that you would test HIV-antibody positive in the hypothetical situation you propose.

Would a 13-week test be conclusive? Yes. HIV-antibody tests taken prior to three months, such as your 5.5-week and 11-week tests, are not considered definitive or conclusive. Certainly your negative tests to date are encouraging; however, they are not conclusive.

Finally, I have a question for you: aren't all 22-year-old Sydney studs "really horny?" I've never met one that wasn't. Maybe horniness is directly proportional to the ingestion of Vegemite!?!

Good luck on your 13-week conclusive test.

Dr. Bob



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