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Too many symptoms to be just a coincidence
Mar 15, 2007

Dear Dr Frascino,

I am truly sorry about your brother and I wish you strength during this difficult time. I also want to thank you for the invaluable work you are doing. I have frequented this site for over a year now and I finally decided to ask a question or actually quite a few questions.

I am a 30 year old male living in a central European country i.e. away from my home, which is up North in Scandinavia. I moved here last fall, and as I have not yet been able to find close friends here, I feel particularly vulnerable with my fears, which are having a paralyzing effect on my life now.

About 15 months ago, I had sex with an hiv+ man. Prior to having sex, however, we discussed safe sex, and he told me that he had recently been tested and he is negative. In other words, he lied to me. His reassurance made me take risks that I would normally not take. He also told me that he works for an hiv-prevention/awareness organization, which attempts to reduce the infections among intra venous drug users. This further reassured me.

This is what happened: I was the receptive partner in anal intercourse, which occurred two times during that night. Condom was used for the intercourse, and as far as I remember/noticed, it did not break. Water based lubricant was not available, so saliva & some lotion were used for lubrication. He did not ejaculate inside me. However, just before he ejaculated, he pulled out, took the condom off and I finished him off with my mouth. Thus, he ejaculated two times into my mouth. I do not remember having sores in my mouth, but then again, I suppose minor cuts and sores may go unnoticed.

Four days after the incident, I fell sick. I had fever and a sore throat. After a while (a week or two) I also developed aphthous ulcers in my mouth, which I only remember having had around the age 20. At that time, I was not worried, as I still believed that he was negative. I now assume that this may have been ARS. What do you think?

Later, out of curiosity, I typed his name into Google and discovered that he is an active member of an association for hiv-positive people. I called him and he finally admitted having been positive for over 10 years. This is when I became totally devastated. I asked him abut his viral load, and he told that it had been undetectable ever since he started medication. However, I am painfully aware that undetectable plasma viral load does not mean that there was no virus in his semen. And I cannot be sure if he lied about that, too, just as he lied about his hiv-status in the first place.

My best friend is a medical doctor, but hiv is not his specialty. He told me that I was probably negative and that I should calm down, which I did. I gathered all the information available and concluded that is was unlikely that I was infected. I did not get tested, partly because I was scared, and partly because I later on forgot the issue.

Then I developed a small wart like thing in my mouth about 2-3 months after the exposure. My dentist said that it is nothing that he knows a name for, but does not look dangerous. And then, in July (i.e. 7-8months after the exposure) I got a very painful anal fissure/tear, which lead to an even more painful infection of my anus and the surrounding area. My doctor said she did not know what it was, and she consulted a gastroenterologist, who asked whether I had hiv. His suspicion might have been due to the fact that he was informed that I was a gay man engaging in receptive anal sex. Nevertheless, I got extremely scared again.

My second actual question is: would hiv cause such symptoms as early as after 8 months from initial infection?

I was trying to figure out other causes, (other than hiv) but I could not think of anything else, except that I had had protected anal sex which could have ruptured my anus and subsequently caused the infection. At that time, I was also trying to lose weight, and I was using a medicine called Xenical, which caused me very frequent need to use the bathroom (actually, diarrhea). I was thinking whether such mechanical irritations could have lead to my infection. The infection healed in a couple of weeks with antibiotics, topical creams and herpes and fungus medications (the doctor prescribed all of them, since she didnt know what was the cause and I was so much in pain I couldnt go to the toilet).

Last August, I moved from my home country. This obviously caused a lot of stress to me. I was also under a lot of stress because my huge workload in my new job. I hope that stress - and not hiv - was the reason why I developed seborrheic dermatitis. I have had it (or similar problems) in my scalp already many years ago, i.e. before my exposure to hiv. However, this time I had it also on my face. My habits of washing my face with a cleanser once/twice a day decreased, as I worked such long days that I would just go straight to bed (I know, a very poor excuse indeed). Thus, Im asking, could this poorer hygiene, accompanied with stress and the use of oily moisturisers have lead to my seborrheic dermatitis, instead of hiv? I suppose it is worth noting, that I am wearing a hairpiece, and the seborrheic dermatitis also appeared close to the area where the hairpiece is glued onto my scalp, i.e. upper forehead, above temples. But I am definitely not allergic to the glue, as I have used the same adhesive for a long time.

Seborrheic dermatitis and the anal infection seem so obscure and typical of hiv, that I am worried to death. Do such symptoms appear during the first year of infection? I thought that there should be an asymptomatic phase, but then again I have heard doctors saying that seborrheic dermatitis is one of the most typical first manifestations of hiv, appearing at the early stages of infection. Well how early is early?

Dr Frascino, I know that I need to get tested. I would just love to get your opinion and maybe some reassurance from you. Even with the help of sleeping pills, I cannot sleep more than a few hours per night, because I am so worried.

I wish you all the best from the bottom f my heart.

-Nordic guy

Response from Dr. Frascino

Hello Nordic Guy,

Do I think you are HIV positive? No, I do not. Statistically, the odds would be astronomically against your having contracted the virus, based on what you've told me.

Your risk is oral receptive sex with an HIV-positive dude who has difficulty telling his partners the truth about his HIV status. (In other words, a real scumbag!) The estimated per-act risk for acquiring HIV from unprotected receptive oral sex with an HIV+ scumbag is 1 in 10,000 exposures. Your receptive anal sex would not be considered a risk if the latex condom was used properly and did not fail. I would not recommend using "lotion" as a lubricant, as some lotions may contain oil-based products that can harm the integrity of the latex.

Your symptoms four days after your trick-and-treat sex-fest would not be due to HIV ARS, as symptoms associated with acute retroviral syndrome generally take weeks, not hours or days, to become manifest. Your "wart like thing" in your mouth and the painful anal fissure with subsequent infection are most likely red herrings and not related to HIV immunodeficiency. Likewise for the seborrheic dermatitis, if that is what it actually is. Remember, the vast majority of cases of seborrheic dermatitis have absolutely nothing to do with HIV.

Yes, Nordic Guy, I agree you need to get tested. You also need to stop procrastinating about doing so! All this worry and all the sleepless nights can be ended with a simple HIV rapid test. You'll have your definitive answer in just 20 minutes. That's less time than it's taken you to type out your question or me to type out my response. (I'm a shit typist.)

Good luck! Now get going and get tested!

Dr. Bob



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