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5 questions, 5 minutes of your time. Living in fear.
Mar 20, 2007

Dear Dr. Robert: I misplaced the questions in the fatigue and anemia forum, I think the questions are for this forum. I am sorry.

First of all excuse my English as I am not a native English language speaker. Second: thank you very much for the opportunity to consult a top professional.

Facts:

May 2006: Negative Elisa Test after 3 months of last risky encounter. September 2006: received oral sex, without condom, from an unknown status guy. October 2006: gave oral sex to an unknown status guy (no ejaculation, brief period of 30 seconds) then protected anal sex, the guy ejaculated but the condom did not break (I was the receptive partner).

One week after the October encounter I developed a dyspnea (I am asthmatic but this was a dyspnea without the wheezing and with a cracking sound in my lungs), very sharp pain in tonsils (also swollen and in a couple of times in the night I felt them pulsing and like blocking my ears), a sore throat, a mild, dry cough; sharp pain in armpits, and, a month and a half later, sharp pain in groin area; and a skin desquamation in hands and feet.

I have to say you that afer the dyspnea and tonsils episode, I made the mistake to search symptoms over the internet and searched for Hiv and dyspnea, and, of course, found relations between these words (swollen pulmonary glands due to hiv, or pulmonary symptons due to PCP, etc.). I became paralyzed and terrified, as I am a married man, and I self-diagnosed with HIV, and also saw many symptoms in my wife (she had a sore-throat, 2 days with fever, a chest rash and a not normal pap).

I did not have fever or other symptoms in the last 5 months (but living in fear). Now I do not have dyspnea, but the tonsils sharp pain, armpits and groin pain are ocassionally present. I am waiting for the 6 months mark to test.

Please let me ask you these questions (Due to the odds I am disregarding the september oral sex episode):

1) Are these symptoms consistent with ARS? 2) Could the dyspnea and the cracking sound be triggered by PCP so soon? 3) Are you aware of any STD (except HIV) consistent with these symptoms? 4) Would you recommend an HIV test for anyone involved in an episode similar the one I had in October? 5) Could my mind and anxiety be triggering the armpit and groin area pain, and the skin desquamation after the internet search?

Thank you Dr.

Carlos E.

Response from Dr. Frascino

Hello Carlos,

Gosh, yet another married man having man-on-man sex on the down-low who develops some symptoms and then, with the help of an Internet search, self-diagnoses HIV disease!!! You're at least the 10th one this week! Like all the others (check the archives), your problem has much more to do with guilt surrounding your clandestine gay encounters than HIV infection.

Proceeding directly to your five questions:

1. No. They are consistent with a viral illness, but not HIV.

2. No. Your symptoms and disease course were not consistent with PCP.

3. No. Most likely you developed a respiratory tract infection, rather than an STD.

4. Your HIV risks are extremely low (unprotected oral, protected anal receptive); however, I do recommend periodic HIV screening for sexually active folks with multiple partners. Also, I recommend HIV screening for anyone who is worried that he or she may have placed him or herself at risk for HIV. The screening test should be performed three months after the last potential exposure.

5. Anxiety could be contributing; however, in light of the constellation of symptoms you experienced -- sore throat, cough, bronchospasm, skin desquamation, etc. -- chances are you did have a viral (not HIV) illness.

Finally, what to do!?!

1. I strongly recommend you level with your wife. It's not only the best way to confront your guilt over your actions; it's also the right thing to do.

2. Get HIV tested three months after your last potential exposure.

3. Consider counseling to help with your irrational fears of being HIV infected and also to address underlying sexual orientation issues.

Good luck, Carlos!

Dr. Bob



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