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asking for the 3rd time, please help
Apr 6, 2007

Dear Dr. Bob,

I am hoping 3rd time's a charm in getting you to answer my question. I know you are a busy man and are probably sick of answering questions like this but I wouldn't be asking you if I wasn't losing my mind over this. I have no one else to ask. I had oral sex with an HIV positive man and all I want to know is if my symptoms suggest HIV to you.

Day 21 post exposure: chills, abdominal pain, nausea, vomiting (10 times in 4 hours), headache and fever of 102F. Day 22: felt almost completely better, but with a headache and fever of 100F at night. Day 23: felt entirely better and no fever Day 26: bean-sized swollen lymph node in the front of my neck (right side) by the pulse. Has been swollen for 6 weeks now. complete blood count normal except for a slightly elevated basophil count.

8 weeks: deep cough with white phlegm, mildly sore throat, aching leg muscles, fatigue and "sick feeling" but no fever. These symptoms persisted about a week with a few more days of lingering cough and stuffy nose. Lymph node in neck still swollen and now I also have another swollen pea-sized one behind my right ear and pain in my left armpit but can't feel anything swollen there. 8.5-9 weeks: itchy red rash on front of neck

Thank you Dr. Bob for your amazing work and for your time! I will donate whether or not you respond to this when I get my neck paycheck because your organization is wonderful and I appreciate your work regardless.

Response from Dr. Frascino

Hi,

Symptoms, no matter what they are, are notoriously unreliable in predicting who is and is not HIV infected. If someone has placed themselves at risk for HIV, they need to be HIV tested at the three-month mark, whether they are completely symptom free or if they have every symptom in the book.

I can't diagnose your symptoms over the Internet, but I can say they are not worrisome to me. (Your short-lived symptoms at day 21 sound more like acute viral (non-HIV) gastroenteritis. Your isolated lymph node enlargement is not consistent with ARS. Your symptoms eight weeks out would be too distant from your potential exposures, etc., etc., etc.)

What I can do is advise you of your level of risk. Oral sex carries only a very small risk for HIV transmission. I've written about the estimated statistical risks for unprotected insertive and receptive oral sex many times in this forum and you can review those comments in the archives.

Thank you for your donation. Try not to freak out during the window period. Focus on the fact that your HIV risk is minimal at best. I'll send my good-luck karma that your definitive three-month HIV test is negative, OK? I strongly suspect it indeed will be negative.

Dr. Bob



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