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freaked out pianist - $100 donation made
Nov 6, 2007

Hi Dr. Bob, Ive just made a contribution to your AIDS Foundation (ref# ETHE1D4AE017), and would encourage your other readers who are financially able to do the same. I have been living in hell for the past six months, and would greatly appreciate your sage advice. Please bear with my rather long-winded history.

In May of this year, I made the unfortunate choice to visit a sex worker. The girl was Korean and, judging from her poor English, has not been in this country for very long. Although I used a condom for vaginal intercourse, Im pretty sure that it was slipping around a bit due to the use of lubrication and the fact that I wasnt completely aroused. At any rate, I wasnt able to ejaculate inside and she eventually climbed off. I noticed that the condom, although still on my penis, was only covering to about one inch past the glans. She removed the condom and soon after brought me to orgasm with a hand job and the use of lubrication.

The very next day, I started experiencing symptoms which lasted for one week. These included: achy chest and arms, headaches, and a throbbing feeling on both sides of my neck. One week post exposure I had an STD panel including an hiv EIA, all negative. I experienced no symptoms for the next six weeks. Seven weeks post exposure, I started experiencing the following symptoms: a noticeably yellow tongue, extreme fatigue, weak and achy muscles, diarrhea, and frequent burping. These symptoms have all been more or less chronic and have continued to this day, six months post exposure.

I had a CBC with differential at 3 months, which showed low lymphocytes (13%) and high neutrophils (80%), with a total WBC of 4800. I had a repeat CBC at 3.5 months, which again showed low lymphocytes (15.7%) and relatively high neutrophils (74%), with a total WBC of 5300. I had a PCR DNA test as well as a pooled NAT test done at 4 months, both non-reactive. In addition, I recently (6 months post exposure) had an hiv 1/2 rapid test done, which was negative. My questions/comments are the following:

1) How risky would you consider my encounter, considering there was most likely vaginal fluid on the shaft of my penis when she gave me a hand job.

2) Although Im pretty confident I dont have hiv-1 subtype B, I have read a lot of information about the prevalence of hiv-1 subtype CRF01_AE amongst the hiv+ hetero community in Korea, as well as its increased transmission risk in comparison with subtype B. Ive also read that the PCR DNA and NAT tests are optimized in this country to detect subtype B, and are generally not as effective in picking up other types. How concerned should I be that my tests have missed non-B subtypes?

3) Im going to have another CBC soon. In the event that I continue to have lymphocytopenia, would you recommend that I see an infectious disease specialist and be tested for CD4% and PCR RNA viral load? I wouldnt be so freaked out if it werent for my abnormal CBCs and continuing symptoms.

Thank you SO much for your advice. I appreciate your great sense of humor, compassion, and wisdom. I have spent much time reading comments from doctors on this and other forums, and have come to the conclusion that this is indeed a very rare combination. Please stay healthy and continue the amazing work that you do. By the way, Im a fellow pianist. Have you listened to Martha Argerichs recording of Schumanns Fantasie? Its unbelievable.

Thanks again, Tickler of the ivories

Response from Dr. Frascino

Hello Tickler of the Ivories,

First, thank you for your donation to The Robert James Frascino AIDS Foundation (www.concertedeffort.org) and your very kind comments. Both are warmly appreciated.

Next, you can't judge how long a person has been in the U.S. based on poor English skills. Using that criterion, Dubya would be a recent unschooled immigrant. Of course even a recent unschooled immigrant could do a better job of communicating (and running this country) than Dubya, but that's another story.

So, on to your problem or, more accurately, non-problem!

Regarding risk, your condom may have slipped, but the business end of your tallywhacker remained latex enshrined. Therefore your HIV risk was negligible at best.

As for symptoms, whatever you experienced beginning "the very next day" and lasting for one week could not have been HIV related. ARS (acute retroviral syndrome) symptoms take weeks to become manifest following primary HIV infection.

The symptoms that showed up at week seven are not suggestive of or worrisome for HIV ARS.

Your laboratory results also do not suggest HIV in any way shape or form! Your negative HIV-1/HIV-2 at six months plus your negative PCR DNA and NAT at four months are absolutely definitive and conclusive. The mild (and resolving) CBC abnormalities are not suggestive of HIV!

To respond to your specific queries:

1. Vaginal fluid on the shaft of the penis is not a risk for HIV. The virus can not penetrate intact skin. The shaft of the penis is covered with skin. The mucous membrane, which can absorb HIV, is limited to the urethra (pee hole).

2. Your chances of contracting a non-B subtype from the activities you describe and not have it be detected by the testing you've had to date are nonexistent.

3. Your CBC abnormalities are absolutely not related to HIV, because you do not have HIV! I can't diagnose the exact cause over the internet, but these types of mild abnormalities are extremely common and often resolve spontaneously with time. Don't perseverate on an illness you could not possibly have. Proceeding on with PCR RNA, CD4 subset analysis and infectious disease consultation is not warranted! Save your money. Buy all of Martha Argerich's CDs instead. It's a much better and more worthwhile investment.

Regarding the 88s, yes, Argerich is phenomenal. I've seen her perform several times and it's been magical.

Now stop worrying and yell WOO-HOO, OK? And get back to the piano and practice that Fantasy. The second movement's triumphal march (in E flat) has some very tricky jumps in the coda.

Be well. Stay well. (You are indeed well!)

Dr. Bob



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