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Failed attempted at safe sex with a lady. Please help?
Nov 6, 2007

Dear Doctor Bob,

I find myself here disappointed and disgusted that I am even in a situation where I need such council. The only consolation I have for my own dignity is that I did do as you should to prevent the situation without taking in to consideration the actual act involved.

I had a stupid encounter with a mate of mine in Thailand just 3 days ago with a well there is no nice way of saying it prostitute. During what I am fairly certain to be the last 60 seconds I ejaculated only to find I was without a condom. I mean it was nowhere to be found. I believe I was protected for all other penetration up until this point. I had been using them (more than one due to a swapping of sexual activities) but to this moment I truly do not know what happened in the end. He on the other hand was protected throughout.

I sought medical attention and was on PEP (Zilarvir), Doxycycline and Clinovir (for herpes) within 15 hours of the encounter. I then spent the next two nights looking for and finally finding the lady in question. I persuaded her to come with me to a doctor who had told me he would open the clinic any day or night with 30 mins notice to have her tested for me. The kindness of this man is of the highest order and I do not know why he would care so much about a stranger. I am hoping and praying for a 2 for 2 with this my second of two great asks of two good men.

The blood test for HIV & Syphilis was negative. He then performed an internal examination and test on her and found a slight infection. The side effects of this cocktail of drugs on me are awful. The constant nausea, disorientation, body aches and fatigue are affecting my ability to function normally however please do not see this as a whinge. I am here due to my own poor choices.

His advice to me is/was: Discontinue the use of the Zilarvir and Clinovir as he feels they are no longer warranted. Continue using the Doxycycline for one week and not the month that he originally prescribed He went on to say that only 1% of the working population in Thailand are HIV positive.

My questions to you are: Do you believe this to be a correct assessment (the removal or the non-necessity of these drugs post negative result)? I obviously would like not to feel this ill for a month however I am sure you will see to it should you feel it is required. Given the 6 week window HIV has, what is the likelihood if it can not show up on a test, that it could be transmitted if present? Is this due to low viral load? What are the statistical odds of a white anglo-saxon male (if this counts for anything) contracting AIDS from someone who returns an initial negative result?

I am sorry if this has been slightly long winded however I feel that more information is better than less when trying to make comment on it.

I appreciate any assistance you can give me and of course will make a donation to your foundation should any be forthcoming.

Thank You Dr.

Response from Dr. Frascino

Hi,

The condom was nowhere to be found? Hmmm . . . perhaps your hooker's love triangle is a Bermuda triangle??? No matter, unprotected is unprotected. That you only banged cock in Bangkok unprotected for 60 seconds would mean your potential exposure was brief. That your Thai Three-Way Gal tested HIV negative decreases your HIV-transmission risk very significantly. You are correct in assuming that now your only risk is that Thai-Gal was in her window period, during which she would be HIV infected but not yet registering detectable levels of anti-HIV antibodies and thereby testing negative on screening HIV-antibody tests. (During this period a person with primary HIV infection could have a very high viral load and be quite infectious.) The chances of her being in her window period are remote at best.

So on to your specific questions:

1. Your HIV-transmission risk, considering all of the above, is very low, but not completely nonexistent. PEP is generally recommended only when there is a significant HIV exposure. Considering you are not tolerating your Zilarvir (AZT + 3TC), well, I believe it's reasonable to discontinue your PEP and retest at the three-month mark.

2. I discussed your HIV-transmission risk above. Your statistical risk would be extremely low, but not completely nonexistent. (In the very unlikely scenario she was in her window period, her viral load would be expected to be very high, not low.)

3. There are no estimated statistics for this hypothetical situation. The number would be vanishingly small.

Finally, please note my work here is free and available to all. Donations to The Robert James Frascino AIDS Foundation, while very much appreciated, should only be given in the spirit of compassion and generosity and not as an inducement to encourage me to respond to a question.

Good luck! I'm here if you need me.

Dr. Bob



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