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Scared & Ashamed II
Apr 11, 2008

Hi Dr. Bob, I've been to your forum so much. I've noticed you haven't been posting many responses lately. I hope your doing O.K. & that it's because your just taking a short break & it's nothing serious.

When & If you are able to respond to questions, I'm hoping your insight can help me out.

I posted a while back but not sure if you saw it. Anyway, my question is about the onset of ARS symptoms & their timetable & possible exposure.

O.K. here I go. About a month & a half ago 2/25/08 I stupidly had sex with a crack addict prostitute. I didn't assume she was until I saw her later. Well, the night we had sex I briefly penetrated her vaginally & unprotected for all of maybe 5 seconds( less than a minute for sure). When it became apparent to both of us that she was dry(no vaginal fluid) & decided to use lubricant. At that time I also donned a condom. She lubricated herself & we continued with vaginal & then anal. All protected with condom at theses times. As we continued I began to get turned off & started to lose my erection. The condom was slipping off during anal but when I withdrew the condom remained in her. I took it out & tried to reapply but I wasn't able to "get it up. Well even more stupid was that I tried to reinsert unprotected but couldn't because I was still limp. At this point I gave up & just touched her clitoris until he was satisfied. I didn't orgasm but I also fingered her anally pretty vigorously but didn't notice any blood or anything. Anyway after she was finished I left the room & immediately started questioning what the heck I had just done. I began to worry about HIV & STDs. Afterwards I asked her if she was ever tested for HIV or if she was clean. She responded as though she was not infected( she said she didn't have HIV but I don't know if I can believe her)she then said "you used a condom didn't you? what are you worrying about. I'm worrying about the unprotected portion of or act & the rough anal fingering episode. I have not seen her since but I continued to worry. I have had alot of symptoms that seem like ARS to me (joint aches, muscle twitching, white tongue). The white tongue seemed to appear about 2 to 3 weeks after the exposure but has since subsided. Then about a month later 3/22/08 I started to have diarrhea(or something like it). My stool was like water with some blood. Then it seemed to have mucous. That lasted for about 2 or 3 days . It then turned into severe constipation that seems to still be with me a bit ( I've been eating more food trying to keep my weight up & more fiber( little help). I noticed too that I might be suffering from lipodystrophy or atrophy (one of them) where my muscle seems to be dwindling,legs getting smaller, veins are popping up all over my arm like never before ( I'm already thin but it was never like this)& I seem to be thinner over all. Now I think I have Erythrodermic psoriasis. It's not red but it itches a little like my skin is drying up. I've been drinking gallons of water & Gatorade but nothing helps. I'm also urinating alot & sweating a little a night. I always sweat a little at night but now it has me paranoid. Since the flaky skin started my fingernails seem to hurt every so often near the cuticle too. So far I've had no fever, swollen lymphs, vomiting, or flu like illness but I do have a not so frequent dry cough & sneezing. After all that my question is this.

1) Can Erythrodermic psoriasis be a sign of the onset of HIV? Is it an ARS symptom?

2) Can HIV advance to AIDS a month and a half after exposure?

3) If it's not ARS, whatever it is do you think it is suppressing my immune system & how will this affect an HIV Orasure test? Can it prolong antibodies?

4) At this point will a 6 and a 1/2 weeks Orasure be helpful? Don't know if I can wait 3 months.

My head is also having fleeting headaches every so often ( 2 or 3 times a day).

Doc please I scared & sooo ashamed. I can't help but hate myself right now.

Anyway, Once again I do hope all is well with you & that you return soon. The world needs your assistance. Be Well, Stay Well. Hope to hear from you soon.

Thanks in advance, Scared & Ashamed

Response from Dr. Frascino

Hello,

First of all thank you for your concern. I know it may come as a surprise to some readers of this forum, but I actually do have responsibilities and a life outside of my volunteer efforts here at Safer Sex Central! Presently I'm in Montreal, Canada and my activities here prevented me from posting responses every day. However, I still will read every question that comes into the forum and will eventually respond to those that merit a personal reply. In the interim I, as always, encourage those seeking information or reassurance to check the archives. Over 99.9% of the questions submitted to this forum are similar to questions I have already responded to in the past. Check it out! Try the archives. You'll be glad you did!

Next, your specific questions:

1. Thinking you have "erythrodermic psoriasis" and actually having that condition are two very different things. Rather than worry this is a sign of the onset of HIV or a symptom of ARS, I would suggest you see a dermatologist to find out what's going on with your skin! To specifically answer your question, no, psoriasis is not an early sign of HIV or ARS.

2. No.

3. I do not believe your immune system is suppressed. Your fears are unwarranted, based on the information you presented. I see no reason your OraSure or any other HIV test would not be accurate.

4. HIV-antibody tests taken prior to the three-month mark are not considered to be definitive or conclusive.

Your HIV risk is brief unprotected penile-vaginal insertive sex and anal fingering with a partner of unknown HIV status. Fingering is not considered an HIV risk, assuming the skin is intact. Unprotected sex does place you at some degree of risk for STDs, including HIV. Your exposure was brief and your level of anxiety about acquiring HIV is way out of proportion to any degree of actual risk.

Your symptoms are not excessively worrisome for HIV and in fact are more consistent with anxiety and stress than with HIV disease. You are not suffering from lipodystrophy or lipoatrophy!!!

My advice is simple:

1. Get a single rapid HIV test at the three-month mark.

2. See your general medical doctor if you are having ongoing or persistent "symptoms." (I very strongly doubt these are HIV related!)

3. Consider getting some help for your anxiety. Anti-anxiety medication or counseling may help you cope with these unwarranted fears while you wait out the window period.

4. Finally, although I doubt I have to tell you this now, as I'm sure you've now learned this lesson the hard way, unsafe sex is not worth the risk!

Your overall HIV risk, though not completely nonexistent, remains very low. The odds you did not contract HIV from this indiscretion remain all in your favor.

Good luck!

Dr. Bob



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