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3rd Time the Charm?
Apr 15, 2008

Hey Dr. Bob:

No complaints, I know you are busy. This is my 3rd submission...

I April of 2005 I had an encounter with a high risk (sex worker and admitted IV Drug User) lady of unknwon status. I used my thumb to pull open her vaginal lip: no insertion and amount, if any, of vagnal fluid transferred to my thumb unknown. I did not insert and/or finger her. When I left the club I noticed a small cut on my thumb: it was not bleeding, I saw no dried blood and I even squeezed the area and could not get it to bleed. Does this encounter justify a test?

Some months (about 4) later I was in the same club with a different lady of unknown status and I fingered her anus: when I withdrew my fingers there was feces on the fingers. No known cuts on the fingers, I immediately washed my hands and at no time did the feces come in contact with my mouth. Does this justify a test?

Except for these exposures the only other things I have done are lap dancing and the girl putting the head of my penis in her mouth through my clothes: no direct contact.

The last three years have been difficult with me vascillating between terror and consistent concern. I had no known symptoms at first; eighteen months after incident #1 and approximatley 14 months after incident #2 I noticed what I thought might be a swollen lymph node in my groin. I went to a clinic where two either Doctors or PA's looked at the area; one said it could be swollen nodes, one said it looked more like the area where the blood gathered where two or more veins came together. In order to even see this area you have to pull the testicles to the side and the only time I can feel this area is when the testicles are pulled to the side, at which time the "nodes" feel very soft and pliable. If I simply feel the area without pulling the testicles to the side I do not think I can feel anything.

Since I first noticed these possible nodes (18 months after incident #1) I have since then had toenial fungus, on again/off again pain in the arm pits (cannot feel any nodes), on again/off again pain in the inguinal canal, on again/off again dry and itchy skin, on again/off again red bumps on my arms and my lower back and butt cheeks, occasional very minor muscles aches (mainly early evening). The itchy skin and the red bumps on my butt cheeks are here now and have been for two weeks. I also have what I think is one large swollen node directly under my left ear that showed up about six weeks ago; occasionally I feel some minor pain there. There may be another very small node very near my Adams Apple that feels more like a vein running horizontally. I also have experienced some on again/off again burning sensations in my feet and I had some sore joints in my thumbs that I went to a rhumetologist for (thought I had RA; not). At no time have I had fever, sore throat, thrush, weight loss, etc. The symptoms I have had are listed here. The main things are the dry and itchy skin (which seems to get worse immeidately after eating when I also seem to get temporarily hot)and the possible nodes in my groin and neck.

Of the several hunderd times I have called various HIV hotlines in the last three years 99.9% of the time they tell me everything from "low to no risk" or "HIV is not transmitted this way." What about my symptoms? Am I correct in thinking that the time frame for these symptoms is not consistent with HIV (ARS happens between 3-6 weeks after exposure and then normally no symptoms for 8-10 years at which time opportunistic infections, not symptoms, show up)?

Except for a "check up from the neck up" what do you think I need to do? I am terrified of getting tested. If the news is bad what kind of life expectancy can a 49 year old male in average health expect? I feel guilty and scared daily and occasionally depressed. One year ago I had a complete physical and had high cholestrol and triglycirides and slightly elevated glucose; everything else fine except I am too fat and lazy.

I do not know how you do it; I cannot fathom how I would handle a bad test result. The area of the country I live in is not well known for understanding how "those people" get HIV.

Thanks for Listening

Mad Max

Response from Dr. Frascino

Hello Mad Max,

Episode 1 (April 2005): HIV-acquisition risk is nonexistent. HIV testing not warranted.

Episode 2 ("4 months later"): HIV-acquisition risk is nonexistent. HIV testing not warranted.

Episode 3 (head of penis in lap dancer's mouth through your clothes): HIV-acquisition risk is nonexistent. HIV testing not warranted.

Your "symptoms" are not worrisome for or suggestive of HIV ARS (acute retroviral syndrome) or HIV disease.

I absolutely agree with the 99.9% of HIV hotline advisers who told you "several hundred times" that "HIV is not transmitted this way."

What's this nonsense about being terrified to get tested? It's time to man-up and grow a pair! You don't need testing, but if you did, you shouldn't fear it. It could save your life. If I had never been tested, I'd be six feet under right now!

I absolutely agree you need a "check up from the head up." You definitely have a problem; however, that problem is not HIV infection. It's a totally irrational fear of HIV. You are living up to your moniker "Mad Max." Get some counseling and Relax Max!

Dr. Bob



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doctor bob you keep ignoring me please ifeel am so depressed why wont you answer me !!! you helped me so much now your leaving me in the dark
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