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asking again regd HIV & ESR test
May 15, 2008

Hello Doctor,

I had sent you a mail earlier, and wish to write to you again, its been almost 10 months since my oral exposure (blow job received without condom froma sex worker ) i tested negative in both ocassions, after completing 2 months and 4 months respectively, and then upon completion of 6 months , had an ESR test done, which was in normal range , I would like to know, that a normal ESR result at 6 months completed is good enough to decide that ive not contracted HIV ?

Response from Dr. Frascino

Hello,

The information you seek was already waiting for you! Where? In the archives, of course! Dr. Bob says check it out! (See below.)

Briefly, ESR is a nonspecific test that gives an indication of inflammation. It is not HIV specific and can not be used to diagnose HIV or rule out an HIV infection. Only HIV-specific tests can do that.

Dr. Bob

Why dont you answer my question....i know i'm flooding your mailbox by trying to seek answer 5th time.....u gotta understand my pain...plz plz plz answer asap Mar 30, 2008 This is my fifth attempt to hear from you before going for test, I dont have anyone to talk. I dont know any other way to plead, Im in pain. I dont think my scenario is stupid enough for you to not answer. Please answer asap. I assure you that Ill donate for your noble cause. Hello Sir, I dont know how to start even now while seeking help from you by asking this question my hands are trembling. Im a 26 yr uncircumcised male. It started so bad that, it was my maiden sexual encounter that too with the prostitute on 10th Dec 2007, during which the condom broke-off. I pulled out while ejaculating thinking that Ive a condom at place only to see that the tip of my penis protruding out of condom and I ejaculated few drops at the bedding as well. I was scared as hell and very next day got tested for HIV & Hepatitis-B along with few STIs (all came negative). Real worry started almost 2-3 weeks after that when I developed ARS kinda symptoms like chronic fatigue (so bad that I slept for 12-14 hrs a day), fever (which went on-off for few days but was never over 99) and on 3 occasions suffered night-sweating as well. 7 weeks after a possible exposure I went to dentist for dental cleaning and 4 days after that (i.e.20.01.08), I realized something is wrong with me tongue. It was bruised from both sides at the back and later doctor diagnosed me for Aphthous Stomatitis. Now after almost 2 months the ulcers on my tongue have started to heal. But in between I was diagnosed for Tonsillitis (with white patches on both sides) I had a thick white coating on my tongue so I got myself tested for its culture & sensitivity and the result came as, klebsiella & e coli species found, Heavy growth. My doctor put me on the Antibiotics for 5 days and again for 3 days, but I still have a white coating on my tongue. Ive few swollen lymph nodes (slight but persistent pain) in my groin area where as the one I had on my neck is no more there. After 2 months of the exposure, I got tested for Hepatitis-B, HSV 1&2 and few other STIs (all negative, I feel so happy to write negative) along with Oral Thrush. Candida you call it, (result negative) but couldnt gather courage for HIV test. Sir, anxiety is killing me, my heart rate is in 90s and hands are trembling and sweating all time. Ive had sleepless nights all this while. I really cant stand HIV. I dont have courage to go and get myself tested for HIV and therefore looking for some mental food to clam my nerves. Sir, please clarify few things for me: 1. I tested myself for ESR all this while, result shows Jan-02, Feb-04 and March-12 (ref. range 1-10)isnt it pointing towards HIV 2. Are my ARS symptoms for real? 3. Dont you think it is too early for Aphthous Stomatitis to happen if Im infected? 4. What does klebsiella & e coli has to do with HIV ? 5. When you say you have 1 in 500 or 1 in 1000 chance of getting infected, how does that work, is it you come across 500 people with possible symptoms and 1 get infected or all 500 get some amount of virus thier immunity/body fight it out and exceptionally 1 gets infected? 6. In a hiv infected person, does lymph nodes atay swollen all the time o they go back to their normal size? 7. Considering my symptoms what are my odds of getting infected, please be honest Sir. ( I know its a stupid question but really couldnt control myself). 8. Coated tongue eith red dotsis it a sign of early hiv infection? Sir, I expect you not to disappoint me.

Response from Dr. Frascino

Hello,

You report: "I really can't stand HIV. I don't have courage to go and get myself tested for HIV and therefore looking for some mental food to calm my nerves." OK, let's start with realities:

1. You are 26-years old and it's time to grow up. I understand getting HIV tested is anxiety provoking, but since you are adult enough to have sex, you must also be adult enough to accept the responsibility that goes along with it!

2. The only "mental food" that will calm your nerves is an HIV test. Stop procrastinating. You obviously know what needs to be done. So continuing to torture yourself makes absolutely no sense. Further procrastination will only make your anxiety worse.

Briefly responding to your direct questions:

1. ESR is not a surrogate test for HIV. You cannot determine HIV status from an ESR result. Get HIV tested.

2. Symptoms are notoriously unreliable in predicting who is and is not infected. Get HIV tested.

3. Hypothetical guessing games are not helpful in determining HIV status. Get HIV tested!

4. Nothing. Get HIV tested!

5. Estimated HIV-acquisition risk statistics are population based and cannot be applied to an individual's specific situation. The purpose of the estimated risk statistics is to help gauge the relative likelihood of infection of one type of risk activity versus another. If you want to know if your failed-condom experience resulted in HIV transmission, the only way to know for certain is to get tested!

6. This varies from case to case.

7. First of all, I'm always honest. Next, the best answer to your question, since the condom broke, is that you had what amounts to unprotected vaginal insertive sex with a partner of unknown HIV status. This does put you at some degree of risk for STDs, including HIV. The only way to know for certain if you've acquired the virus is to get an HIV test at the three-month mark. Statistically speaking the odds are astronomically in your favor that you did not acquire HIV from this single unfortunate incident.

8. Once again, symptoms are totally unreliable in predicting HIV seropositivity or negativity.

Well, I don't know if this reply "disappointed" you or not. However, I feel it was important for you to realize two basic facts:

1. Your degree of anxiety is way out of proportion to any real degree of HIV-acquisition risk.

2. Perseveration on HIV infection and procrastination when it comes to getting a definitive HIV test only make your anxiety worse and will not change the outcome.

Thank you for your pledge to make a donation to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). In return I'm sending you my good-luck karma that your definitive HIV test will be negative. Write back and let me know the results so we can hopefully celebrate your WOO-HOO experience together, OK? Good luck!

Dr. Bob



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