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Help concerned about symptoms (they are very specific)
May 16, 2008

Dr Bob,

I have been really confused lately and it all seems like this is the end. The only thing I want to believe now is your words. My story: I am afraid I may have been infected about 8 weeks ago in an encounter with csw. The condom slipped and I am afraid now. I developed non-pruritic macular rash at 4.5 weeks, basically small brown spots 1mm - 5 mm on back and chest, a few on arms as well. and also had mild fever and sore throat for 3 days after 20 days of the incident. My most recent result was oral swab test for HIV 1/2 and was negative at 2 days short of 8 weeks. I am at your mercy. Please help. I donated my worthless money for your great cause. Please reply with your precious time for my worthless existence! and I promise to do something worthwhile for humanity for the rest of my life (how ever long it might be) Thankyou

Response from Dr. Frascino

Hello,

Calm down!!! Don't you think you're being just a wee bit overdramatic? ". . . It all seems like this is the end. . . . my worthless money . . . my worthless existence . . . ."!!!

I don't know exactly what you mean when you state: ". . . the condom slipped . . ." but apparently you were having protected sex with a CSW and something happened to the condom. OK, like the old saying goes: "manure occurreth." Even if the condom failed completely, the CDC's risk estimate for HIV acquisition per act of unprotected insertive penile-vaginal sex with a partner confirmed to be HIV positive is 5 per 10,000 exposures. Your estimated risk would be even less, as we do not know the HIV status of your hooker and your exposure may have been brief or partially protected, because your condom only "slipped." So yes, you may have had some degree of HIV risk, but overall that risk remains low.

Next, your "very specific" symptoms are really not very specific at all! In fact they are extremely nonspecific! However, even if you did have "every symptom in the ARS book," "symptoms" are notoriously unreliable in predicting who is and is not infected with HIV.

Next, you've had negative HIV-1 and HIV-2 tests out to eight weeks. That is extremely encouraging, but not completely definitive. The vast majority of folks who are HIV infected will have detectable levels of anti-HIV antibodies in their blood within four to six weeks. Some individuals may take a bit longer. The current guidelines recommend testing at the three-month mark. And that is exactly what I'm recommending for you.

To sum up, your HIV risk is low; your symptoms are not worrisome; and your negative HIV tests to date are very encouraging. Therefore the odds are astronomically in your favor that you did not contract HIV and that this is not "the end" of your "worthless existence." No doubt you are having difficulties with guilt, anxiety, depression and self-worth issues. I'd recommend you seek psychological counseling to address these issues as well as to help you cope with the anxiety associated with the window period.

Thank you for your donation to the Robert James Frascino AIDS Foundation (www.concertedeffort.org). In return I'm sending you my good-luck karma that your definitive three-month HIV test will, like your previous test, be negative!

Good luck.

Dr. Bob



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