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Aug 26, 2008

Dear Dr. Frascino,

First, I apologize for my English. Second, I donated 50$ to your foundation, which I am sure is nothing compared to the great service to provide to the public. Third, I have few questions that you might be of a great help:

Personal Info: 26 years old, quite fit, poor physical movement;

Symptoms: pain in left hip/butt, left flank/left upper abdominal, left groin, left inguinal fold. tender left testicle. Visible swelling/enlargement/tenderness in left flank area and left groin/inguinal fold area. Urgency to pee or bowel movement. I feel more relived after bowel movement or urination. I have these symptoms constantly for more than 1.5 months and on/off for 3 months. I had Cipro for last 2 months, didn't help . Pain is less in the morning and worse at night. General tiredness. Previous history Sep 07: white penile discharge. Blood drop in Urine. Burning during urination, high frequency of urination. diagnosed for prostetites and epydemites. They put me on antibiotic until the blood and infection presence in my urine disappeared.

Test history: Negative HIV, Syphilis, HSV 1,2, Chlamydia, and NGU in Oct 07. Negative HIV and Chlamydia in Apr. and Aug. 08. Ultra sound of kidney (no stone found) Oct. 07. Frequent physical examination of prostate, finger insertion via rectum (They all said the left side of my prostate is tender/enlarged. Tender left testicle.

Back x-ray to see if I have hernia or disk , or bone issue. Aug 08- it was normal.

Questions:1- What are the risks of unprotected performing oral sex in presence of period blood and untreated teeth cavity, receiving unprotected oral sex while having Urinary Track Infection, and protected intercourse while using of body lotion as lubricant?

2- I had HIV negative results 4 weeks after my last exposure. My first and second partners were tested negative 13 and 10 weeks after their last exposures. My Tests are done in Mayo Clinic and theirs in a general health Clinic. How reliable are negative test results for us (4,10,13 week respectively)?

3- In general, if someone has the HIV symptoms (for example enlarged lymph node) could they still test negative? I mean, I tested negative while I had the pain.

4- Could it be a cancer? Prostate cancer, pancreas cancer, or colon cancer? or splenomegaly? is splemenomegaly a sign of hiv?

5- The pain manifest itself in left chest (been to ER to rule out heart attack). Could it be pancreas issue?

6- It is probably the hardest question; but what is yor evaluation? Do you see a symptom for HIV/STI?

Response from Dr. Frascino


1. Oral sex in general carries only a very low potential risk for HIV acquisition/transmission. Certainly the presence of menstrual blood in an HIV-infected woman would increase the risk during unprotected cunnilingus. Cavities in teeth are not considered an increased risk. Depending on what you mean by "urinary tract infection," there could be some increased risk for HIV transmission. (For instance, if you had gonorrhea, the inflammation in the urethra could increase the HIV-acquisition risk.) If the body lotion was oil-based (rather than water-based), there is increased risk of condom failure. Oil-based lubricants can denature latex, compromising its integrity. You do realize you've just snuck four questions into your "Question #1," don't you? Very sneaky! By the way, I've addressed all these issues previously. Check the archives!

2. HIV-antibody tests taken prior to the three-month mark are not considered to be definitive or conclusive. Consequently, the 13-week test is definitive. The other two tests are only "encouraging."

3. Symptoms are unreliable in determining who is and is not infected. Rely only on your HIV test results!

4. I cannot offer a diagnosis over the Internet, although cancer would certainly be unlikely. I would recommend an evaluation by a urologist if you haven't done this already. Enlarged liver and spleen is seen in 14% of folks experiencing acute retroviral syndrome symptoms.

5. I cannot offer this type of assessment over the Internet without access to your medical file and laboratory tests and without the benefit of a physical exam! However, from the limited information provided, I do not believe this is a pancreas issue.

6. My evaluation is that you had prostatitis and epididymitis. These types of infections can become chronic or recurrent. I encourage you to see a urologist for evaluation and ongoing treatment. As for HIV, if you placed yourself at risk for possible HIV, you'll need an HIV-antibody test at the three-month mark, whether or not you have symptoms.

Thanks for your donation to the Robert James Frascino AIDS Foundation (

Dr. Bob

effective indirect transmission
What exactly is "clinical suspicion for HIV"?

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