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Stupid and Scared
May 28, 2009

Hi Dr. Bob, I have been reading you forum and found it excellent.

I am a married man with bi tendencies. Around three months ago I had anal sex with a gay guy. I was stupid and didn't use protection. I guess that in the heat of the moment I just didn't think. But I guess he is high risk since he lets strangers fuck him bb.

Now, the day after the exposure I started to feel ill - white coated tongue, feeling just unwell. Three days later I had a mild illness - feeling cold and fatigued, wrapped up on sofa, etc. Didn't check my temp, but didn't really fever. This went away after a few days. About this time I started worrying about HIV and reading up about it. Due to stress I guess I lost appetite. At four weeks I went to a clinic and was tested negative for STDs including HIV but I know 4 weeks is not conclusive. Around this time I started getting strange oral symptoms - tongue was whiteish but red patches started to appear along with tingling/discomfort. I went to the docs and he said it didn't look like thrush but gave me nyastin anyway. This didn't appear to do much as the patches were still there when I finished the course but went away not long after. I found that it may have been geographic tongue and thinking about it I have had this in the past. Anyway, although the patches went away my tongue stayed white - nothing could be scraped off - and continued to tingle/burn. Then a week ago, the red patches started to reappear with strong burning/discomfort. The patches do seem to have a white edge but this can disappear from time to time. I also had some discomfort further back in the throat. I googled and found that thrush is common in early HIV, especially erythematous which is often mistaken for geaographic tongue. Now, 12 weeks post exposure, the burning has subsided a bit although the patches are still there. I am convinced there is some thrush present at the back of my tongue where I can scrape some whiteness off. I have not treated it this time - would thrush disappear if my immune system was damaged?

Anyway, I am due to retest this week. Am scared as hell, it would ruin my life. As you can imagine I am extremely stressed which I understand can compromise immune system somewhat.

Do these symptoms sound indicative of early HIV infection? Is the 4 week negative of consequence? Is oral thrush likely so early in infection with no other real symptoms?

I really appreciate an answer doc and will be keeping my "thing" to myself from now on, regardless of outcome.

Response from Dr. Frascino

Hi,

Another married guy with bi tendencies having Brokeback Mountain commando-Rambo unsafe sex with a high-risk stranger??? Gee you're like the fifth one this week! There must be a Republican Southern Baptist Convention in town.

OK, here's the scoop. Unprotected anal sex places you at risk for STDs, including HIV. Consequently testing is warranted.

A negative test at four weeks is encouraging but not conclusive or definitive. You'll need to wait for the three-month mark for a conclusive test result.

Symptoms are notoriously unreliable in predicting who is and is not HIV infected. The reason to worry or test is related to HIV-risk exposure not the presence or absence of symptoms.

Symptoms that begin the day after exposure or within several days of exposure are not HIV related. It takes several weeks for acute retroviral syndrome (ARS) symptoms to become manifest.

Why would a doctor treat you with Nystatin if your physical exam was not consistent with oral thrush? That makes absolutely no sense!

Most likely much of your anxiety stems from your walk on the wild side stemming from your "bi tendencies". I would suggest you level with your wife. It's not only the best way to confront your guilt; it's also the right thing to do. I'd also strongly suggest you seek psychotherapy to explore sexual orientation issues and reasons you may have forgot to use a condom during your Brokeback Mountain hookup.

Good luck.

Dr. Bob



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