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Beard Burned and Bummed (A test of your endurance)
Sep 25, 2009

Hi Dr. Bob, In case you decide not to make it through my overly long post I want to start by saying I think you are an amazing person. Thank you for all your hard work and efforts dealing with both this horrible epidemic and all the worried wells which I pray to God I am one of. You are an inspiration and proof that life goes on (and unfortunately that this can happen to the best of us). While I know youve responded to variations on most of this. Perhaps a response could be like a Greatest Hits album for you. :) Now on to my story. In early July after much drinking I decided to experiment with my sexuality and went home with another man I met at a bar. We engaged in deep kissing and mutual masturbation for a few hours and I performed a few minutes of protected oral sex. When I sobered up the next day I realized what I had done but thought my only concerns were my sexuality (straight with an asterisk?) and reputation if anyone found out. While certainly stupid on my part for going home with a random last call dude, I thought I had played everything safe. (No knowledgeable contact with semen or ass play.) Then two weeks later I got a horrible pain in my right ear when swallowing and a white coated tongue along with chills and fatigue nothing too debilitating little pain in right jaw, no rash or cold symptoms. Lymph nodes maybe, maybe not; Im no doctor. Just one under the right jaw if you ask me and thats still here. The pain lasted for about 10 days with the coated tongue persisting about a week longer. Normally I probably would have chocked this up to an ear infection and simply got on with my life but then a friend mentioned I should be careful because I could have strep throat. While searching the web for the cause of this pain I realized it probably was due to referred pain from the throat and that this could be due to primary HIV infection/ARS which perfectly fit the time frame. And so I began my descent into this Lovecraftian nightmare world I now inhabit. I went to the doctor and described my situation and symptoms and all he could say was Well theres no such thing as safe sex and yes ARS can present as tonsillitis. Taking away my theories it could be TMJ, GERD or ottis externa/media. I was tested for STDs 31 days post exposure and all results including HIV came back negative. Though he also said I wouldnt test positive this early unless I was exposed to a lot of the virus. Any truth to that? I figure Ive got 60% accuracy maybe. Hope Im in the healthier half. Since then I have experienced other symptoms including persisting fatigue, loss of appetite, and diarrhea, occasional painless mouth ulcers and blood blisters near my back molars and even separate episodes of seborrheic dermatitis on the nose (mild) and armpits (alarming). Also some torso/arm zits Im not too happy about. I really hope this is all just hypochondria and anxiety and it could just be pride but my symptoms do seem more legit than many posters. While I know the symptoms are very nonspecific and could be due to a number of causes, nothing seems more likely than HIV. (Never thought Id think Please let it be cancer.)I know the only way to end this nightmare is to be tested outside the window period but I am scared Dr. Bob. Ive reached what is probably the bottom of my downward spiral of depression and fear but am afraid this test could make the bottom drop out and introduce me to an unknown world of horror. Ive spent pretty much every waking hour since then going through the various forums and what not and believe my chances to be very remote but not impossible. I do have occasional bleeding gums (which has worsened) and am a finger biter so am afraid of these theoretical routes. Also a small abrasion where he was doing the yanking and the titular beard burn which honestly should have been punishment enough. Ive seen hundreds of stats but of course there is almost no consensus on any of them which is frustrating. One stat I dont see repeated often outside the CDC is that ~1/4 of MSM have HIV. (HIV education is seriously lacking here in the States all around.) While I am glad that HIV is no longer regarded as a gay disease, I think this is a stat that should be put out there both for the practicing MSM population as well as anyone that may choose to experiment. And being as my guy was not a well adjusted Will but rather a last call loner who when asked about condoms replied Why Im clean. Im guessing not. And in retrospect probably someone not on meds and with cofactors. Mid 30s Looked kinda wasting. Oh hindsight... Anyway Dr. Bob, I want to again thank you for all your hard work and ask you to send me your good luck/ good health karma for a negative 3 month test I should be taking in early October maybe Home Access because my fear of it being positive is overwhelming and I think Id need a good period of isolation before having to tell anyone. I really want to go back to my old life but am starting to fear it may never be a possibility. I can hardly bear the thought that it could be true but also couldnt bear to hurt anyone. (Though its hard to think how much a diagnosis would hurt my family. Me = college guy) Please forgive my rambling and poor attempts at humor, Im trying to keep it together here. The rest could be hypochondria but the ear pain on swallowing was very real and I feel like I cant get close to anyone (ex gal) as long as its even a remote chance. I guess something that may help or may not but tests your med odds trivia: What are the odds of getting a nonexudative tonsillitis in any particular week? Adenovirus, CMV, and strep seem kinda rare. And mono being a one time deal I doubt Id have that as an adult. As a couple side notes Ive come to think that the most commonly stated transmission rate stats are far too low as there is no way wed have this kind of epidemic if it were really that hard to transmit. (But I guess 40K from 1M isnt the worst it could be.) I mean 50/10000 suggests even unprotected receptive anal is 99.5% safe. What is this only brief condom break stats of low VL patients and no cofactors? Thats better than condom stats only used effectively 80% of the time and a 2% breakage rate or 3 month test accuracy stats 97%. And the case reports of female to female, kissing and skin cream transmission are frightening. Not to mention the alarmingly large number of no identifiable risk cases. All these things dont add up unless people are simply far more ignorant promiscuous and dishonest than I give them credit for. Although on the other side how is it possible that only 90% of infected transfusion recipients are themselves infected? Id figure that would have to be 100%. Secondly Medhelps position that the only routes of transmission are anal/vaginal sex, IV exposure and mother to child PERIOD, IMHO borders on par with Denialism. (Unless this is a case of choosing the population over the individual or maybe vice versa. Im sure its a complicated issue in controlling an epidemic, dealing with unnecessary stress and respecting human beings. No disrespect meant for Dr. HHH, Teak, or Liz) Not trying to start any expert forum troubles. I just hope dealing with all the worried wells doesnt make you all jaded and that all the optimistic data is not just a rouse to get people calm the f down and confidently test because it may make folks just not test. Im aware your primary role is to make people recognize only relative risk and that you are not a walking Ab test (though wouldnt that be sweet you know aside from people wiping exudates on you to see if you turn colors) but paranoia has gotten the best of me and all the research is overwhelming and most of it seriously flawed. So what do you think Doc? Should I assume as Medhelp would say (and I thought as well) that this really was a no risk activity and the symptoms were just a coincidence or should I be worried? If gingivitis is enhanced by HIV wouldnt it be likely blood would always be present in saliva and that deep kissing (with a surface area much larger than the urethra, gingivitis and alcohol permeablization) could pose a significant risk? Also why dont we allow the home test kits here in the US? Are they not accurate or is it just bad policy? Ok. Done. Sorry. Hope you made it. Believe me theres a lot more rambling I could do but Ill spare you for now and hope I never have to speak of any of it again. Provided Im not wiped out by ARVs/testing bills, I will be sure to donate after I get that test and infected or not Ill be doing whatever is in my science-y powers to wipe this thing out. Gene therapy looks promising. Much love, Beard Burned

Response from Dr. Frascino

Hello Beard Burned and Bummed,

Even though your post is indeed a bit on the "long winded" and "stream-of-consciousness" side, I'll try to respond by being succinct and hitting the high points, OK? Since indeed I have responded to many of these issues previously, I will refer you to the archives at times to review my "greatest hits" and QTND (questions that never die).

Like many others in this forum, I believe your level of anxiety is amplified because of your "experiment." Guilt related to your first guy-on-guy sexperience as well as concerns about your sexual orientation are most likely a large part of your current level of high anxiety despite a relatively low-risk encounter.

Deep kissing, mutual masturbation and protected oral sex are not considered to be risk factors for HIV transmission. (Check the archives.)

Your symptoms are not consistent with nor worrisome for HIV acute retroviral syndrome (check the archives).

The physician you consulted is woefully uninformed (or misinformed) about HIV, as was particularly demonstrated by his comments about testing positive early if you were exposed to a lot of virus! He clearly does not understand basic HIV pathophysiology! I would suggest you find a more competent physician!

I agree your problem is primarily hypervigilance, hypochondria and anxiety resulting in your "downward spiral of depression and fear." To that list I would also add "guilt".

I also agree with your belief that your "chances are very remote" for acquiring HIV.

You have a lot of confusion about HIV statistics and their limitations Review the chapter in the archives dedicated to statistics. It should help clear up your confusion.

I can assure you that dealing with all the worried wells has not jaded me. I have well over a quarter of a century of experience treating HIVers and remember, I'm positively charged myself!

I concur that "paranoia has gotten the best of (you)."

The United States does have an FDA-approved home test kit. It's called Home Access Express Test and can be purchased online or at any pharmacy. (You can read about it guess where? Yep, in the archives.)

I'm very confident your definitive three-month HIV test will be negative.

Thanks in advance for your donation to The Robert James Frascino AIDS Foundation (www.concertedeffort.org). In return I'm sending you my good-luck/good-health karma that your conclusive three-month test remains negative.

Finally, I suggest you consider seeking psychotherapy (counseling) to help with your anxiety, depression and guilt. It might also be helpful in exploring your "asterisk" (sexual orientation issues).

Good luck. Be well.

Dr. Bob



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