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Extremely worried

Nov 27, 2009

Dear Dr, I'm a medical student who has been worrying alot for the past few weeks. I had an exposure to CSW during a visit to massage parlour, which I truly regretted. She licked the tip of my penis for few minutes. Subsequently, she applied some 'liquid'(?massage oil) on the tip of my penis and did a handjob on me for about 15minutes until I ejaculated. It was about 2 months ago. However, 2 weeks after the exposure, I developed flu-like symptoms for 2-3days which recovered with some over-the-counter medication.

However, for the past 3-4 weeks, I have been feeling uncomfortable with malaise, coated tongue, dry throat and mild dysphagia. I began to freak out upon knowing that some masseurs in the massage parlours here are trying to spread HIV by putting their blood and vaginal secretions into the massage oil, which they will apply on the penis of clients.

I felt I had generalized lymphadenopathy but my doctor said it was not. My painless submandibular lymph nodes are slightly palpable (??normal variant) as well as my inguinal lymph nodes. However, my throat looks injected but painless. It has been the same for the past 2-3 weeks. Occasionally I have chills but no night sweat. Body temperature ranges from 36.5-37.5 celcius. A few episodes of diarrhoea for the past 2 months after exposure, an episode of body rashes (1 day), no joint pain, no night sweat, no past history of sexual exposure or IV drug abuse.

That was the only high risk exposure I had in my life and I'm freaking out now. I had HIV antibody test(ELISA) at 5th, 6th and 8th week post-exposure but all results negative. I'm following up with an infectious disease specialist and still waiting for another HIV antibody test at 12week post exposure.

I'm very depressed now as i'm wondering what could be the cause of my occasional chills and prolonged painless injected throat. I used to have frequent sore throat in the past before the exposure but it was not as painless as current one.

The thought of people trying to spread HIV through the massage oil and also the oral contact with the tip of my penis is driving me crazy. I'm not able to concentrate in my studies for the past 2months due to that. Pls help me Dr. Am i at risk of contracting HIV? I know HIV PCR test is not recommended as a screening tool. I'm thinking of going for p24 antigen test but it's quite costly in my country. I will go for another HIV antibody test at 11week just for a piece of mind. Otherwise, i'm freaking out each day, with sense of depersonalization and i'm on the verge of seeking psychiatric help.

I truly appreciate your reply. I will never step my foot into any massage parlour again in my life!! Thanks Dr

Response from Dr. Frascino

Hello Extremely Worried Medical Student,

Masseuses in massage parlors are trying to spread HIV by putting their blood and vaginal secretions into the massage oil???? And you heard about this where? In the Journal of Urban Legends perhaps??? Dude, the rub-and-tug gals are not homicidal psychopaths trying to kill off their clientele and HIV would not survive in massage oil! Your fears are unwarranted.

Your HIV-acquisition risk is brief oral sex, which carries only a very slight risk for viral transmission. Your "symptoms" are not worrisome for HIV acute retroviral syndrome (ARS). Also, I should point out that "symptoms" are notoriously unreliable in predicting who is and is not HIV infected.

Your negative HIV-antibody tests at 5, 6 and 8 weeks are extremely encouraging, but not yet definitive. You'll need to wait for your 12-week result for a conclusive test.

Your current problem is anxiety, guilt and irrational fear of being HIV infected. You mentioned you were "on the verge of seeking psychiatric help." I would encourage you to do just that. You need help with your anxiety, depression, guilt, and irrational HIV fears. I'm very confident your 12-week definitive HIV tests will be negative. I'm hopeful this terrifying experience will provide you with many insights, not only concerning HIV, but also of how fear of an illness can affect a person mentally, physically and emotionally. This is a valuable lesson for a future physician.

Good luck.

Dr. Bob

Nurse stuck with Needle from HIV patient

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