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ARS Reassurance
May 1, 2010

Dr. Bob; Thank you very much for all of the diligence you give to The Body. I know that day after day you receive thousands of questions - many of them repetitive - but I assure you that there are folks like me that read them. Anyway your hard work is sincerely appreciated. I consider myself pretty knowledgable about HIV and Prevention and I am HIV- (I hope). I had a recent encounter as the insertive partner in anal sex with a person of unknown HIV status. Naturally I used a condom but at the end of the act and in an extremely dimly lit room I slid the condom off my still erect penis and deposited it in a waste can. I did not thoroughly examine the condom but as someone who has used condoms for many years nothing seemed unusual. In other words it didn't feel broken but I never really held it up and looked at it. Immediatley I went and washed up and again, my penis didn't look like it had any unusual lubricant or anything else on it. I also urinated after I washed up. Now low and behold about 11 days later I started to not feel so good. Felt like a slight burning sensation in my penis and just felt chilly with upper body and arm weakness like I was fighting an infection. No rash, no diarrhea, no sore throat but constantly chilled with occaisional feeling very hot during sleep. I took an antibiotic for 7-days with no affect. Naturally I plan on getting tested but now I'm 6-weeks post-event and still chilly and still mild burning sensation in tip of penis. And naturally the demons of stress and anxiety have kicked-in where I'm beginning to fixate on it and I'm feeling completely exhausted. Bottom line, any reassurances you can give me or positive karma? Any indication if mild constant chills for almost a month are any indication of ARS? If a condom breaks, don't you think it would be more obvious? Should I get tested after 6 weeks to help reassure me? Thanks for any sage wisdom Doc.

Response from Dr. Frascino

Hi,

Yep, I get loads and loads of questions and not surprisingly many are indeed similar. Sometimes I feel like I work for "The Department of Redundancy Department."

Your HIV-acquisition risk is essentially nonexistent, assuming the latex condom was used properly and didn't fail (break).

Your symptoms are not worrisome for or suggestive of acute retroviral syndrome (ARS).

When a condom breaks, it's not a subtle occurrence. (See below.)

Your six-week test will undoubtedly be negative. It may well be encouraging, but it won't be definitive. You'll have to wait until the three-month mark for that.

Dr. Bob's good-luck karma has been signed, sealed and sent. I'm confident all will turn out well (including you!).

Good luck. Be well.

Dr. Bob

Condom Breaks May 1, 2010 Hi Dr. Bob,

I just wanted to share a recent experience with you and your readers concerning the ill-advised confidence we have over the integrity of a condom.

About 6 weeks ago I had intercourse with a sex worker. We used a condom and the sex was somewhat firm but not in anyway aggressive. After ejaculation I could see no trace of a breakage - not that I was really looking, I mean what are you supposed to look for?

Eight days later I had an acute epididymitis infection that saw me hospitalised for 5 days and taking a cocktail of antibiotics. I was discharged with another 20 days of antibiotics to go. Just 5 days ago in the last week of antibiotics I was violently ill. Vomiting, chronic diarrhea, fever, fatigue, muscle weakness - all the classic symptoms of seroconversion and all within 5 weeks of exposure. I have been wracking my brain to find how it could be possible that I may have contracted the infection as an STI and that I am now a candidate for HIV!! How is it possible if I was wearing a condom?? A little research on the internet reveals that condom breakages are common and that users are advised to examine the condition of the condom (I guess if time permits) whilst flinging away at each other.

The concern for me now is that I have no idea if I was going through seroconversion or just reacting to the dosage of antibiotics. The only way to know for sure is to do a HIV test at the 3-month mark. No amount of speculation is going to alter the outcome so I calmly await my turn.

But I have been reading all the comments in this forum and can appreciate the panic and concern expressed by many, and I simply wanted to share my experience to make people aware that safe sex can protect but you should ALWAYS check the condom afterwards (at the very least) if you want some peace of mind. My doctor has told me that the epididymitis could have come from a non-STI source like a bladder or urinary tract infection, so again this is all inconclusive and circumstantial. The HIV test at the 3 month mark will provide the definitive answer.

I have also donated some money to your fine organisation. I believe you are a genuinely unique person Dr. Bob and the service (and humour) you provide are beyond words.

I'll let you know how things pan out for me...

All the very best to you...

Response from Dr. Frascino

Hi,

Thanks for writing and sharing your story.

Regarding condom use, I do not believe there is an "ill advised confidence" in their integrity or ability to prevent HIV!

When a condom fails (breaks), it's generally not a subtle occurrence. Remember, condoms are just an ultra-thin piece of latex stretched tightly over a throbbing tallywhacker. When they break, the latex tears due to intense stretch and friction from the ol' "in-and-out" maneuvering. Mr. Happy's head generally pokes out the condom just like your head pokes out of a turtleneck sweater! Like I said, this is not subtle, nor are you likely not to notice "while flinging" or disposing of the used condom.

I absolutely agree epididymitis can indeed be (and often is) unrelated to an STD! Bacterial seeding of the epididymis can come from a urinary tract infection.

Another point that must be made is that merely "using" a condom is not protective. You have to use it "properly," and that is often not the case! You can review proper condom technique and common ways condoms are misused in the archives.

Regarding your recent symptom flair five weeks after exposure, if your doctor is concerned this represents HIV ARS (acute retroviral syndrome), he could order an APTIMA HIV RNA test, as this test is FDA approved for diagnostic purposes and should be able to identify HIV infection prior to the three-month window period for HIV-antibody testing.

Do write back with your results and I'll post your follow-up for our forum readers.

Thank you for your kind words and support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). Both are warmly appreciated. In return I'm sending you my good-luck/good-health karma that you are now and will always be HIV free.

Good luck. Be well!

Dr. Bob



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