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Testing and possible ARS
May 10, 2010

Hi Dr. Bob, I've been looking at the site here now for almost a month and appreciate all the feedback that is given here. I must say it has been a help to some degree in my current situation. But hopefully you can give me some insight or even at least just help me to calm my thoughts.

I'm a 28yo bi male, married. Second week of April I did the stupidest thing I could and messed around with another guy I met online. We talked for a bit before we started and he assured me he was HIV- and STD free so when it came down to sex I didn't use and protection, I figured a guy who was upfront about things wouldn't lie. Although he said it's been over six months since the last time he was tested...

Well my anxiety got the best of me and on the third day I went and got screened for STDs and HIV, I know all too soon but it came back negative and I figured that would relieve my worry but it didn't. During the screening I asked the clinic about possible PEP but apparently I don't think they were very knowledgeable as he told me he would only recommend it had I been stuck with a needle or something similar.

Well yesterday marked the 3rd week since the encounter and just to try and ease my mind a bit I decided to get a rapid test, still negative, but I just don't feel right... Since yesterday I can feel what I know is a nasal infection coming on as when I blow my nose I get a yellowish mucus, sometimes with blood in it. I don't think I have a fever or anything but I know I feel weak a lot. My questions are however..

1. I know a three week test isn't conclusive in the slightest, but wouldn't a negative be a pretty accurate assumption as to how a 6-week or 3 month test will come out?

2. If this nasal infection is indeed the beginning stages of seroconversion, wouldn't a rapid test show up positive or inconclusive?

3. Considering my risk (Unprotected oral and anal, as the top) would it have been wise to try to seek out PEP or was the doc at the clinic right about my chances still being fairly in my favor?

I'm all beside myself, I haven't been able to sleep for more than a few hours and the stress is just making me feel horrible. I'm sure my wife is also picking up on it as I'm not as affectionate as I normally am. Hopefully you can give me some words of wisdom and that I can WOO-HOO and put this all behind me. Again, thanks Doctor Bob for being an Awesome guy!

Response from Dr. Frascino

Hi Bi-Guy,

You "figured a guy who was upfront about things wouldn't lie"??? What? Dude, when it comes to the dance with no pants, some guys will do and say just about anything to get a piece of the action. I wouldn't believe what another guy said about his HIV status, even if he had a lie detector strapped to his throbbing tallywhacker.

Your risk is unprotected oral and unprotected insertive anal sex with a partner of unknown HIV status. This does place you at some degree of risk for STDs, including HIV. Responding to your three questions:

1. A negative three-week HIV-antibody test is encouraging, but not definitive or conclusive.

2. No, not necessarily. By the way a nasal infection is not suggestive of HIV acute retroviral syndrome (ARS).

3. PEP is warranted when there has been a significant HIV exposure. We don't know if you were exposed or not. Consequently the use of PEP would be a judgment call based on the likelihood your partner was positively charged. (Many HIV specialists would not recommend PEP for a scenario such as the one you describe.)

My advice is that you level with your wife if you haven't already done so. Does she know you have sex with men? If not, your anxiety over this incident may be a result of your guilt over gay extracurricular activities. I would also suggest you get an HIV-antibody test at the three-month mark. You and your wife may wish to use latex condoms until your HIV status is definitively reconfirmed to be negative.

Good luck.

Dr. Bob



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