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possible exposure
Jul 25, 2010

Dear Dr.

Greetings. I would like to know if you can help me with a question that I have. About seven weeks ago, I did an incredibly stupid thing: I went to a massage parlor in Atlantic City and had protected sex with a CSW using a latex condom. I have never done this before or since. After returning home, I masturbated before showering.

About 2-3 weeks later (its hard to say exactly on what date), I began to have a strange symptom of pimples/ulcers-first two on my thigh then a crop on the shaft (but not the head of my penis). There are five in total. Three are quite tiny (white spots, really) and two had some red inflammation around them, were larger and raised.

A few days after that, I began to experienced a sunburn rash on the back of my neck and scalp. I know that I definitely did expose my back and neck to the sun for a long period of time but am concerned because I have read neck rash can also be a classic ars symptom. This lasted only a week. As my anxiety about having contracted HIV increased, I stopped eating and began loosing appetite (also having diarrhea.) I had severe anxiety, lack of sleep and night sweats too. At some point during this period, my temperature was slightly elevated to about 99 F. All of these symptoms seemed to end immediately with the anxiety drugs.

My doctor initially thought that it was herpes, but two separate herpes tests cam back negative. Also, the acyclovir 3 day regiment (done 2 weeks ago) did not seem to expeditiously decrease the symptoms (although the two on my thigh are completely gone).

Still concerned, I went a few days ago to a reputable STD clinic in Philadelphia where the sores were looked at by a nurse practitioner. Using a special lamp, he thought the sores are fungal and gave me an anti-fungal cream. This cream does seem to help dissipate the sores, but is working very slowly.

I took both an antibody test and a DNA PCR (which I ordered myself from LabCorp) at five weeks. Both were negative. My doctor says that all we can do is wait and repeat the antibody test later. He told me to take it easy. He seemed unconcerned with my blood work and did not wish to repeat the PCR.

Given my various symptoms, I have already accepted that I may be indeed been unlucky and contracted HIV from this encounter. Im no longer overly anxious, but a couple questions may help me just to put this all in perspective:

1. Is it possible that I infected myself by masturbating myself after the encounter (i.e. could I have inadvertently spread the virus in the womans vaginal secretions that may have ended up on my uppermost shaft or scrotum to the mucus membranes of my penis head and or/urethra)

2. Could the PCR be correct and I dont have HIV (i.e. is there a high false negative rate?).

Thank you for all the work that your organization does. I gladly made a $50 donation towards your valuable organization on 7/23.

Thank you

Response from Dr. Frascino

Hi,

Responding first to your specific questions:

1. No, this is not possible. HIV does not live long outside the body.

2. Yes, I believe the undetectable PCR is indeed correct and you have not contracted HIV. False-negative results are not a problem with PCR testing.

Your HIV-acquisition risk is negligible at best, assuming a latex condom was used properly and did not fail (break).

Unfortunately I cannot diagnose the skin rash on your tallywhacker. If it persists or you are worried, see a dermatologist (MD) for a definitive diagnosis.

I agree with your doctor: Additional PCR testing is not warranted. A simple repeat of your HIV-antibody test at the three-month mark is all that's warranted. The odds are astronomically in your favor that you did not contract HIV from your wham-bam-thank-you-ma'am massage.

Thanks for your donation to The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated. In return I'm sending you my good-luck karma (it's never failed to my knowledge!) that your definitive three-month HIV-antibody test remains negative.

Good luck.

Dr. Bob



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