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Oral guided bone regeneration (GBR) membrane exposure and mouth-to-mouth contact (ie, kissing) with seropositive individual = ineffable panic
Jul 28, 2010

Dear Dr. Franscino:

What kind of a name is Franscino? Just curious.... More importantly, thank you on behalf of all of us frightened readers/writers whom you take the time to help with your responses.

My story goes like this: About three months ago I underwent oral surgery to attempt to repair an infection in my palate (as a result of a failed root canal); a non-resorbable membrane was placed at the site of the bone grafting. One month later, the membrane became exposed as the surgical borders began separating. I've been using clorhexidine mouthwash as indicated by the surgeon and so far (3 months after procedure, 2 months after exposure), there hasn't been an infection. One week ago, however, I made out with an individual who, at the time, did not share his seropositive status with me. I understand his reasoning - kissing is not a very risky practice, he takes his medication dutifully, his CD4+ count is normal and his viral load is undetectable. The protective effects of saliva and my general good health notwithstanding, I am freaking the f out. I was not bleeding from the exposed sites and the tissues did not appear to be inflamed or otherwise irritated at the time. Since disclosing my situation to the gentleman, he has apologized for not having told me and has not mentioned oral health issues that would lead him (or me) to believe that he was bleeding in his mouth at the time we made out. Then again, I haven't asked "are you currently suffering from periodontitis?"

A bout of oral herpes, a runny nose and slight pain in my superior deep cervical lymph nodes in the last week have consolidated my despair. Adding insult to injury, my maxillofacial surgeon is on vacation and I have not been able to get a hold of her. She is likely too busy buying some more Christian Dior purses at a duty-free shop in the Netherlands Antilles.

It is now too late for PEP and I cannot stop thinking about the possibility of seroconversion going on inside my bloodstream at every moment. Hooray for HAART - I do not want to have to be on it for the rest of my life, thank you very much to all the brilliant researchers who've made such great strides in keeping viral replication and mutation under control. And the prospect of three (and later six) months of this is enough to make me want to immerse myself in the world of psychoactive stimulants which I've so arduously worked to relinquish. I am, I assure you, scared s*}}less.

My questions are: How risky was my behavior? Are the odds stacked against me; should I expect a positive test result? Is the bone material underlying the membrane particularly receptive the virus? Is an antibody test at 3 and 6 months as conclusive (given that the bone graft may be progressively integrated into my own bone, harboring virions until it is integrated and then releasing them into my bloodstream)?

Pretty please help me.

Regards, and once again I assure you of mine and others' deep gratitude.

Response from Dr. Frascino

Hi,

1. It's Frascino, not Franscino. I'm second generation Italian.

2. Your HIV-acquisition risk is negligible.

3. The odds are not stacked against you. You should expect a negative test result.

4. No.

5. A single HIV-antibody test at the three-month mark is all that would be medically recommended. If you wish to have a follow-up test at six months for peace of mind, that's up to you.

Good luck.

Dr. Bob



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