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Mistakes, A lesson to be learned
Aug 1, 2010

Hello Dr.Frascino,

Im a gay male who does not learn from his mistakes. I have had 3 previous HIV exposures with 3 different strangers of unknown status from gay bars. The first exposure was unprotected oral (Insertive & receptive) and also protected receptive anal with ejaculation. A latex condom and lube was used so Im pretty sure it was used correctly and did not break or slip off. The second exposure was unprotected insertive oral for like 30 seconds and also he licked my rectum then rubbed his penis around the outside of my rectum (unprotected frottage), again for like 30 seconds. The third exposure was protected receptive oral and protected frottage, he may have inserted in my rectum slightly for like 30 seconds. He also pre-cummed a lot so Im a little concerned that pre-cum may have somehow gotten on the outside of the condom and into my rectum when he slightly penetrated. After that I let him ejaculate on my back and he ended up shooting his cum on a fresh scrap/cut I got like 20 minutes before we started fooling around. I was also a little concerned that he may have gotten some of his cum on my rectum although it was unlikely.

For the last/third incident I started PEP (Combivir) around 21 hours after the exposure. I realise all my exposures are low risk. I was feeling pretty confident that I was HIV negative. But now, around 6 weeks after the second exposure and around 4 weeks after the last exposure I pretty sure Im seroconverting. About a week ago I began to have swollen lymph nodes but I didnt think much of it, but yesterday I began to get a really sore throat which started on my the right side of throat and then to my left side. Last night I basically had every symptom of Primary HIV infection. I had a very sore throat, fever, chills, night sweats, muscle weakness, very swollen lymph nodes, nausea, very stuffy nose and congestion, and a terrible headache. Last night was also my last night of taking Combivir (day 33). Today Im feeling alright, just have a little bit of a stuffy nose and a little bit of a sore throat, my voice is very raspy. Today I had diarrhea a couple times which also concerns me.

I realise these symptoms could be of something else but Im extremely worried that they are from serocoversion. I have had my flu shots so it cant be the flu. Im mainly concerned because this happened right in the time period where primary HIV infection symptoms usually occur. Can seroconversion or the HIV flu like symptoms occur for 1 day and 1 night only? Is congestion a symptom of primary HIV infection? What else could this be if its not ARS symptoms? I plan to see my doctor but he is on vacation until mid august and the walk in clinics where I live are closed on weekends.

I have booked a rapid HIV testing appointment around a week from now (9 days) which will be 3 months and 3 weeks after my first exposure, 7 weeks after my second exposure and 6 weeks after my third exposure. I know that the results wont be definitive for my second and third exposures but the test should still be a good indication of HIV my status. Im starting to prepare myself for a positive test result and Im becoming very self destructive right now. From what I have told you, do you think that Im HIV positive? Please Help Im in need of some support. Im freaking out.

-David

Response from Dr. Frascino

Hello David,

First, I should point out that you have not "had 3 previous HIV exposures" if your 3 strangers were of "unknown status!" At best you've had three potential HIV exposures. Next, your anxiety level is way out of proportion to your actual degree of risk. Oral sex carries only a very small risk for HIV transmission/acquisition. Protected sex is indeed protected, assuming the latex condoms were used properly and did not fail (break). Rimming and frottage are not considered significant risks for HIV transmission. Your concerns about pre-cum and/or ejaculate landing on a "scrape/cut" or your rectum are also blown (excuse the expression) out of proportion. PEP, in my opinion, would not be warranted for this level of potential HIV risk.

As for your symptoms, please note symptoms are notoriously unreliable in predicting who is and is not infected. As for seroconversion symptoms lasting for only one night, no, that would not be at all likely. Acute Retroviral Syndrome symptoms generally begin two to three weeks after infection and persist for a week or two. Your symptoms may very well be a transient viral (non-HIV) infection. Yep, a common cold or flu. (The flu shot does not prevent all types of colds and flus!)

I agree with your decision to get HIV tested. You will need to wait until the three-month mark from your last potential exposure for a conclusive test. From what you've explained, the odds are all in your favor that you did not contract HIV from your trio of strangers. Preparing yourself for a positive test result and becoming self destructive are obviously counterproductive and completely unwarranted. David, if you are considering harming yourself or having difficulty with anxiety while waiting for your definitive HIV test result, you should seek the help of your doctor or a mental health professional (psychiatrist or psychologist). I'm quite confident that when you do get your conclusive HIV test results you'll be WOO-HOO-ing and not BOO-HOO-ing. OK? Take some time and peruse the wealth of information on this site and in its archives. You should find the information and testimonials reassuring.

Good luck. I'm here if you need me, OK?

Dr. Bob



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