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Application for ex-WW club, WOO HOO needed please!
Nov 13, 2010

Dr. Bob-

First off, a million thanks for all the work that you do for HIV/AIDS patients everywhere. Quite honestly, I don't think I could have made it through the past 12 weeks without you. You are indeed a gentleman, a scholar, and a beam of light through my dark 12 weeks. Here's my story, and a couple of questions.

On August 12th of this year, I went to a strip club. Long story short, the stripper I was with (her status unknown) performed an unprotected bj on me for about a minute, and there was also brief frottage with her (like 10 seconds). There were no other sexual acts. It was dark in there, but when I got home I didn't see any blood on my penis or anything unusual. My shaft skin was irritated from the pre-bj lap dance (I had a couple of scabs form the next day), but I didn't think too much of the experience from a disease perspective.

Then, a couple weeks later I got concerned about HIV- not sure if it was guilt, or seeing something on the news, but the seed of fear was planted in my mind. I then became VERY concerned 3 weeks after the incident, because I started to get sick at that time. And not like "I think I may or may not have a pimple on my butt, is this an ARS rash" sick. Now granted, I got sick the day at the 3-week period after a 12-hour flight back from Europe (the night I got back, also I went out with friends even though I was exhausted and drank a ton and smoked, which I know I should not do). My sickness at 3 weeks started out only as a non-productive cough, which became productive over 4 days (green/yellow mucus coming up from my chest, burning pain in the right area of my chest). After these 4 days of cough, on the 5th day (~4 weeks after the bj incident) I had sudden chills and suddenly got a fever of 100-102, which prompted me to go to the doctor. No rash, no sore throat, no swollen lymph nodes (as far as I knew). Doctor thought it was a possible pneumonia/respiratory infection and gave me a z-pack (I told him about the strip club encounter and he didn't seem overly worried, but I got a chlamydia and gonorrhea test, as well as an HIV 1/2/O EIA ordered). That night after I got home, I took the first z-pack dose, the next morning I felt MUCH better and within 24 hours of the first dose the fever was gone and the productive cough diminished (although the cough, which became dry, lingered slightly over the next week). Overall, the fever lasted about 48 hours in total. I did have some diarrhea as well after taking the z-pack.

I was somewhat reassured that these symptoms went away quickly after the antibiotic (hopefully bacterial and not viral) and there was no rash, but I couldn't help but think that this was ARS (I still have fears about this, as it seems too coincidental). Knowing that ARS timing and presentation are variable, it didn't seem outside the realm of possibility that this could be ARS (the fact that I had a 100-102 fever terrified me, and I also had sweats, chills, and diarrhea). Also, what if I coincidentally just started taking the antibiotics at the exact time the fever stopped? I have had no symptoms since this illness 8.5 weeks ago (it is now 12.5 weeks post-incident), except for some loose stools (I've had a ridiculous amount of anxiety though- haven't eaten much and have lost about 15 pounds over 3 months). During this time I stopped exercising, have thought about HIV 24 hours a day, and have generally been depressed and anxious. I'm not sure how I made it through work during these months. Dr. Bob, this site and you have helped me tremendously.

In any event, the HIV 1/2/O EIA ordered at the doctor at 4 weeks post-encounter was negative (non-reactive). I then got the following tests: Oraquick Advance oral rapid @6.5 weeks (negative); Oraquick Advance oral rapid @8 weeks (negative); Oraquick Advance oral rapid @9 weeks (negative); Clearview STAT Pak 1/2 fingerstick rapid @9.5 weeks (negative); Oraquick Advance oral rapid @11 weeks (negative); Clearview STAT Pak 1/2 fingerstick rapid @83 days (negative); HIV 1/2/O EIA @84 days (negative, non-reactive); Oraquick Advance oral rapid @87 days (negative).

So here I am at 12.5 weeks and here are my questions Dr. Bob: 1) I know that tests trump symptoms, but getting sick at 4 weeks entirely terrified me, especially since I had a fever. Could that have been ARS, but then I didn't make any antibodies or am still making antibodies at such a low level that weren't detected by the 84 days HIV 1/2/O EIA? If that were ARS, wouldn't the EIA have picked up antibodies at 12 weeks? 2) Can I WOO HOO with my (excessive) testing results? Even after the 84 day EIA, my anxiety is coming back and now I'm starting to worry about late seroconversion past 12 weeks (I don't have any extenuating circumstances that I know of) and am afraid I will start testing every week until the 6 month mark (I already tested once with the oral rapid test after the 84 day EIA!).

I would love to join the ex-WW club and hear a WOO-HOO from you. In addition, I'd like to donate to your organization. Hopefully you can address my queries and I can start to move on with my life!

Thanks again, Dr. Bob, you are truly a hero to me.

- Kinda Sorta Worried But Trying Not To Be

Response from Dr. Frascino

Hello Sorta Worried But Trying Not To Be,

1. Could your symptoms have been HIV ARS? No absolutely not. Would your 12-week EIA have been positive if your symptoms were HIV related? Yes, absolutely.

2. Yes, your multiple negative HIV-antibody tests out to 12 weeks are definitive, conclusive, highly excessive, WOO-HOO-able and move-on-already-able! HIV is not your problem. No way. No how. No additional HIV tests are warranted.

Your HIV-acquisition risk was extremely low. Your excessive HIV-antibody tests are conclusively negative. Your symptoms are consistent with a bacterial respiratory tract infection, not HIV. HIV would not respond to antibiotics. Your problem is irrational fear of HIV, not HIV itself. Additional testing is not the answer. I strongly suggest you seek psychological counseling to help you confront and conquer your irrational fears of being HIV infected. You need help with your anxiety and depression. In addition I would strongly counsel against binge drinking and smoking! If you don't quit smoking, cigarettes will kill you in a very painful and undignified fashion.

Regarding your HIV scare, it's time to stop worrying and start WOO-HOO-ing. Ready? Here it is: WOO-HOO! Now get your lazy butt back to the gym, start eating properly and get the psychotherapy you need, OK?

Thanks for your support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated. In return I'm sending my good-luck karma that you are now and will always be HIV free!

Good luck and a warm welcome to the X-Files! (Ex-Worried Well Club).

Dr. Bob



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