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one month post exposure..no pep.
Mar 5, 2011

Hello Dr Bob,

First of all thank you for replying to my last post http://www.thebody.com/Forums/AIDS/SafeSex/Archive/Infected/Q213257.html . I am still in Brazil. I went to hospital after writing to you. After waiting for a long, long time I was met by a very tired Doctor who didnÂt really seem very interested in my story. He refered me to a surgeon in the hospital who checked me out and told me I had not been anally raped (one good thing). I was told that I had waited to long for PEP, although I was still within 72 hours and did not see an HIV specialist. I am now waiting for the three month mark to take the test. I have had no fever or night sweats, but I have developed a canker sore and have sore glands. Does this mean I have seroconverted? Would you advice me to take a test now or wait until 3 months? In the hoped for situation that I am negative after 3 months, would you consider this woo-hooable, or is my risk significant enough to warrant a six month test as well?

Thanks again for your help, I will be making a donation.

Response from Dr. Frascino

Hello,

It's unfortunate the emergency room physician you saw was so incompetent. The 72-hour window for commencing PEP is widely accepted. Considering your terrifying experience, most HIV specialists would have recommended a course of PEP. Also, have you been screened for other STDs? If not, you should be.

Regarding canker sores and sore glands, I would not be overly concerned. "Symptoms" are notoriously unreliable in predicting who is and is not HIV infected. Your symptoms would not be worrisome for HIV acute retroviral syndrome or seroconversion.

A negative HIV-antibody test at the three-month mark would be extremely encouraging. However, since we really don't know what happened after your blackout, other than you awoke having unprotected insertive anal sex with a guy, I'd recommend a six-month test for a definitive WOO-HOO.

Thanks for your support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated. In return I'm sending you my best good-luck/good-health karma that your definitive HIV tests will be negative.

Good luck. Be well.

Dr. Bob

Unprotected anal sex Jan 27, 2011

I have been living in Brazil for the last six months. I dont know if this is approprriate for this site but I dont know what to do. The night before last I went out to a club with some friends. I met a girl who was apparently into me, we danced and I spoke to her and her friends, a mix of girls, boys and (I think) transgender. At the end of the night she asked me If I wanted to go back with her. I said yes. A lot of people got in her friends car (I think 8 in a five-seater) but this is not unusual here. I was a bit drunk but no way was I off my face. I remember the car journey started and then I black out.

When I come to, I was having unprotected anal sex with a man who I had no recollection of seeing before. I was on my back and he was riding me. My penis was semi hard and came out and then he tried to put it back in again several times. He did not use lubrification. He was a very big guy and I was terryfied. I dont know if this is rape or what this is. I am straight and not attracted to men.

I managed to get out from under him when he tried to put his penis in me when my penis was soft (I did not ejaculaate). I could not find my things, my phone, my keys, my wallet. Only my shorts were on the floor. I asked him where they were (my things) he said I didnt have anything. I left his house and went home in just my shorts. I recognised the street when I left the place and went home.

I had a shower and the head of my penis was dirty, had blood vessels and my fore skin is still very sore. I have had anal sex before with my ex girlfriend and it never hurt like this.

I went back to the street later to see if I could work out what had happened. I saw the guy at a table in the street with three old ladies. I asked him if he my stuff and what happened. He told me, that he was on the street when I was thrown out of a car in just my shorts. I asked him if he knew the people in the car, he said yes and that he would get my stuff back for me. The old ladies were convinced I had been drugged, the guy didnt say much else and I went.

At the moment aside from a strange emotional numbness (I want to cry or get angry but I just feel strange)physically I have a big spot next to my anus. My anus feels a little sore. The head of my penis hurts, and pulling back my foreskin in very painful. I am worried because I am I have been drugged and had unprotected anal sex. I do not know what happened to me in the car or what the guy had done to me before I woke up. Do I need to go to the hospital? I think I am at risk of HIV too.

Response from Dr. Frascino

Hello,

Frightening story! Yes, you should seek medical attention immediately from your personal physician or hospital emergency room. Post-exposure prophylaxis may be warranted. (Additional history will need to be taken and a medical examination performed before a recommendation one way or the other can be made.) STD screening will need to be done as well. Don't delay. If PEP is warranted, it needs to be started as soon as possible and no later than 72 hours after the exposure.

Good luck.

Dr. Bob



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