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Struggling with Anxiety (3rd request) please help
Mar 29, 2011

Doctor Bob,

I've been reading your form for a little while and commend you for your work!! Below is my scenario, please help me, idk if I'm just suffering anxiety or I am at serious risk.

I got drunk and made an awful mistake, First time.i went to a Latin Tranny sex workers hotel to engage in activity.Everything that was done, was done with a condom on.We exchanged protected oral and then she penetrated me.I don't remember what type of lube if any was used.i then told her I wanted to perform oral on her.she changed into a new condom.I performed on her.she then got behind me put 2 fingers in my rectum very briefly and then penetrated til completion(in the condom inside of me).when she was done I saw the condom didnt break.she took it off and then performed protected oral on me til completion.The next day I was in a panic.I woke up with diarrhea and wiped hard and saw blood on the toilet paper.my butt also felt like it was leaking a watery material (it still feels like this 3 days later).I also noticed a huge wart on the lining of my pelvis directly next to my right testical maybe 6-8 inches from my rectum.I decided to go to a hospital.they rapid tested me (negative result) and then gave me combivir.I am now on my 3rd day of these pills, took my first one 28 hours post encounter.i feel like there is a 50% chance I am infected

What is the probability of infection from what I described (assuming she was infected) 1 in 2, 1 in 5, 1 in 10 etc (in your professional opinion)?

Am I overreacting? With an enabled condom that wasn't lambskin, would my risk almost be zero?

I have read combining combivir with kaltera is more effective PEP, why did I only receive combivir?

Is PEP common in this situation? How effective is it?

Even though the condom appeared to be in tact, what are the probabilities of failure? Could the condom have been damaged and had microscopic holes that transmit the disease?

What are the odds of transmission in this scenario? Can this wart that appeared 30 hours later be from this encounter? What can it be? why does my rectum feel like it has been leaking water for the last few days? What is the timeframe for testing after the combivir? How effective is combivir if I am infected? I started 28 hours post exposure The next day I showered and went to work...I put on clean khakis, but when I got home I notices a stain on the outside and inside near where my rectum is, what can this be??

I am not wealthy by any means but, I am going to make a donation to your charity as it is for a great cause!! please provide a link to do so.

I am very thankful for advice, would also love some of that good luck karma...

Response from Dr. Frascino

Hi,

I agree with the title of your post. You are indeed "Struggling with Anxiety"! I do not believe you are struggling with HIV. PEP (Combivir) was not warranted in my opinion based on the information you provided. HIV cannot penetrate intact latex. No way. No how. Consequently, since "everything that was done, was done with a condom on," your HIV-acquisition risk would be essentially nonexistent, assuming the latex condom was used properly and didn't fail (break).

I'll briefly respond to your 11 (ELEVEN!!!?!) questions:

1. Essentially nonexistent. See above.

2. Yes, you are overreacting.

I have no idea. You would have to ask the prescribing doctor. Two drug PEP regimens (such as combivir) are sometimes prescribed for various reasons. Personally I prefer the three drug regimens. As mentioned above, I do not feel any PEP regimen was warranted in your situation.

4. Nope, not common.

5. All I can say is that if it was used properly, your risk would be essentially nonexistent. I have no way of knowing what the probability of your not using the condom properly would be.

6. I've already answered this question at least three times! Enough already!!!

7. No, warts don't appear that quickly. I can't diagnose what you have over the Internet. See a dermatologist if you're concerned.

8. This may be a consequence of your first anal receptive experience. If you continue to "leak," have your doctor check you out. (I doubt this will be necessary.)

9. The guidelines for post-PEP testing recommend HIV-antibody testing at four to six weeks, three months and six months from the date of exposure.

10. There are no statistics, as each case is different. We do know that PEP, when appropriately prescribed and taken, does help to decrease the risk of HIV transmission. However, there are PEP failures.

11. I obviously have no way of knowing! You could be leaking excess lube or have sat on ketchup!

I would suggest you talk to your doctor about your "struggle with anxiety." Anti-anxiety medications and/or psychotherapy (counseling) may be very beneficial in helping you confront your guilt as well as your anxiety. Counseling might also help with sexual orientation issues.

Thanks for your support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's very much appreciated.

Good luck.

Dr. Bob



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