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Great Work Doctor ($50 just donated to your charity)
Apr 3, 2011

Dr Bob,

I appreciate your humor and insight helping people with troubling times. I applaud your work and continue to wish you the best!

I just sent a donation of $50 your way

My situation is as follows:

I was on vacation in SF last week and got really drunk. I ended up going over to a latin tranny sex workers hotel (these are EXTREMELY high risk individuals)

We exchanged protected oral, not sure if the condoms were polyurethane or latex or if they had spermicide or nonoxynol 9? i have read polyurethane is almost as successful as latex?....I have also read that nonoxynol 9 is not recommended, if the condom remained intact would that still be a factor?

she then penetrated me, i was drunk and unaware if lubrication was used...this was pretty brief and I told her I would like to perform oral...she switched into a new condom...i performed oral, this was my first time so is there a chance i damaged the condom while performing?

after 2/3 minutes she then got behind me and inserted 2 fingers into my rectum (possibly using spit, i dont remember, i feel that is pretty low risk? but your opinion is much appreciated)....she then penetrated me to completion...one of the only things that i placed a firm memory on from that night is seeing the condom intact, hanging on her penis, filled with semen.....

I have read on tons of previous posts you have written that hiv cannot penetrate intact latex, does the same apply if by chance it was polyurethane?

you have also written that there is no way, no how if the condom doesnt break (fail)....if the condom failed, would it have failed and shattered everywhere, could there have been a microscopic hole in it from my teeth? if there was a tiny hole, all it would take is one little drop of semen to infect me....this was my first time, so i assume internally i was probably bleeding as well, i am sure this increases my risk! the next day i had diarrhea and afterwards when i wiped i had blood on the toilet paper....

I went back to confront the tranny and she told me I had nothing to worry about...i asked her her last time taking a test and she said a year....a year!!!! im terrified from one encounter, how can she be so calm!!!???!!!

she told me she always uses protection and I am fine....to say the least, this was the opposite of reassuring!!!

I decided to go to the hospital and get PEP, they only gave me Combivir 150/300, i wish i had also received kaltera with this...i started pep kinda late (28 hours) so i am concerned it wont be effective....if there is blood is HIV guaranteed? i know the odds are 50 per every 10000 unprotected, and i am assuming she was infected and somehow the condom failed, with the blood i had on the tp the next day i put my odds of hiv infection between 10 and 50%....also if the wrong lube was used on the condom (i am not sure of this) would it lead to little microscopic holes or tears, or would the condom just shatter like a popped balloon?

I am now walking around like a wreck, everyone i talk to can see that I am falling apart...I dont think I can hold it together for the next 4 months of testing...are there any more rapid tests i can do? if so will the pep effect these tests...I have worked so hard to set myself up for success and have finally saved enough money to propose to my gf of 3 years, i love her and wont touch her until i have a definitive status under my belt...I am having difficulty breathing at times, just knowing that I have ruined everything on one drunken mistake!

Do I need to go to a specialist?

What can I do?

I am almost sure that I am now infected!! I am having serious difficulties keeping it together...

Please help!! Please break my situation down as an expert in the field....

Some good luck would also be nice ;)

Thanks in advanced Doctor Bob!

Response from Dr. Frascino

Hi,

And so an innocent young lad decides to vacation in San Francisco, gets wicked drunk and winds up playing Brokeback Mountain buddies (luckily with a condom) with a caliente Mr. Sister (Latin-Tranny hooker). Hmm. You're like the fifth one this week. One wonders if there is a rightwing religious-zealot tea-baggers' convention in town!

Your HIV risk is essentially nonexistent, assuming the latex (or polyurethane) condom was used properly and didn't break. PEP was not warranted. Your problem is guilt, not HIV. I'd recommend psychotherapy (counseling) to help you confront your guilt and your irrational fears of being HIV infected. You might also consider discussing sexual orientation issues, considering in your inebriated state with loss of inhibitions you wound up seeking out had having so much backdoor action.

I don't believe you've "ruined everything," but I do believe you would benefit from psychotherapy (counseling) and treatment of your guilt and anxiety. I'd also recommend you level with your girlfriend. It's the right thing to do.

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

Good luck. Be well.

Dr. Bob



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