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Closeted guy with possible exposure and symptoms
Apr 16, 2011

Hello Dr. Bob,

I want to start by thanking you for helping so many worried wells. I know that you receive hundreds of emails everyday but please continue reading my message as I am very nervous and I need Dr. Bob style assessment (and hopefully reassurance). I wrote to you before but now I had some symptoms (including rash) that are really making me worried. As a background, I am a still closeted gay student and I have a phobia of getting HIV. That's why I don't really get involved sexually to avoid the risk. About 2.5 weeks ago I dated a guy (claimed to be negative many times but I later learned that hes rather promiscuous) which ended with protected receptive anal sex. Before that, however, he was rubbing his penis (uncovered) on my anus and at some point I noticed higher than normal pressure which caused me to freak out so I stopped him immediately. The push (maximum of 2-3 seconds) was not similar to an attempt for penetration but since Im very new to anal sex, Im afraid that slight penetration (1/4inch) might have occurred (he later claimed that nothing happened). There was no pain and the sensation was not similar to what I felt during anal sex later that night. After this incident, I am mentally a train wreck and I am still unable to sleep, eat or really function well.

About 10 days later, I developed 4 small (5mm) red spots on my chest. There were gone by day 12, so they last for 1.5-2 days. In addition, on day 11, I started to have minor throat discomfort (not a real sore throat) which was cleared completely by day 13. I never had any fever or generalized swollen lymph nodes.

Now I have few questions that hopefully you can answer:

1- How do you assess my risk (theoretically and realistically)? Do you think that there might have been a penetration (without a pain or rather high push)? 2- I know that you always say that symptoms are notoriously unreliable for determining the risk but are my symptoms consistent with the ARS? I have read that the rash is often more diffuse and there are significantly more that 4 spots. Also there is almost always fever. Are these true? 3- What is your recommendation for me while Im waiting for my 12-week window period?

Thanks, Worried S.

Response from Dr. Frascino

Hello Worried S,

"Still a closeted gay student" and you still have HIV phobia and now you are "mentally a train wreck, unable to sleep, eat or function . . . ." Hmm. Obviously these facts are all intimately linked!

Responding to your specific questions:

1. Negligible risk. Unlikely penetration.

2. Nope. Yep.

3. Seek psychotherapy (counseling) to help your coming out process and to help you confront and cope with your irrational HIV fears. You may well benefit from treatment of your anxiety as well (anti-anxiety medications and counseling).

Good luck.

Dr. Bob



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