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Anxiety and HIV Symptoms
May 20, 2011

Dr. Bob,

I am a nervous wreck typing all the way from Kuala Lumpur, Malaysia. I have been a virgin all my life until recently in March when what devil possessed me I don't know, to pay for a night of sex with a pre-op transsexual escort. We have sex three times the whole night, the first being protected anal sex in which she was the recipient. The second time was a protected oral cum hand job. What I really feared was the third sexual act during early morning when in the throe of the moment I STUPIDLY agree to penetrate her anally unprotected. I did not ejaculate because strangely I lost my erection halfway and pulled out of her. I was not aware then but I am now after surfing through the various websites online that if she has HIV even several seconds to a few minutes of unprotected anal sex would give me a very high chance of being infected. I also have a heavy session of tongue kissing with her during the sexual acts and she also bit on my nipple but did not draw blood or any wound (I am listing all these down because I am not sure if the tongue kissing and nipple biting may contribute to HIV infection as well).

Anyway, 2 days later, I felt something like a sore throat which was then followed by severe pain of the back part of the neck which lasted all through the first week after the sexual encounter. During this time, I could feel painful lumps on the back of my arms near my shoulder, below my right rib cage, and on both the left and right of my inner thigh and below the back of the knee which may be enlarged lymph nodes. The pain in the lumps felt like muscle pains. By the end of the first week, the neck pain subsided to be followed by pain on both the left and right sides of the neck where the cervical lymph nodes are located. I massaged both sides of the neck constantly and ended up with a painful large lump on the left side which may be an enlarged lymph node either due to the possible HIV infection or my having 'overpressed' on the area. Anyhow, I also develop pain in both shoulders which comes and goes until the present day. After a couple of days of enduring the painful lump on the left side neck, I tried applying muscle relief ointment and a hot water bottle which manage to make it subside in a day's time. I began taking hot baths which helps relieved my muscle/lumps pain for several hours and applying hot water bottle also helps immensely. After the lump at the side of the neck subsided, I develop pain at the front of the neck by the left and right side of the voicebox where the thyroid gland is located. I can feel the lumps which are like enlarged blood vessel where the pain is located and it also hurts when I opened my mouth wide. This went away in 3 to 4 days. Starting on the third week after the possible HIV exposure, I started developing itchiness on my thighs and develop what may be rashes that looks like enlarged follicles of brownish to dark red colours. It is at this time that I took up courage and went to my regular doctor for an HIV test. After I insisted on a test that can 'immediately confirm' my HIV status, the doctor recommended the Western Blot Confirmatory Test which I took at 3 weeks and 2 days after the possible exposure. After taking the test and awaiting the result, I develop further symptoms. The night two days after taking the test and while I was applying hot water bottle to my feet and the back of my neck, I felt a strange sensation sort of like a cross between tingling and warm water rushing through the blood vessel of my feet from the toes up to the calf area on both legs. This was soon followed by mild pain in the toes and the muscles of the leg. A day later, both my arms felt the same sensation and I experienced pain in the thumb muscles and little finger muscles of the palm of both hands as well as pain in the finger joints of both hands. I am a report writer and my work entails a lot of typing with both elbows bend against the top of the table. Several days after developing the hand and finger pains, and while working I felt pain on both elbows and upon checking found that they were bright red as if swelling with dry peeling sking on both sides of the elbows. These went away in a couple of days but now whenever I bent my elbows in a certain way, it brings pain to the palm of the hand and the finger joints as well as muscle pain up the back of the upper arm to the shoulders. The pain to the hands also happen when I bent the wrists a certain way. The weird sensation in my legs also kept on coming and going at all times followed my muscle pain and soon the sensation migrated to the abdomen, the neck and now the face. The problem is i have felt these sensations way before my possible HIV exposure but they are always confined to the toes of my feet (particularly the big toes), the area below the mouth and the head occasionally and they are never followed by muscle pains so i don't really know what to make of these as possible HIV infection symptoms. Two weeks after taking the test, the Western Blot Confirmatory came back negative for all assays and the doctor declared me "FREE OF HIV DESPITE MY STILL BEING IN THE WINDOW PERIOD" and that I only need to come back for my yearly blood test and body checkup. He dismissed my symptoms as psychological due to anxiety and guilt, and the rash as my 'overscratching' the follicles of my skin. By this time though, i have already surfed enough HIV websites to doubt the doctor's words. Thus I went to another doctor for a second opinion several days later. This second doctor disagrees with what the first doctor said, his reasoning being that I should not have been subjected to a Western Blot in the first place but should instead go for an ELISA test at 3 months, and then 6 months after the possible HIV exposure. If any of these two tests came in positive then I would be subjected to a Western Blot to confirm before going on to a CD4 Count test. tThe second doctor also question why the first doctor did not conduct STD TESTS to take possible STD infections out of the equation. As such, he ordered STD tests as well as an ELISA test on me at about 1 month and 2 weeks after the possible exposure. The test came back a week later negative for everything but the doctor did advise me that I am still in the window period for HIV and to come back for an ELISA test in June when it is 3 months after the exposure. if the result is negative I should come for another ELISA test in October 6 months after the possible exposure to confirm 100% that I am in the clear. He also dismissed my symptoms as being psychological. At this time right up until the present, I have been developing itchy rashes accompanied by tiny whitish puslike circular nodules at the end of the rash mostly on my follicles, and occasional stinging pain which develop into hive-like rash which quickly disappears within the hour. The itchiness also sometimes develop into small blisterlike papule on the legs. Recently I develop ichiness on the back of the thigh slightly above the buttocks which looks like the maculopapular HIV rash shown in pictures on the websites. Then again, they also look like hives and heat rashes. They can be described as large red patch of slightly raised skin with red-coloured follicles within the patch. I've had them for three days now and applying calamine relieved the itchiness immensely. The weather here has been very hot and I have been sweating profusely these couple of days but I have never experienced something like this before for all that I can remember. I have also developed occasional tinnitus on both ears which were preceded by the weird tingling/warm water sensation on the back of the neck leading to the ears, but then again I have had occasional tinnitus on both ears all my life but never preceding the strange sensation I described. I also have fasciculation in the muscles of my body. Again, because I have fasciculation before my possible exposure, I don't know whether they have increased in frequency and whether they are related to HIV infection. Plus, all these pains i described however did not disturb my sleep pattern throughout the whole ordeal. I am awaiting for my June ELISA test at the 3 month period but these symptoms are bothering me doctor. Can the mind be so powerful as to help me 'create' these symptoms out of anxiety and guilt? I try in the past weeks to live a happy life and not think about the pain and everything but the strange sensations in my legs and arms appeared suddenly followed by the mild pain and I am dragged right back in again. The symptoms happening without me thinking of it is prove this is not my imagination and is a high possibility of HIV infection am I correct? My shoulder pain which now connects to the elbow and hand which started almost two days after the possible exposure and has not recovered fully with the pain coming and going and sometimes with painful lumps at the side of the arms near the armpit (just below the shoulders) which I am not sure are muscle lumps or enlarged lymph nodes should also be clear indication of HIV infection correct? And lately i think I have been noticing dents in the muscles affected by the weird sensations. Could this be muscle wasting due to peripheral neuropathy? I read that arthritis and neuropathy are clear indication of HIV infection even before someone is tested positive for it. One note: I have not experienced any fever throughout the ordeal and only a mild sore throat in the third week which lasted for a day and a half followed by coughing with clear phlegm which has already subside. i have had the occasional sneezing and runny nose on and off. But fever is not the constant criteria in HIV-related symptoms and i might be the few who who would have developed all the HIV related symptoms without fever. I know this is a rather long note but the anxiety of the symptoms is killing me and I need to have an opinion at least so that I may be prepared for the ELISA test in June for a possible acceptance that I may be HIV positive. Thanks Doctor Robert.

Response from Dr. Frascino

Hello,

You report you're a report writer and your work entails a lot of typing.... From the detailed missive you posted I have no doubt you're very good at your job! -- lots of typing indeed!

So you've "been a virgin all your life until...." Actually, isn't that everyone's story? OK, OK, I know your decision to lose your virginity with a pre-op transsexual escort is indeed a bit on the unusual side. Did you get tired of waiting for a match on eHarmony.com? Oh, never mind. Let's examine your HIV-acquisition risk.

Pre-op tranny episode #1 was "protected insertive anal." Protected sex is indeed protected, assuming the latex condom was used properly and didn't fail (break). So let's assume no risk. So, no problem.

Pre-op tranny episode #2 was "protected oral cum hand job" -- whatever the hell that is. But since it too was "protected," the same logic as above applies. So, no risk. No problem.

Pre-op tranny episode #3 was unprotected insertive anal sex. Oops! Problem! What happened? You were doing so well with episodes one and two. Your assessment is correct: unprotected sex does place you at some degree of risk for STDs, including HIV. Consequently STD/HIV screening is warranted.

The tongue kissing and nipple noshing without causing a wound or bleeding would not be considered an HIV-acquisition risk.

Next, let's talk symptoms. Symptoms are notoriously unreliable in predicting who is and is not HIV infected. That said, your symptoms are most consistent with anxiety, not HIV. You ask: "Can the mind be so powerful as to help me create the symptoms out of anxiety and guilt?" The answer is absolutely! Just review the archives for gazillions of examples!

Finally, let's discuss HIV-diagnostic testing. Basically everything Doctor #2 told you is correct! Doctor #1 is a nitwit who shouldn't be practicing medicine! Follow Doctor #2's advice. The odds are all in your favor that you did not contract HIV from your tranny sexperience. I would also suggest you consult a licensed mental health practitioner to help you confront and cope with your fears of being HIV infected. You should also explore sexual orientation issues and ways to cope with your guilt. In addition you would benefit from treatment for anxiety with anti-anxiety medications and/or psychotherapeutic counseling.

Good luck. Be well.

Dr. Bob



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