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How do you read all these emails? Oral, Pep, Ars, Anxiety and other QTND from a numbnuts cybercondriac
Jul 13, 2011

Dr. Fascino -

I am writing to you for several reasons: (1) To thank you for all the time and energy you donate to this site! I have been reading the archives and your blog entries, you are both witty and direct in your analysis. (2) Because I have experienced an exposure of some level of risk (I know, anything practically beyond breathing is a theoretical risk) and have outstanding concerns. (3) There are questions I have that do not seem to have direct answers, even after becoming a cyber-condriac. (4) Finally, because anxiety is making me dysfunctional and your good karma might benefit me, and others reading this, as well.

I do hope that you have an opportunity to respond to this message, as all people do I'm sure, and wish you well.

That all said, let me start with my exposure risk: Back in February of this year, during a business trip, I performed unprotected oral sex on a male of unknown status in Dallas, TX (Although, he lives in Austin, TX day-to-day). The male was 41 years of age, Hispanic origin (but a native American English speaker) - he stated he did not have any STD's or HIV however also admitted to not being tested recently (citing no need due to no recent sexual experience) but who knows. The experience included deep-throat sex for approximately 20-30 minutes without ejaculation. My throat was sore and my initial freak out occurred after he left when I coughed up a small pea sized amount of bright red blood mixed with saliva (this was the only instance of seeing any blood), I was unable to see the throat trauma myself. My oral hygiene includes zero gum issues, I did not brush for 4 hours before or after, I did not eat for at least 3 hours before or after. After, I did rinse my mouth with water. Yes, I see several issues with swallowing a questionable trouser snake at all - most of them easily can be signed off to stupidity :-). Approximately 24 hours after the event, while my anxiety was not subsiding, I presented to urgent care and received a prescription for PEP (Combivir only) along with a host of blood work (including HIV test). She also prescribed antibiotics, as a prophylactic. I followed up with my GP 2 weeks later, receiving another host of blood work. All blood work was normal. At 4 weeks (28 days post exposure) my GP requested I perform another HIV blood test (antibody) - which was non-reactive. I also suffer from genital HSV but was not having an outbreak during the exposure risk (nor are my genitals in question, at least this early in the post).

And to finish up this wonderfully entertaining story, around 14 days post-exposure, I began having a sore throat, severe headache, similar to a dehydration headache about the forehead on both sides of the head, with a potential rash on my forehead and neck (The rash by itself is not abnormal for me though, it happens often) and a change in odor in my groin area that is difficult to explain. I have never had a headache like this before. No fever associated to this. This lasted until day 19 or so. During Pep, I somehow missed 1 dose, discovered about 2 weeks after being on pep, otherwise my adherence was excellent, I set a timer and took the pill +/- 5 minutes of scheduled times, everyday.

Fast forward to the future - (ok, the present): This week I came down with strep as did my son, I am on amoxicillin and am recovering. Additionally I have been suffering from a small discharge from my urethra and off and on diarrhea. A dirty catch UI was negative for everything. There is no burning, but it is not going away. Note I mention my son, yes I have a son and a girlfriend. She was present for the encounter, he was not (of course)... She thinks I'm being a little nuts, but we are rain coating it anyway, even today after the event. There was one condom failure and she was still breast feeding at that time. Our son did come down with an illness, which presented as infantum roseola (Hope I spelled that right) a few weeks after that break with an ear infection, no other issues to date (except the recent strep).

So, you are probably wondering - is there a question in all of this information, or crap, depending upon the audience. and YES! Low-and-behold there IS a question or two involved here.

(1) Calculating risk is difficult at best. Even though I already know your answer, to hear it might do good. Would you consider this a low risk of contracting HIV in my particular case? Yes, I know.. you have answered this, everyone says their case is unique, and to some small extent, all of them are a little, but very little changes story-from-story and it at least provides as anxiety reassurance. I also am aware, this is the biggest QTND

(2) In the worst case scenario, if I am infected, what is the risk that both my girlfriend and son are infected from the broken condom incident - I would be in acute infection, therefore the risk would be high, yes?

(3) Listed in my 'potential' ARS symptoms was a change in groin smell - is that possible as a symptom of ars? I've never seen it listed anywhere, but almost everything else in the world is a possible symptom. Additionally, does the headache sound like a candidate for the type of headache one would experience?

(4) Can my recent strep, diarrhea, and discharge be attributable to a weakened immune system, potentially due to HIV?

(5) If my infant son was infected, what would be his prognosis? Will he be okay?

(6) I know a negative test at 4 weeks is encouraging, and I'm [almost] sure that is all you will say, but I'm going to ask anyway... Is there statistical significance to this 4 week negative test? Specifically, is there a statistically relevant 'odds' of seroconversion after a 4 week negative test - every site was something different to say, some say a 4 week test in 90% accurate, others say 50% - maybe they are all guessing, or perhaps there is some statistical data out there in the medical circles, I really don't know, Do you? I ask because this could potentially alleviate some of my anxiety (Or make it worse I suppose :-) )

As a final word, yes - of course I do plan to get tested again at the 6 month mark (even though a 3 month test was indicated I missed it) however I am currently being dysfunctional over this - hell, I would be working right now, not writing you, and would appreciate any words you have.

Thank you for your time, knowledge, and dedication.

Regards, Numbnuts

Response from Dr. Frascino

Hello, Cyber-chondriac Numbnuts.

1. Yes, I would consider your "business trip" extracurricular activities to be a low risk for HIV acquisition. And yes, it is indeed a QTND!

2. Remote to nonexistent, leaning very heavily toward the nonexistent side.

3. A change in groin smell??? Tell me you're kidding. Please tell me you're kidding. (And tell me, how exactly do you sniff around down there anyway?)

4. Nope.

5. He's not infected.

6. Nope; it's just encouraging.

If your anxiety and HIV fears are causing you to be dysfunctional, I'd advise you consult a licensed mental health professional to help you confront and cope with your fears as well as to treat your anxiety.

As requested my good-luck karma is headed your way!

Good luck.

Dr. Bob



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