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Two incidents haunting my mind
Jul 15, 2011

Hi Dr. Bob: How are you? Please clarify if my HIV test at 3 months is really woooAAAAbllle (whatever...). Incident 1: A guy came on my thighs after solo masturbation (this I know is non-risky, right?), with a tiny drop reaching one of my eyes; Incident 2: The same guy touched my butts and a little bit of the inner region of my butts (not near the anal region) with his hands containing fresh sperm. The problem is that I have a lot of foliculitis and atopic dermatitis in these areas, and Im afraid this might have infected me. I cleaned immediately everything under the shower, but might have rubbed some sperm against my skin with the towel I wore on the way to the shower. I think he is HIV-positive, and my symptoms were severe plus low cd4 (312), anal HPV and oral candidiasis. Interestingly, I never had anal penetration in my life, nor oral sex. Also, nobody has ever touched my anal region. How on earth did I get HPV there? Low immunity? I had an HIV 1 quantitative RNA PCR and HIV 1 and 2 Elisa (dual test)that came back negative after 14 weeks from exposure. The Elisa was done twice. I also developed hives, dermographism, neck pain and seborrheic dermatitis that have become annoying. Should I still worry and get another test after 6 months? What are the odds that I am one of those atypical cases? I have a work contract to sign up, but my decision is pending on this. Please help me! Im a great fan of yours!

Response from Dr. Frascino

Hi.

"WoooAAAAblle"??? I can't even pronounce that.

Your HIV-acquisition risk from the two incidents you describe is negligible at best. I would consider negative HIV-1-and-2 ELISAs and an undetectable quantitative RNA PCR at week 14 to be definitive and conclusive.

Regarding your symptoms, HPV can be spread by skin-to-skin contact. You could have touched an HPV infected area and then immediately touched your anal area. Alternatively someone could have touched your backside without you remembering. Getting HPV does not mean you have "low immunity." Regarding oral candidiasis, was this diagnosed by a physician? It's an overly diagnosed condition and lots of folks who think they have it actually don't. Those that do usually have a reason, such as recent use of antibiotics.

You also seem to have a variety of skin problems: "folliculitis, atopic dermatitis, hives, dermatographism, seborrheic dermatitis." I'd suggest you see a dermatologist to get these sorted out. They are all very treatable conditions. I do not believe your multiple skin conditions are HIV related.

Finally that leaves your low CD4 count of 312. Why was this test ordered? Your HIV-antibody tests were negative and your PCR RNA was undetectable. Consequently there was no reason to order CD4 counts based on HIV. CD4 counts are nonspecific tests. I would suggest repeating the CD4 count one to two months after your initial test. If your counts normalize, no further workup is needed. If they are still low, your doctor (or a clinical immunologist) can run additional studies to try to find out the cause.

Do I think you are an atypical HIV case? Nope. I think you're a typical worried well case!

Good luck.

Dr. Bob



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Help me Dr Bob please..... (WHAT YOU DONT KNOW CAN KILL YOU, 2011) ( IS IT BETTER TO GET HIV TESTED OR NOT TO KNOW, 2011)
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