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There once was a man from Nantucket....
Aug 22, 2011

Dr. Bob,

I was reading through the archives and saw someone reference you as the Wizard of Poz, thought that was brilliant! I've spent the past few days exploring this site, your blog, and your archived responses. I cannot believe how compassionate and caring you are, but witty and fun. Far less has happened to people I know, and they are far more bitter and unhappy than you. You are like a bright light shining in the world. Cheers to you!

Com'e' stato il tuo viaggio in Italia alcuni mesi fa? OK, that wasn't my question, but an important one nonetheless.

I tested negative about 2 years ago. Had been with the same person (woman) during that time, until earlier this summer. I had two potential exposures (read: unprotected) with the same woman--of unknown status. Once in about mid-June and another time in mid-July.

I am not exactly sure when, but I think since about middle July I have had what I believe to be is a constant outbreak of herpes (Was not a primary infection; I had the herp from before). While it has not been severe (no weepy lesions, etc), it has been more or less constant with redness around the fold of my foreskin, typical itching/tingling, and small bumps. Also, have had prodromal symptoms pretty much the entire time (transient tingling, burning, sharp pains in the back of my legs, thighs, some in my feet, in my arms, and maybe a little in my hands---this has been characteristic of my prodromal symptoms over the years--only now the feelings aren't as pronounced as when I have a doozy of an outbreak coming on).

I noticed this 3-4 weeks ago. I have been a Valtrex guy for suppression for a while, and I realized something weird was going on when it didn't knock out this outbreak within a few days. A couple of weeks ago I was trying to figure out what the heck is going on and there I saw it: chronic herpes simplex outbreaks (>1 month duration) are common in the HIV setting. So that really threw me off course. Since then I have been examining my little fella multiple times a day and trying to always not were I am feeling the tingling or burning of the prodromals.

I know I have put myself at risk and need to get tested, but was wondering the following:

1. How frequent have you seen/heard chronic herpes outbreaks being a symptom during ARS/seroconversion/early stage HIV infection? When I read things like the WHO HIV staging document and other more "academic" style papers and case studies, it looks as though chronic herpes is most often a later stage (lower CD4 count) complication.

2. I know that one's immune system takes a beating during initial infection/seroconversion, but would it be abnormal/unique for chronic herpes to be my first symptom of ARS/early stage HIV? Would Valtrex really be so ineffective against an outbreak in HIV as this experience seems to be?

3. I am sure that it is very possible and most likely somewhat common for newly infected folks to move right into the symptomatic stage (or is it not?), but again, in your experience would you think that I would have experienced at least some other symptom prior to experiencing one that is identified by WHO as Clinical Stage III?

I'll make you a deal...indulge me with a response and I will (a) go get tested and (b) never have unprotected sex again. Deal? Actually, to be honest, I'm going to do both regardless, so if you'd respond anyway...I'd be eternally grateful. Can't take much more of the stress and anxiety the past 3-4 weeks have been marked by.

You are more than the Wizard of Poz. You are an angel....Mille grazie,

Steve in Nantucket (well, the weekends anyway)

Response from Dr. Frascino

Hello, Guy from Nantucket.

1. Chronic herpes outbreaks are not a commonly seen feature of acute retroviral syndrome.

2. It would be extremely unlikely. Valtrex should still be effective.

3. Yes.

4. Deal!

Buona fortuna.

Il mio viaggio in Italia e stato in una parola favoloso.

"Wizard of Poz"



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