extremely worried


Hi Dr.

First off let me say how much i admire your strength and determination. You should feel very proud of yourself for the work you do. My story is as follows. After a while my sex life with my wife turned for the worst. instead of talking through it and finding therapy ( we love each other very much ). I resorted to call girls. Always protected vaginal sex, but once or twice unprotected oral ( performed by them ) before i could even stop them. it would last for a few minutes, then i would have the guts to stop them. I dont recall having a broken condom ever, but you never know. The last time i remeber one of these onprotected orals was almost a year ago. i dont remember ever having what people call the initiall infection syndrome ( flu like ) but maybe i did and called it just that. I do remember having a stomach flu that lasted one day and one night. fever, vomit, and diarrhea. but again....it was gone the next day. and i dont remember if this was before or after one of these unprotected oral situations. Since about six months ago, I have decided to talk to my wife and resolve our sex life. its been great....of course..i have tried to always use a condom because i have always had HIV in the back of my mind. But a couple of times she has protested. nto knowing what i have done. About a year ago i slammed my finger in a door. the fingernail completely turned black and started to fall off. having a habit of biting my nails i chewed and picked on it all the way until there was nothing there...pretty disgusting ( also working on this habit ) then i started started noticing little dimples in my finger nail as it grew out. psoriasis like dimples. it then got covered with them over time. About 3 months ago...after a very stressfull time at my job due to tremendous amount of work and decision making. I started noticing ALL my finger nails with little pits or dimples in them. Could this be psoriasis cause by HIV ? Six months ago i had an ingrown toenail(big toe)...i usually get them cause i have a bad habit of hacking at my toenails when i cut them. This one was painful to the point that it was painful walking. We took a trip to south america where i surfed in "questionable waters" and around the same time ( 3 months ago ) i noticed that my left big toe had a white crusty patch coming out from the cuticle...i could use my finger nails to remove some of it, and as i did, now there is a dent in it. i also notice the same thing...not so severe, happening on all the other toe nails.....white flaky tissue coming from the cuticle. I also have this on my fingernails along with the pits. does this sound like Subungual Onycomycosis ? it spread to the skin around the big toes. causing the calluses to dry up and crack. i have treated this with moisturizers, and it seems to help the skin, but not the nails. i have heard this is a definite clinical sign of HIV infection....also heard of psoriasis to be a clinical sign of infection. SInce then i think i have worried myself sick. I have a 13 month old son. my wife got her routine blood tests before the babyb was born and she testes negative for hiv. they tested the baby for HSV, and came back negative. both me and my wife have genital herpes. with very little outbreaks. i havent had one in about 18 months...not visible anyway. i cant bring myself to telling her about all of this....and i cant bring myself to getting testes cause i am completely alone in this. 2 weeks ago i got what seemed to be a sinus infection...severe headache and pressure behind my eyes, tuffy nose in the morning, but ok in the after noon, but the pressure got worse in the afternoon. i treated that with sudafed. and three days later the headaches were gone. But i developed diarrhea....maybe due to the anxiety ? stress ? i still have it....a month later !! and during a recent trip to south america with the family i cought some sort of cold, i have a cough that has lasted almost a week, no runny nose...very sore throat. and finally....for the past 4 nights i have not been able to sleep. my family is away for the holidays...i am stuck working, and i am having trouble falling a sleep, when i do, I wake up at exactly 4 am....and then toss and turn until its time to go to work. its killing me. is there anythin you can say to help ease this anxiety ? does it sound like i am infected ? the baby is thriving...walking, talking, eating....he has had the occasional runny nose and temperature due to teething. but i am worried sick. i dont kow if i could live through telling them i have infected them. maybe i havent ? again...thank you very much for the work you do Dr Franscino. I hope my donation will be helpful to your organization. and i hope i can get over this and find the strength to get tested....i guess its my only option to know for sure.



Let's analyze your situation, even though it's extremely similar to so many others already posted in the archives.

Your risk is negligible at best, assuming the latex condoms used for your secret tryst were used properly and didn't break. By the way, if a condom does break, it's not a subtle occurrence and you would indeed know it happened! Mr. Happy pops out just like your head pokes through the top of your turtleneck sweater. So your actual risk is now reduced to insertive oral sex, which carries only a negligible risk for HIV transmission.

Next, your symptoms. If you are not a dermatologist, I doubt you are really qualified to diagnose psoriasis based on "dimples" in your fingernail or subungual onychomycosis based on a "white crusty patch coming out from the cuticle" of your toenail. Even if you did actually have these skin and nail conditions, which I doubt, neither is "a definite clinical sign of HIV infection!" In fact the vast, vast, vast majority of cases of both psoriasis and onychomycosis have absolutely nothing to do with HIV/AIDS! Regarding your other symptoms, I agree: anxiety and stress are definitely involved.

My advice to you is exactly the same as that given to all those similar cases already posted in the archives. (Check them out!)

  1. Level with your wife. It's not only the best way to confront your guilt; it's also the right thing to do.

  2. If you are having ongoing problems with your skin or nails, see a dermatologist for proper evaluation and treatment if needed.

  1. Get a rapid HIV test. You'll have an accurate definitive answer on your serostatus in as few as 20 minutes. The odds are astronomically in your favor that you did not contract HIV from your walks on the wild side. You played safe (well, safer anyway). Your anxiety is way out of proportion to any real risk. You are driving yourself insane with guilt, depression and anxiety. This will only get worse the longer you procrastinate. You don't need "strength" to get tested. All you need is common sense. Your fears are irrational and could well ruin your marriage, your health and your life, if you don't resolve these issues.

Thank you for your tax-deductible donation to The Robert James Frascino AIDS Foundation. I can assure you your one gift will touch many lives in desperate need. In return I'm sending you my best good-luck/good-health karma that your definitive HIV test is negative. I'm quite confident it will indeed be negative and you'll soon be able to add your testimonial to the gazillions of other X-Filers (Ex-Worried Wells) already populating the archives.

Good luck.

Dr. Bob