Symptoms? What Symptoms?

Posted on August 2, 2012 by drtan

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I am writing this story while it is still fresh in my mind. This only happened a few days ago in my clinic.

It was a terribly busy Wednesday evening. For those of you not familiar with the weird and wonderful world of medical practice inSingapore, Mondays are traditionally the busiest days. So there I was trying my best to clear my patients as fast as I could in order to keep waiting times below normal human limits of patience.

That was when Mr. A walked in. You would like Mr. A. He came across as a really friendly unassuming chap with a nice smile and spoke extremely casually.

Mr. A led what you would call a ‘fast life’. Frequent trips to Thailand,Vietnam and other South East Asian countries were the norm. And these were not work trips, these were party trips. He would hook up with friends and paint the town red. Bar hopping every night and ending up with a different partner in bed. Mr. A was also a very tolerant with his sexual tastes and would have sex with both men and women. He would sometimes use condoms but more often did not bother. Often, the trysts would end with Mr. A not even knowing the name of the person he just slept with. He really took the term ‘casual partner’ to the extreme. On the flip side, he never employed the services of a commercial sex worker.

This went on for years until one fine day, Mr. A noticed a rash on his forearm. It started out as a pimple and progressed to a red mottled rash that covered the entire left arm and up to the shoulder. Mr. A visited his GP who diagnosed the rash as an allergy and prescribed him some medicines. The rash responded very quickly to the medicines and began disappearing within 2 days.

One night, when Mr. A was casually researching what could be the cause of his rash on the internet, he came across the word ‘HIV’. Upon further reading, Mr. A realized that his lifestyle could place him at risk of a HIV infection.

It was with this background that Mr. A turned up at my clinic that busy Wednesday evening. At the time, his rash had completely disappeared thanks to the expert treatment by his GP. He also looked perfectly fine and healthy. My nurses even commented that he had a nice pink flush to his face. But his lifestyle history raised many red flags in my head.

So it was with not much surprise to me when the HIV rapid test showed a reading positive for HIV infection. Mr. A however was utterly shocked. ‘I feel so well’ he said, ‘My appetite is good, I do not feel short of breath, I do not feel tired, I never had a fever.’ I carefully explained to him that we cannot rely on the presence or absence of symptoms to diagnose HIV. In fact, I told him that it was pure luck that he mistakenly assumed his rash was due to HIV when it obviously was not. The unfortunate fact is the rapid test is positive. We had to proceed on to the Western Blot to confirm the infection.

We are still awaiting his Western Blot results but looking at the rapid test, I had to honestly tell him to prepare for a life with HIV.

Learning points:

1. Symptoms? What Symptoms? Never rely on symptoms to diagnose or exclude HIV. Having symptoms does not mean you have HIV. Not having symptoms does not mean you do not have HIV.

2. Always use protection. Even though it is not 100%, it could well save your life.