2099 Case 2-2006 is dumb as a rock and supporting an entire industry with our tax money

Sipping my Starbucks today, I opened the NEJM, Jan. 19 issue to p. 284, "A 31-year-old, HIV-positive man with rectal pain" is the title of the case. Reading a bit further. He smokes a pack of cigarettes a day, regularly uses marijuana and meth. He is unemployed. (What a surprise!)

He has AIDS, rectal discharge, pain when defecating and blood in his stool, pelvic pain, nausea, and weakness. It's the pain, not the AIDS that has sent him to the doctor this time. He has regular anal intercourse without condoms with his "usual partner" who also is HIV positive, and he has other partners.

He was diagnosed 12 years ago (as a teen-ager) and has had sporadic care over 10 years including zidovudine, lamivudine, nelfinavir, and ritonavir-lopinavir, but has been inconsistent. A year ago he was sick and hospitalized with some things too long to spell or pronounce, but I know they are bad, and received cephalexin, clarithromycin and ethambutol.

After discharge from the hospital he received didanosine, stavudine, and efavirenz, after which he developed Kaposi's sarcoma, oral thrush, rectal herpes simplex and anal condylomas. Then he was treated with acyclovir, fluconazole, and dapsone.

For the current problem, he got ceftriaxone and azithromycin. Now he is diagnosed with proctitis--a first for him. The list is narrowed to gonorrhea, herpes simplex, chlamydia and syphilis--all common among men who have sex with men--but lab tests showed he didn't have those (small miracles).

So there are more tests, as his symptoms ease and then return--probably because he keeps reinfecting himself with more anal sex. The diagnosis section of the article says "he should be screened for sexually transmitted diseases, . . . and a thorough contact investigation should be initiated."

He is referred for a sigmoidoscopy and rectal biopsy, and it is determined he has lymphogranuloma venereum proctitis. (Never heard of if, but so far I know it is very expensive and self induced.) I won't even describe what the author says will happen if this condition goes untreated, but apparently the patient shares many of the clinical and epidemiologic features of other men in an outbreak that appears to be centered in the Netherlands and has spread to Western Europe, United Kingdom and the U.S. Now he's treated with doxycycline, which resolved his symptoms.

Now his "partner" is feeling poorly with the same symptoms.

My mind is going cha-ching, cha-ching for Medicaid and the drug companies. A marriage between the pharmaceuticals and gay men with the state governments the attendants. There are about 100 pages of text in this journal, and 55 pages of advertising by pharmaceutical companies.

The internet is listed as one of the means to spread these diseases that case 2-2006 has, as men find sexual partners across great geographic distance. Sort of gives a new meaning to computer virus, doesn't it?