Tales from the Tail — The Night That Changed Everything.

Dr. Evan Goldstein
Jun 4 · 6 min read

Client’s Tale

Okay. Here it goes. I don’t even want to think about this one any more. Because every time I do, I become so enraged, mainly due to internal isolation. I am fucking numb to it at this point. But read on.

I arrived in NYC from The South to film a new television series. The evening of my arrival, my agent took me out for drinks with him and his friends. You know, the usual scene of being introduced to all the local everybody’s (for whatever that’s worth). And that’s the last that I remember.

I woke up in my apartment, knowing nothing of how I got there. And from the second I awoke, I could tell something was terribly wrong with my asshole. I am totally fluid (sexually), yet was only 19 at the time and had little experience with anything. But it doesn’t take a rocket scientist to know when your hole just ain’t right. And boy was it not right.

I was in ridiculous pain, but rode it out for a few weeks. It did get somewhat better, but never returned to normal. I was so fucking ashamed and didn’t know who or what to turn to. Finally, I mustered enough confidence to see a professional and was diagnosed with too many things for me to even talk about. But here it goes… Positive for Gonorrhea. An anal abscess from the infection, which had to be drained because I’m an idiot for waiting so long. And, lastly, HPV and anal warts. What a trifecta, right?

I got the abscess drained and the STD treated and found my way to Bespoke Surgical for a full evaluation. No, I didn’t press charges, I just wanted to move on with my life. I did tell the agency and right away he was terminated. I was told something to this effect had happened prior to someone else. That didn’t make me feel any better. And I know some will judge me for not doing anything. But honestly, I couldn’t even find the energy to take care of my own issues, let alone the fucking criminal system.

I need to have anal wart removal and now the anal fistula surgically treated (a sequelae from the abscess), of which I am scheduled in the coming weeks in Bespoke’s LA office. Oh yeah, I moved right the fuck out of NY. How could I be there? It was beyond tainted and I wanted to start a new life away from it all. But seriously — how fucked up is this? My first night in NY, here to live out my goddam dream. Fuck me.

Now, here’s the worst part of all. It’s been months since this happened and Dr. G did some routine bloodwork to make sure everything else was OK prior to surgery and, yeah, you guessed it, I am now HIV positive. I can’t fucking believe it. I got every STD that night. What more can I say?

My Discussion

Yes, what more can we say, other than sorry. Sorry for you to have experienced such a traumatic event in your young life. Sorry for all the pain, both emotional and physical. Sorry for the fact that you are still going through all of this and sorry for having to take a pill for the rest of your life that reminds you each and every day of such a travesty.

First: many will critique, including myself, for not going to the authorities, though one can understand the PTSD someone could be experiencing after such an event. And now, more than ever, with the revelation that HIV was transmitted, this becomes a much more serious situation. To think of this fucking asshole, still walking around NYC, potentially doing this to other humans is mind-boggling. I do hope this young man will reconsider his position and I am more than happy to help navigate the rough road ahead.

Second: the first step in management is to optimize his viral load count as it relates to HIV. I see many anal manifestations that do not improve and the first thing we need to think about is whether it’s a new infection, such as in this case, or an existing one that is showing a skyrocketing viral load or improper viral suppression. One should immediately re-evaluate with their HIV specialist for more optimal medications and/or a newer generation of meds.

Once this has been initiated, my first plan is to treat the anal warts both in and out and clean the anal fistula by placing what’s called a seton. Remember: a fistula is a connection from inside the ass to outside. There are these glands that secrete mucus and sometimes, more so when an STD is present, can get clogged and then cause an abscess. Simply put: it’s a bad pimple in a bad place. The abscess was drained, but in 50% of the cases (this one included), the connection still persists from in to out and that’s called a fistula. With all else going on, the best is to clean the warts and clean this track of the fistula out and exclude any recurrent abscess. I will definitely advance and improve the fistula from the get-go; however, he will need a second surgery for completion and correction. With his HIV medication implantation first, this will then set the stage to assist healing of all of the above anal issues.

With this particular case, and many others I see, there is not just a physical process, but also a mental one and sometimes this is even harder to manage. He plays quite strong, but we discussed coordinating his care with amazing consultants from all fields, making sure we all not only have his best interest at hand, but also are on the same page each step of the way. This is a dual process and we all need to concentrate on forward progress with his care, both mentally and physically.

Another thing I’d like to point out is the importance of getting checked out immediately after a situation like this. While many of us by now are hopefully familiar with PrEP (Pre-Exposure Prophylaxis), which is the use of Truvada to prevent HIV negative people from becoming infected, not everyone knows that there is also PEP (Post-Exposure Prophylaxis), which involves taking antiretroviral medicines (ART) after being potentially exposed to HIV to prevent becoming infected. PEP should be used only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV. This is something you can request from either your doctor, a clinic, or an ER. Not only do we need to be knowledgeable ourselves, but also we must demand that medical professionals know to ask the right questions about sexual history so that they can administer PEP, when necessary (like in this situation).

Everyone would agree that this is a despicable tale and no other human should ever experience. I wanted to share his tale to ensure we, as a community, take a step back and understand what some of us go through. I hope those reading this will undergo some introspection because this could affect any one of us or the ones we love. As always, we must come together hopefully to avoid situations like this in the future, or, at the very least, assist those who were less fortunate. There’s a lot to learn here and more will be updated as it develops.

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Bespoke Surgical

An elite practice purpose-built for today’s male and focused on sexual wellness. Founded by Dr. Evan Goldstein.

Dr. Evan Goldstein

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NY | LA Gay Surgeon discussing ASS: A\rt, S\cience, and S\ex www.bespokesurgical.com/

Bespoke Surgical

An elite practice purpose-built for today’s male and focused on sexual wellness. Founded by Dr. Evan Goldstein.