Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Jonathan Volk

Jonathan Volk, MD

Infectious Diseases

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

San Francisco Medical Center
Appt/Advice: 415-833-2200

See all office information »

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A healthy immune system protects against infections and disease. HIV (human immunodeficiency virus) is a virus that attacks the immune system.

HIV and AIDS are not the same thing. If HIV infection is untreated, it can progress to AIDS (acquired immunodeficiency syndrome). 

  • HIV destroys specific blood cells of the immune system, called CD4+ T-cells. These cells are important in helping the body fight diseases.
  • AIDS results from a weakened immune system and can lead to the development of multiple infections and even certain cancers. 

Although HIV infection and AIDS are serious medical conditions, new treatments allow people with HIV/AIDS to live long and healthy lives.

Risk Factors

Only specific body fluids from an HIV-infected person (blood, semen, vaginal secretions, and breast milk) can transmit HIV. These fluids must come in contact with a mucous membrane or damaged tissue, or be directly injected into the bloodstream (from a needle or syringe) for infection to occur.

HIV can be spread from one person to another in these ways:

  • By having unprotected anal, vaginal, or oral sex with a person who has HIV. 
  • By sharing needles, syringes, or other injection equipment with a person who has HIV.
  • Through pregnancy, the birth process, or breastfeeding from an HIV infected woman to her baby.

HIV is not spread through:

  • Donating blood
  • Kissing (there is a rare chance of getting HIV from open-mouthed or "French" kissing if there''s contact with blood)
  • Touching, like a handshake or a hug
  • Sharing food or drinks
  • Sharing personal items, such as utensils (forks, knives, or spoons), towels, bedding, or telephones
  • Using toilet seats

Tests and Diagnosis

When a person is infected with HIV, their body responds by making antibodies to protect them and fight the virus. Blood tests for an HIV infection determine if antibodies to HIV are present, rather than testing for the virus itself. HIV test results are either reactive or nonreactive.

Reactive. This means the test found antibodies to HIV. If you test positive for HIV antibodies in your blood, it means you have an HIV infection. Next, you will be referred to your doctor or an HIV specialty clinic doctor. Getting early medical care when you are HIV positive is an important part of living a long, healthy life.

Nonreactive. This means the test did not find any HIV antibodies in your blood. However, if you were exposed to HIV in the past 6 months, the antibodies may still be developing, even if your results are HIV negative. You may need to be tested again, depending on your risk factors.

Indeterminate. On rare occasions, a test is inconclusive and additional testing is necessary. The lab will perform several additional sensitive tests to confirm an HIV infection. This may often take an additional 1 to 2 weeks. An indeterminate sample does not always result in a positive test for HIV antibodies. 

It's important to know that once HIV enters the body, it takes about 2 to 12 weeks, or up to 6 months, for HIV antibodies to be present in the blood and show up in an HIV test. This is often referred to as the window period for detection. This means that if you test HIV negative, but were exposed more recently than 6 months ago, you may still have HIV but have not yet developed antibodies. 

We recommend you discuss your need for additional testing with your doctor.


Within a few weeks of exposure to HIV, you may develop a flu-like illness called the acute retroviral syndrome. Symptoms can include fever, swollen lymph nodes (glands in the neck and groin), rash, and feeling very tired. Usually these symptoms go away within a few weeks. It's also possible to have no symptoms of HIV infection for many years. Even if there are no signs of illness, you can still pass HIV to another person.

As the HIV infection progresses, your immune system gets weaker. On average, it takes up to 10 years for more serious symptoms of HIV infection to develop. These symptoms may include:

  • Night sweats from which you wake up soaking wet.
  • Fever over 100°F with chills that continue for weeks at a time.
  • Persistent, severe fatigue that makes it difficult for you to perform daily tasks or go to work or school.
  • Lymph nodes that are swollen and stay swollen for months.
  • Long-term (chronic) diarrhea.
  • Unexplained weight loss.
AIDS symptoms

AIDS is the late stage of HIV infection when the virus has damaged your immune system so severely that you're no longer able to fight off infections and some cancers. Without medical treatment, HIV can progress to AIDS in just a few years. 

We now have many well-tolerated medications that reduce the amount of HIV in your body and slow the progression of the infection. This can allow you to live many years or even decades with HIV, and current life expectancy can approach normal for many.

Not everyone with HIV develops AIDS. While some people have a genetic trait that may keep them from progressing to AIDS, this is a rare occurrence. For all others with HIV, maintaining good health and carefully following their treatment plan is the only way to help prevent progressing to AIDS.


There are effective ways to prevent the spread of HIV. Follow these guidelines to protect yourself from exposure to HIV or from spreading it to others if you have HIV/AIDS.

The most common ways to transmit HIV are through anal or vaginal sex or by sharing needles or injection equipment with a person infected with HIV. Steps to reduce these risks include the following.

Practice safer sex. Latex condoms (or polyurethane condoms if you or your partner is allergic to latex) can help to protect you and your partner against HIV and many other sexually transmitted diseases (STDs).

Do not share needles. If you use IV drugs, use clean needles whenever possible. If you do share needles, clean them first with bleach and water. If you get a tattoo or any body piercing, make sure the person providing the service is using new needles.

Talk with your partner. Talk openly and honestly with your partner about safer sex. Be clear about what you will and will not do sexually. Also, respect what your partner will and will not do. Decide together what is right for both of you.

If you think you were exposed to HIV within the last 72 hours, let us know immediately. We can provide you with medications that help decrease the likelihood that you'll become HIV positive. These medications are most effective when started soon after a risk exposure. For immediate assistance, call to speak with an advice nurse who can arrange for you to get care soon. Advice is available 24 hours a day, 7 days a week.

The latest advance in HIV prevention is pre-exposure prophylaxis (PrEP). People at high risk for HIV infection can take a daily medication to lower the chance of getting infected.

Studies show that PrEP:

  • Helps prevent an HIV-negative person from getting HIV from a sexual or injection-drug-using partner who's positive.
  • Is highly effective for preventing HIV when used as prescribed.
  • Is much less effective when it's not taken correctly and consistently.

Talk with your doctor if you feel PrEP might be right for you. Even though PrEP can be extremely effective in preventing infection with HIV, it doesn't protect you from other STDs (such as gonorrhea, chlamydia, syphilis, hepatitis C, and others). Continue to practice safer sex methods.  

Pre-Exposure Prophylaxis (PrEP)

What is PrEP?

PrEP (pre-exposure prophylaxis) is a way for people who do not have HIV to reduce the chance of becoming infected by taking a prescription pill once a day. PrEP is highly effective for preventing HIV infection. 

While PrEP prevents HIV, it doesn’t prevent other sexually transmitted infections (STIs). You can use condoms along with PrEP to reduce your risk of other STIs. 

PrEP is appropriate for anyone who feels they would benefit from a once-daily pill to reduce HIV infection.

How do I know if PrEP is right for me?

PrEP may benefit you if you're HIV-negative and ANY of the following apply to you:

  • Have an HIV-positive partner.
  • Don’t use a condom when you have sex with someone who might have HIV.
  • Have sex with more than one partner and don’t use a condom.
  • Don’t use a condom when you have sex with a partner who has other partners.
  • Don’t use a condom when you have sex with a partner who uses injection drugs.
  • Recently had a sexually transmitted disease (STD).
  • Share needles or equipment to inject drugs.

Talk to your doctor if you are interested in PrEP.

Additional References:

Post-Exposure Prophylaxis (PEP)

What is PEP?

PEP (post-exposure prophylaxis) is a way to reduce your chance of getting HIV AFTER a high-risk exposure, such as not using a condom when you have sex or sharing a needle with someone who might have HIV. PEP should be started as soon as possible, and not more than 72 hours (3 days) after the exposure.

For more information, call our Appointment and Advice line at 866-454-8855 immediately after an exposure.

Additional References:


While there is currently no cure for HIV/AIDS, effective treatment is available to slow the progression of HIV and possibly prevent AIDS. If you test HIV positive you will be referred to an HIV specialist who will get you started on a treatment plan so that you can manage HIV/AIDS and stay healthy over your lifetime.

The management of HIV and AIDS is a rapidly changing field of medicine. At Kaiser Permanente, an HIV specialist who keeps current on the treatment of HIV and AIDS will manage your care. Your HIV specialty care includes:

  • Routine visits with your doctor.
  • Access to other health professionals who specialize in HIV (nurse, pharmacist, social worker, dietician, and health educator).
  • Lab tests to check the health of your immune system and the amount of virus in your body.
  • HAART (highly active antiretroviral therapy) are special HIV medications that help to reduce the amount of virus in your body and maintain the health of your immune system.

When to Call Us

If you think you were exposed to HIV within the last 72 hours, let us know immediately. We can provide you with medications that help decrease the likelihood that you become HIV positive. These medications are most effective when started as soon as possible after a risk exposure. For immediate assistance, call to speak with an advice nurse who can arrange for you to get care as quickly as possible. Advice is available 24 hours a day, 7 days a week.

It's recommended that you have follow-up HIV testing at 6 weeks, 3 months, and 6 months after a possible exposure. If you test HIV positive, you'll be referred to an HIV specialty care team. Important to living a healthy life with HIV or AIDS is regular medical care with an HIV doctor and learning what you can do to live healthily with HIV.

If you think you're at high risk for HIV infection, talk with your doctor who can refer you to a PrEP program. 

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours per day, 7 days per week.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages.
  • Manage your prescriptions.
  • View your past visits and test results.
  • View your preventive services to see whether you are due for a routine screening or updated immunization.
Learn more about your condition
  • Read about causes, symptoms, treatments, and procedures.
  • Find interactive health tools, videos, and podcasts to help you manage your condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
  • Locate health education classes and support groups offered at every medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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