HIV - Prevention Expert Forum
Nurse in need
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Nurse in need

Dear Drs.
While traveling in Europe for a meeting unfortunately I got inadvertedly drunk and ended up on a prostitute house. Although I do have recollection of some of that time, I have some moments where I blacked out. The only thing I remembered is talking to a woman who took me into a room. I honestly don’t remember what happened next. I just remember entering my hotel.  As such I have assumed I had sex with the lady and no idea if protected or not. However for all purposes I have assumed it was not protected and that she was HIV + Upon my return to the US, I treated myself empirically with Azytro and Cefixime. On 10/2 I had routine blood work including RPR, HBSAg, HEPC, and urine for GC/CT- All negative including CMP/CBC. I then developed a severe burning sensation through my shoulders, neck line with headaches and muscle tension- I have had this before during stress times. Did develop some soar throat but really as of today had not seen any LNs or skin rash. My shoulder and arms do feel as if I have developed myositis + feel fatigue and can sleep + weight loss and anorexia. On 10/11 repeated labs and included a HIV 1&2 ELISA- It was negative; other blood work negative as well. I have been in a monogamous relationship for over 18 years - we had unprotected sex twice- (roughly 13 and 21 days after the incident). Since my spouse developed a cough and soar throat with laryngitis-like symptoms + LNs (something that happens to her when she gets this once a year) MY main concern now is that Nov 1st she woke up with a significant rash in her legs (inner thighs and below) red, maculopapular and described by her as quite itchy and bumpy. 5 days later the rash has improved but itchiness persist. I don’t think she has any lesions somewhere else. Rash is what is concerning me the most, as it really looks like the typical HIV rash described by you and its timing (2-3 weeks after sex with her) fits what is described. Because of this, I went ahead and got another ELISA test yesterday (37 days after my incident) I also had a viral load which is pending. Other labs remain negative. Based on this long history (sorry about that) what do you think my spouse's rash means this is HIV?  Can her rash be secondary to another viral infection I might get that was passed to her? EBV perhaps? (Although legs rash only??) What are my odds to have a detectable viral load which means I would be HIV + but without making antibodies yet??
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Welcome to our Forum.  The events and the responses/reactions that you outline above are a great example of the power of guilt to impair rational thinking.  You have added 2 and 2 and come up with 8.  

You don't even know that you had sex, much less whether your partner (if she was a partner) had STD or HIV (statistically unlikely- most people do not have STDs, including HIV) or if she was infected, that you got infected (most exposures to infected partners do not lead to infection).  As a result you have taken what were probably un-needed antibiotics and spent money (yours or someone else’s) which did not need to be spend and.... even with negative results, are taking no solace in the negative tests you have gotten.

The time frame you describe is biologically incompatible with your getting HIV (or for that matter, any other STD including EBV [this suggestion by you suggests you are spending entirely too much to me on the internet]), incubating it and passing it on to your partner to give her an infection which leads to the rash you've described.  Your viral load will almost certainly be negative and when it is please, please forget about HIV.

My suspicion is that your partner's rash is totally unrelated.  Try to work through your guilt.  EWH
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Avatar_m_tn
Appreciate the response Dr. Hook. You might be completely correct (I hope) regarding my guilt and that my symptoms could be related to stress and anxiety. Although I truly dont know the details of my encounter with this sex worker- I do remember having to pull up my pants while I was standing- That is why I had assume all along of this possibility.

What I did not understand from your response is 1) time frame not compatible with HIV infection and 2) that you assume that the 3 ELISA tests I had would be sufficient even when they were done before 6 weeks for the incident.

Are you suggesting that I could not pass HIV to my wife Within 3 weeks of my contact if indeed I was exposed to HIV?

Her rash might be just a perfect coincidence especially with its timing and characteristics...
You provide significant hope with your answer. Will keep you posted once I get the viral load. Thx for the great work you do with this forum
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300980_tn?1194933000
You are correct in the way you put my response together.  The time frame you suggest- for you to have acquired HIV, become viremic (typically occurring at 2-4 weeks) then for her to acquire infection  thgrough sex with you and become viremic in time for her to then develop a rash (which sounds atypical for the rash of HIV by the way.  The rash of HIV is typically NOT localized to the lower extremities but generalized and not itchy) simply is not a biologically probable sequence of events.  Further, had you been infectious, your ELISA test would have been positve 1-2 weeks later.  Thus the timing favors the convergence of your possible exposure and a coincidental rash on her part, not HIV which you got and then transmitted to her.  EWH
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Avatar_m_tn
Thank you again Dr Hook. I have been quite objective and rationale al my life but perhaps under this circunstances I have lost that. Again it is my spouse's rash that continue to be difficult to explain as it happened 4 weeks after my pressumed unprotected contact in Europe and 2 weeks after we have sex with my spouse + the fact that literature does mention atypical rashes (legs) and pruritus associated with it. In any rate, few additional questions for you

1) If I did not have a viral load pending- what would be your recomendation for further testing if any (again 3 negative ELISA tests -2 weeks; 4 weeks and 5 weeks after contact)

2) Based upon the clinical scenario I presented to you- would you be confident and state that the last ELISA should be sufficient- Again most people beleive that you must wait until 3 months for a definitive answer

3) Despite of the limitations of this forum, I have to rely on your expertise and understanding of the disease process. As such I would trust whatever you recomend to me 100%

4) If my viral load is negative as you are expecting, would I need any additional testing for HIV or other STD viral or not ?

Or perhaps should I just simply work on  my guilt and anxiety issues, disclose and discuss what happened with my spouse and try to learn and forget of this unpleasant experience and move on with my life ?

I know you are not in the the psychotherapy bussiness but I predict most of you do as a doctor is counseling, educate and reassure individuals in defferent setting of their illnesses.

Thank you much- I also would like to contribute anyway I can to improve HIV awareness- please send me any information of any foundation or group that you believe is in need of more donations.

Thank you again
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300980_tn?1194933000
You  are repeating yourself; Brief answers:

1) If I did not have a viral load pending- what would be your recomendation for further testing if any (again 3 negative ELISA tests -2 weeks; 4 weeks and 5 weeks after contact)

I suspect that your viral load will be negative.  When it is, believe it an move forward.  No furthertesting is needed.

2) Based upon the clinical scenario I presented to you- would you be confident and state that the last ELISA should be sufficient- Again most people beleive that you must wait until 3 months for a definitive answer

Yes, I would be confident. Even more so after you get the firal load test.

3) Despite of the limitations of this forum, I have to rely on your expertise and understanding of the disease process. As such I would trust whatever you recomend to me 100%

No change in my assessment of advice.

4) If my viral load is negative as you are expecting, would I need any additional testing for HIV or other STD viral or not ?

Repetive question- the answer is sstill no.

Or perhaps should I just simply work on  my guilt and anxiety issues, disclose and discuss what happened with my spouse and try to learn and forget of this unpleasant experience and move on with my life ?

This would be the most rewarding approach from my perspective.  EWH

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Avatar_m_tn
Appreciate your thoughtfulness Dr. Hook. If you dont mind- I will let you know of the viral load results when available. Best
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Avatar_m_tn
Dr. Hook - just to my surprise my test results just cameback

HIV Quant RNA by PCR: Negative for HIV-1 RNA by PCR. copies/mL

Comments: Linear range of assay: 20 copies/mL to 10,000,000 copies/ml.

I gather that based on your medical advice earlier, there is not a possibility things would change ref: HIV status and I should move on with my life and not to retest any more. Is this correct?

You provided hope, optimism and a great service  !
Many thanks
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300980_tn?1194933000
You are correct. Time to put all concerns about HIV behind you and move forward.  EWH
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Avatar_m_tn
Thank you again for your patience and expert opinion.
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Avatar_m_tn
Dr. Hook-
Hope this note finds you well. I would like to ask for your expert opinion on a related matter to my previous tread. Below my comments/questions

1. Have to admit that putting the HIV diagnosis out of my mind as you recommended before has not been easy. Primarily becase what you read in these websites about the innacuracy of HIV ELISA testing before 3 months. Having said that, I continue to believe in your medical opinion and advice to forget about HIV (based on the resuts of my tests at 3 and 5 weeks from incident)

2. Perhaps what contributes to my ongoing concern of an ilness is that I continue to feel malaise, myagias +/- generalized joint pains.These have lasted since mid Oct (2-3 weeks after the incident). Perhaps what is more bothersome is that the palm of my hands- feel blushy and they look like I had some exanthema - As you have indicated that there is no possibility for me to have HIV, in your expert opinion, would it be worth for me to do any additional testing. Specifically I am refering to any bacterial infection or to HBV or HCV- I remind you that 5 weeks after the incident I had HsBAg and the HCV EIA and LFTs-all negative. I wonder if I need a PCR for HCV or a different HBV study that can rule out acute infection.

Any thoughts would be greatly appreciated.

BEst

3. Although I am quite objective as I work on healthcare, my symptoms continue to puzzle me
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300980_tn?1194933000
This will need to be my final response.

1.  You need to stay off the internet which provides a lot of incorrect information  The fact is that the tests you have are highly reliable and accurate.  

2.  The symptoms you are experiencing are quite non-specific and could have many possible causes.  You have already ruled out the possibility of sexually acquired infections, including hepatitis B or C.   there is no reason to be concerned further about the  possibility of these infections.  If the symptoms truly continue to concern you, I suggest you seek the evaluation of your regular doctor.

This ends this thread. EWH
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Avatar_m_tn
Thank you Dr. Hook + comments  noted.

I just did not realize that a RPR done within 2 weeks from a risky encounter was considered definitive. Thx again.
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