Scared again, HIV Symptoms!

[Scaredd12345]

Hello Dr. HHH and Dr. Hook,

Early Monday morning I began feeling intense chills, and had a fever of about 99.8. Then the next day I began having liquid diarrhea and abdominal cramps every time that I ate or drank anything. These symptoms lasted until Thursday night and my fever reached 100.0 at its highest; the diarrhea still remains. Today I took my shirt off and noticed some blotches on my chest and a few on my abdomen. The seven or so on my chest are reddish and the ones on my abdomen are skin colored and only look like slight elevations.

My last sexual encounter was on Feb 11th, during which time I made out with a stranger and fingered her while she gave me a handjob. What worries me is that we were both naked and at one point in the making out the tip of my penis rubbed or was pressed firm against the outside of her vagina for about 10-20 seconds or so. Ironically I had just gotten my last HIV test on the Monday before this encounter so that I wouldn’t worry about a previous encounter back in December in which I had protected sex followed by an unprotected blowjob . My questions are,

1) Do these symptoms fit the timing(9 days later) and description of acute HIV?
2) How high does the fever get in the acute syndrome?
3) What does the rash look like in acute HIV?
4) Is this encounter I described a possibility of transmission? There was no penetration, just the tip rubbed against the outside of her wet vagina.

Thanks again in advance. You doctors have always been extremely helpful to me!

[Scaredd12345]

Hello,
I have one more question on this "no risk exposure" and I truly hope that I am not annoying you with this.
I've accepted that what I previously thought was a rash was merely a breakout from trimming my chest hair. I squeezed one of the tender red marks and pus came out just like a pimple. Also I saw a pcp after I messages you who assured me I was suffering from a viral GE and it was too soon for acut HIV symptoms.
This past week I had a house guest who suffered from sinus congestion and chills. She was there for 3 days and on the second day (march 6th) I developed a sore throat and nasal congestion.
What scares me is that she did not have a sore throat with her symptoms and I am also now experiencing night sweats. I also weighed myself today to be at 183 naked when I was 192 on feb 8th for my last physical although I was wearing clothes.
1) Are these new symptoms from my sick contact or could they be be related to HIV. I'll admit it sounds silly as I type it but the fear is still with me.
2) Are these symptoms too far apart from my "viral GE" to be related?
3) is such a weight loss a serious concern for HIV or any other medical problems? Could I have lost it during the GE or by other means?
I'm sorry again for continuing to post my anxiety driven questions. It just feels like once i accept the one symptom is not related to HIV, then another one pops up. I promise this will be the last on this post.

[Edward W Hook, MD]

You are splitting hairs. No risk is remarkably low, hence the advice I have given you.  No one has ever been shown to get HIV from an exposure of the sort you describe- not ever.  That is remarkably rare in my mind.  I see no need for testing or conern but, as you note, you are concerned.  

The nature of the rash is not particularly helpful.  The rash of HIV however is not typically tender. EWH

[Scaredd12345]

Also, the red blotches on my chest are tender; not at all itchy. Does that point my symptoms in any direction?

[Scaredd12345]

I apologize in advance if I am splitting hairs here but as you are aware, my HIV anxiety is quite high. I have spoken to a psychologist and take lexapro for my anxiety.
You said in the first paragraph that these symptoms could be HIV but the chances are remarkable low, however you said that this encounter was no risk.

1) If this encounter is no risk then what could be the source of this remarkably low risk?

2) Does even this remote risk warrant testing?

I'm sorry again for letting my anxiety take over!

[Edward W Hook, MD]

Welcome back the Forum.  I'll address your questions one-by-one below but let me start by telling you that while the flu-like illness you describe could be HIV, the chance that it is, once again, remarkably low.  The chance that the woman you most recently encountered had HIV is tiny and the likelihood that you acquired HIV without engaging in penetrative sex is virtually zero.  The illness you describe is almost certainly coincidental.  As I read this question and then look back at some of your earlier posts, it appears that your fear of HIV is inappropriately high.  I wonder why that might be and if talking through this with a counselor might be helpful to you.  The specter of becoming anguished over the possibility that you have HIV every time that you have a flu-like illness or enter a new relationship is not a good one.  I say this in a reflective moment in an effort to be helpful to you.

As for your specific questions:

1) Do these symptoms fit the timing(9 days later) and description of acute HIV?
You have a flu-like illness and the symptoms of early HIV are those of a flu-like illness, including fever, diarrhea, sore throat, and a rash.  Body (muscle and joint) aches are also part of the syndrome which tends to occur between 2 and 4 to 6 weeks after an exposure.  Less than 1% of such illnesses however are due to HIV and your symptoms have begun too early following a no risk exposure to have any meaningful probability of being due to HIV.

2) How high does the fever get in the acute syndrome?
The temperature of early HIV is typically high, over 102 or 103.

3) What does the rash look like in acute HIV?
Again, it is variable and non-specific.

4) Is this encounter I described a possibility of transmission? There was no penetration, just the tip rubbed against the outside of her wet vagina.
No, this was a no risk encounter.  HIV is transmitted through penetrative sex, not through non-penetrative encounters, even though it is typical for persons engaged in such encounters to get each others' genital secretions on one another.

I hope you will not worry yourself silly about HIV related to your recent illness.  To do so is a waste of time, money and emotional energy.  If you cannot help but worry then once again I urge you to also spend some of those resources talking through your excessive fears of HIV with a trained professional.

I hope my comments and advice are helpful. EWH