Unprotected Cunnilingus with CSW - Dr. HHH

[davey911]

Dear Dr.H
About 2 w ago I posted a ? About my exposure with a CSW-unprotected cunnilingus. 2to 3 days later I developed a sore throat, had diarrhoea, and 3 days later developed a blister on my upper inner lip which has been diagnosed as a Mucocele by my doc. He felt I bit my lip and caused trauma. My temp was never above 36.8.
About a week and a half post exposure I began to notice redness on my chest but my other symptoms had settled. There were a handful of small red circular patches of skin on my chest which would blanch on pressure and were not sore or itchy. They dissapeared in a day or so. I must be honest I was very very anxious and over analysing every symptom. Your original advise definitely helped calm me down. 
Just over 3 weeks post exposure I started to put the incident behind me and yesterday I woke up noticed a similar rash on my chest. There were 8 to 9 small red areas. I did not have a temp . As the day passed they dissapeared and by this morning (31/03/12) they were away completely . 
As I stated before I have a partner and had not been intimate with her since the incident. Despite your advice that I do not require HIV testing and should carry on sexual relations with her, my anxiety and fear were getting the better of me . 
However this morning , sexual frustration got the better of me and we engaged in unprotected vaginal intercourse . As I was so frustrated, it only lasted under a minute and I withdrew and ejaculated on her abdomen. 
Straight away I began to panic and worry about "what if etc" What if I am positive? What if I infect my wife? You get the picture. 
I have a HIV duo test booked this week --- it will be 29 days post exposure. 
I'm not entirely sure why I'm posting again, mainly to get your expert advice to calm me down again I suppose.  
Am I just being over anxious again?
Are my symptoms related to seroconversion?
Does the ARS rash come and go like mine ?
Will the 28 day duo HIV test be conclusive ?
 Have I put my wife in danger?

[Edward W Hook, MD]

Glad we could help. Take care.  EWH

[davey911]

Dear Dr Hook/ Dr HHH,

I just wanted to say thank-you for the expert advice regarding my cunnilingus episode with a CSW.

I got the results of my HIV duo test at 30 days and they were negative!! :-) as you both had STATED they would be!!

Thank you again for the reassurance and calming words!!

Kind regards

[davey911]

Thank you .

[Edward W Hook, MD]

Last answer.  

Yes, the rash of the ARS typically is associated with other symptoms including fever, sore throat and muscle aches.  The duration of the rash is typically a few days.  

This concludes this thread.  EWH

[davey911]

Thank you ---- I respect your opinion and confidence regarding a negative test .
The lab will be closed Friday , so most likely next week.

Sorry if this is repetitive  . I promise it will be my last line of questioning ! , in terms of an ARS rash, is it associated with a fever and other symptoms ? I had about 8-10 small red areas on my chest , no other symptoms that day and it dissapeared in 24 hours. Would an ARS rash typically be more generalised and last longer than a day. Thank. You .

[Edward W Hook, MD]

I am confident your test will be negative.  I would call Friay if the Dr.'s office is open an see if they have your result.  EWH

[davey911]

Dear Drs,

I bit the bullet today and took the HIV duo test 4 weeks after the unprotected cunnilingus episode with the CSW.

I might get result tomorrow but the doctor said due to the Easter holidays this Friday till Monday, will likely get result next week!! The wait will be torture!

Common sense and reading your many many responses to cunnilingus exposures reassures me but then I have lapses where I keeping thinking about the rash I had and I go into panic mode!!

Any further words of reassurance would be most welcome at this time.

Kind regards

[Edward W Hook, MD]

Of course.  Feel free to provide your result.  I am confident it will be negative.  EWH

[davey911]

Thank you for your comments Dr. Hook.

I assure you I will not be second guessing or coming back with what if situations. As I said, just want to put this behind me now.

Would it be ok for me to update you on my result.

Kind regards

[Edward W Hook, MD]

I think you have alreay answered your own question.  Neither Dr. Hansfield nor I find you to be at any appreciable risk for HIV.  That said, we also understand that a laboratory test can be reassuring. Thus I too think testing for your peace of mind is quite reasonable and that that is really the only reason I would suggest it.   Before you test however, please understand that when the test is perfromed and negative, it is (past) time to be second guessing things and time for you to put your concerns aside.  Your guilt however is another issue an you may need to discuss this with a counselor or other trusted advisor.  EWH

[davey911]

Dear Dr. Hook,

Thank you for your very prompt reply.
I feel reassured.
I guess your points regarding guilt are correct.
I certainly have been suffering from anxiety and guilt since the incident.

So can I take from your reply that you would not have recommended HIV testing in my case despite my symptoms?

And would you agree with Dr H that the only reason for testing would be for my own peace of mind?

I was doing fine until intercourse with the wife today and although I didn't ejaculate in her , reading google sites regarding precum etc . Freaked me out again.

I just want to draw a line through this chapter and get the negative result this week . I know you don't have a crystal ball and the fact that I have more chance to be hit by a meteor from space is extremely reassuring !

Kind regards. Look forward to your comments.

[Edward W Hook, MD]

Welcome back to our Forum.  I'll be answering your question this time as Dr. Handsfield an I share Forum duties.  I hope that when I reinforce the answers Dr. Handsfield has already provided it will give you a bit more peace of mind.

I would suggest you review your earlier interaction with Dr. Handsfield..  I have.  He points out that it is unlikely that the commercial sex worker you were with had HIV and that even if she did, were you to get HIV from your oral sex encounter you would be the 1rst that either of us was aware of despite having both been active in caring for persons with an at risk for HIV since the beginning of the epidemic.  It is simply not a realistic concern - you are more likely to be stuck by a meteorite from space.

On the other hand guilt is an extraordinarily common event.  It is common that, after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned.  This in turn leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times.  I suspect that this is a contributor to your situation.  

In answer to your specific questions:
Am I just being over anxious again?
Yes.  

Are my symptoms related to seroconversion?
No, the rash of HIV seroconversion does not come and go as you describe.  Further, when persons are experiencing HIV seroconversion they o not have single symptoms one at a time.  they feel quite poorly with multiple simultaneous symptoms.


Does the ARS rash come and go like mine ?
No, see above.

Will the 28 day duo HIV test be conclusive ?
Absolutely.  Even when persons have "classical" seroconversion symptoms, it is about 100 times more likely that they have the flu or some other, common, everyday viral illness of the sort that most people get from time to time than HIV.  On the other hand, blood tests are FAR more precise an reliable.  If your DUO test is negative at 28 days you will have further, definitive, proof that you did not get HIV from the encounter of concern.

Have I put my wife in danger?
No.

I hope you fin my comments reassuring. They are meant to be. There is no need for you to worry.  EWH