ARS Rash and Possible (Prob Unlikely) Contact

[seejay654]

I have read a number of former posts and I have found your site to be extremely informative. It is nice to see a site that is based upon fact, not conjecture. Thank you! I am a 29-year-old gay male. I practice safe sex and I am diligent to use protection during anal sex. I have not been as diligent re: oral sex. 13 days ago I met a guy out and went to his hotel.  We discussed that we had both been tested and were HIV negative.  We then proceeded to kiss, masturbate one another and then perform oral sex upon one another (without ejaculation – pre-*** status unknown).  I performed oral sex on him for approximately 5-7 minutes. As we were preparing for anal sex, I turned around to give him a condom and he said he didn’t need one, that it was fine, and that he does “it” all the time. I asked how many times he had had unprotected anal sex and he responded, “lots.” I freaked out, picked up my clothes, and left.  

At the time of the encounter I had a soar throat and it has increased in severity. There is pain in my neck where I know my lymph nodes are located, and I have had a dry cough for several days now. On day 11, I noticed a raised red rash on the upper part of my arm. At first it did not itch, but as the day progressed it did have a tingling sensation to it. I do not normally get rashes and took my temperature and it was 98.3 (no fever). The rash yesterday appeared on the other upper arm. Both are about 3-4 inches long and 2-2.5 inches wide. They are raised red, blotchy areas that are severely itchy and hot to the touch at times and not at others.

I have reviewed your posts and have found little about the ARS rash. I have read of the 1 in 10,000 chance for performing oral sex, however, at my last time to a testing site a CDC study was mentioned that had an 8% infection rate from oral sex alone.  I’m not a statistician, but, this seems like a large range to be considered. If you could shed some light on these issues, I would be extremely grateful.

[Edward W Hook, MD]

You describe mutual masturbation followed by unprotected oral sex, followed by your decsion to leave when your partner's comments lead you to what sounds like appropriate concerns about his risk of infection (despite his claims to be HIV negative).   Masturbation is safe sex - no risk for you there.  As for oral sex, I don't know where you heard the suggestion than 8% (that is 8 out of 100 exposures, almost 1 in 10) of persons with oral expsoures to infected partners acquire HIV but that is absurd.  The quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.  This includes by all of the people who had gum disease, etc.  

As for your current symptoms, you may have missed our repeated statements that the symptoms of the ARS are TOTALLY non-specific and when people experience "ARS symptoms" they are much more likely to have something else, usually some other, more typical virus infection.  When this has been studied in the US, less than 1% of persons seeking medical care for "ARS symptoms" are found to have HIV, the remainder having symptoms due to other processes.  In addition, it is also important to realize that many person who acquire HIV do not experience the ARS.  For a person to try to judge their HIV risk based on "ARS symptoms" is a waste of time.  Thus, despite the symptoms of sore throat and rash  that you are experiencing are compatible withthe ARS, it remains most unlikely that the exposures you describe gave you HIV, or that this is ARS.  My suggestion, see your health care provider about your sore throat.  You likely caught a community acquired respiratory tract infection or strep throat from him, not HIV.  Hope this helps.  EWH

[GreatlyAppreciated]

This is not a question...just a comment.  I just received my 12 week test...NEGATIVE.  I was convinced all my symptoms were a signal that I contracted HIV even though you made every effort to convince me otherwise.  I still see people like myself concerned about symptoms and your consistent statements that symptoms are useless.  My symptoms continued even till today where I have some sores in my mouth and a huge red boil on my neck...so what...they are just that...mouth sores and an unsightly zit !!  It would take me less time to list the symptoms I didn't have from the infamous lists on the numerous web sites that the ones I did.  All useless in the end.  Thank you Dr. Hook for your professional efforts, accuracy in assessment and your logical approach to something that we patients (most of us anyway) are not capable of believing given the situation faced with.

[seejay654]

Thank you very much for your quick response to my question. I also was extremely taken aback by the comments by the clinician worker. Today I did some research (instead of doing work! ;-)) and I believe I found the study that he was referring to. Apparently, a CDC study in 1999-2000 estimated the number of men who contracted HIV by performing oral sex to be 7.8%. Granted, the sample size was fairly small (102 people), but, it is an interesting study. The link to the CDC webpage is as follows:

http://www.cdc.gov/hiv/resources/factsheets/oralsexqa.htm

Apparently there are a number of factors that they did not account for, including bleeding gums. Despite this factor, however, the difference in your estimate versus this estimate seems significant. Has this study been proven to be out of date? Are there more recent studies that have proven this to be incorrect? I apologize, however, my rash seems to be getting worse and I am simply attempting to understand the situation that I am in.

Also, if acceptable, I have one additional question. When should I go to get tested for my own piece of mind (since the possibility of my contracting HIV was so small). Should I wait for 4 weeks or 6, or the full 3 months?

Thanks again for all of your help!

[Edward W Hook, MD]

The study you mention is an outlier which provides and estimate that many (most) experts in the field would disagree with.  There are many studies which estimate the risk of oral sex as far, far lower and those are the basis of our recommendations on this site.  

As for testing, getting testing is fine.  If your testing is to alleviate your concerns regarding the exposure you describe, then wait until at least 6-8 weeks to get tested. In that way you will have results at a time when about 95% (6 weeks) and >98% (8weeks) of tests that are going to be positive following exposure will be.  We do recommend regular,  periodic STD "screening (testing in the absence of symptoms) for persons who have had multiple partners over a period of less than a year.  As a matter of personal protection, we recommend annual testing for anyone who has had two or more sex partners in the past year (we consider this to be health maintenance- we also recommend you get your blood pressure and cholesterol checked regularly). EWH

[Edward W Hook, MD]

I did just look at the reference you cite.  Two things- this is an Abstract and thus the full data are not preented. i will reserve my judgement until there is more to look at.

Even more importantly however is that the abstract does not say the the risk for getting sex from oral sex (single episode) is about 8%, it says, based on what appear to be small numbers of persons, that about 8% of men who have sex with other men in SF may have gotten their infection through oral sex.  This is a very different thing.  EWH

[ja246]

My argument is this:

The trouble with any studies undertaken and what Health Authorities report. A lot of the information obtained on risk exposures is from word of mouth from the patient . How can you guarantee that they are being 100% honest about their exposure?

The information is now out there that unprotected anal sex is a high risk event. Yet are people going to admit that they have done this? To avoid  embarrassment, would they perhaps limit the scenario to a doctor to say just unprotected oral as a way of avoiding what they think will be embarrassment of the real exposure, i.e. unprotected sex?

From what I can gather, a small study like this with a high percentage obtaining HIV from oral, the above argument should be considered? Because, if these were accurate and a true reflection, a hell of a lot more people would be infected in the real world then there is and a hell of a lot of records from hospitals reporting a high percentage of risk exposures for people contracted HIV against this exposure - Oral Sex!

[seejay654]

Thank you for your follow-up and your work on this site.