Kissing/Massage/Fiance/Thrush

Thank you much for your time.

I know that my exposures below are low risk - but I am freaking out over a store throat. I would like your assessment. Like many others on here, I was on my bachelor party. Naturally, I have a fiance I care about harming:

(1) 2.5 weeks ago I went to an erotic massage parlor; I got a happy-ending. She tried to put a condom on me, but I told her I did not want sex. I am worried she cut her hand on the wrapper as I heard her cursing a bit as she tried to open it.

(2) 1 day later I made out with a girl at a club; heavy kissing - nothing else

(3) 1 day after that, I made out with another girl at a club; heavy kissing - nothing else.

5 days after exposure (1) I got a sore throat which I have had for 2 weeks. I was screened for strep, it came back negative. I am terrified that it is thrush. I have attached a photo here: http://s1224.photobucket.com/albums/ee365/greggregory1/?action=view&current=CIMG2570.jpg

My questions:
(1) Does that look like thrush? The two little pustules. They have been present for a few days and move around.
(2) Do I warrant HIV testing or testing for any other STD from the handjob, kissing, etc.?
(3) Can I continue/start sex with my fiance

We both tested clean bill earlier in the year.

Thank you for your help...I am extremely anxious...

[Edward W Hook, MD]

Welcome to the forum. Your situation is, indeed, a familiar one.  Each of the exposures you describe however is zero risk for HIV and does not warrant concern or testing.  On the Forum we have a rule that we do not look at photos but those are primarily for issues related to skin lesions.  I looked at your photo and it does not resemble thrush, which is characterized by white, adherent patches, in any way.  what you have is likely the sort of viral sore throat we all get from time to time, not HIV.

there is no need for you to test related to these exposures and no need to worry about unprotected sex with your fiancé.  EWH

[greggregory]

Also, I'm really sorry that people like me keep posting scenarios like this. It's just hard not to freak out, especially when there are deep underpinnings of guilt.

Thanks again.

[greggregory]

Hi Doc -

My swabs came back negative for strep throat, positive for candidisis for which I have been prescribed nyastin. I can't imagine you would have seen the patches from the photo I sent; nor were the photos appropriate for this forum. Regardless, does this change anything? My doctor said it was "very odd" to have thrush without having been on antibiotics, and said I could "have and HIV test if I wanted." It has been 3 weeks since the event. I turned the test down since I felt like it would just be me succumbing to my worry.

Thanks.

[Edward W Hook, MD]

This changes nothing.  Candida is normally present in the throat, thus your postive culture doesn't suprise me.  I suspect the positive culture is unrelated to your sore throat. If it is, the nystnatin will take care of it.

I agree, there is no need for an HIV test

Try to relax. EWH

[greggregory]

You're the man, Dr. Hook.

[greggregory]

Just wanted to follow-up, and provide some closure (for myself and others reading this thread).

The thrush (which blew up and was quite gross) is gone, thanks to the medication.

At the request of the GP, I had an RNA PCR and a Antibody at 22-days post-exposure. Both returned negative. RNA PCR <20copies/Ml (new test).

GP stated:

(1) RNA PCR Test (Roche Cobas Taqman) was 99.3% sensitive, and perhaps more so during ARS where copies should be in the millions. In other words, while an RNA PCR could have a false negative, as suggested by the 99.3% sensitivity, it would be unlikely to be during ARS, or immediately post-infection, when viral loads should be at their highest. He noted, however, that such studies hadn't yet been done, as RNA PCR was only recently approved for diagnostics.

(2) If Thrush were due to ARS, the antibody would likely have been positive, and most definitely the PCR. Further, likely some noticeable impact on my CBC.

(3) Thrush is not indicative of HIV. Thrush is indicative of thrush, which can be caused by anything from too much alcohol to stress and lack of sleep.

(4) A combination of an antibody and a next-generation RNA PCR at 22-days is conclusive, especially given my risk. No other tests recommended.

[Edward W Hook, MD]

I agree with all of the statements your doctor has stated.  EWH