Not sure if it's an ARS rash?

Hi Doctor,

I'm a male.  I performed unprotected oral sex on a guy I've been seeing, and he ejaculated some in my mouth.  This was 4 weeks ago.  All we did was oral.

About 2 - 3 weeks after this, I started to develop VERY small pimples on my chest, waist line, armpits and face.  They've been getting worse (getting bigger and darker), but seem to be drying up.

I started noticing these small pimples about 3 days after I felt a very sharp pain in my lower back.  The day after the sharp pain, I struggled to get out of bed because the pain was that strong.  Again, this was only in my lower back.  This pain was 3 days after a flu shot at work and it was the only pain I felt.

I've been obsessive about taking my temperature, and the highest it's been is 100.5, but it goes down after a while and has been around 99.0.  I also have noticed some pulled muscles, but these hit me about 2 weeks after I noticed the small pimples.  I've had no sore throat, but did have a "phlegmy" cough.

I told the guy about my symptoms, and he has said he's been with 4 guys in the past.  He's never taking their ejaculate in his mouth, and has never done anal with them.

Admittedly, I have been drinking excessively, and was wondering if my rash could be attributed to that?  I've also been preparing for an apartment move, so could the rash be attributed to dust?

I know the above sounds like a laundry list of symptoms, but I'm really worried about this.

Thanks!

[H. Hunter Handsfield, M.D.]

Welcome to the HIV forum.

Your rash is clearly not due to ARS, which is not pimple-like; could not start so soon after exposure; and could not start to clear up within a few days.  As for other causes, I have no particular ideas.  Just not ARS or any other STD.  Your other symptoms also do not suggest ARS, which does not cause back pain) and came on too soon.  A temperature of 100.5 is out of the normal range, but also happened too soon; it could well be due to the flu shot.

From the information from your partner, he is very unlikely to have HIV.  And even if he had it, the average risk of transmission by fellatio (with ejaculation in the mouth) has been calculated at an average of 1 in 10,000.

In summary, the chance you were exposed to HIV is low; the chance you caught it is extremely low; and your symptoms are not possibly due to HIV acquired during the exposure you describe.

If this reassurance doesn't completely calm your fears, feel free to have an HIV test.  A single test in about 6 weeks would be sufficient.  This is not "code" to mean that I really believe you might have it; I do not.  But it's up to you.

Now comes the lecture:  You had sex with someone whose HIV status you apparently didn't ask about before the exposure.  What were you thinking???  Even though oral sex is safe sex, it isn't zero; and intentions for safety can often drop off the radar screen once sex is underway.  What if in passion you had gone on to anal sex?  All MSM should get into the habit of NEVER having sex without first asking about mutual HIV status -- then either avoiding sex or being particularly certain about safe practices with those who are positive, don't know, or seem evasive about it.  Follow that rule, and you'll likely never get it.  Break it consistently and it's a good bet HIV is in your future.

But for now, no risk to speak of.  Stay safe.

Best wishes--  HHH, MD

[Should_I_be_worried]

Hi Doctor,

Thanks for your response.

I feel like I should clarify something that may have not been stated correctly...  The rash I have now started on my chest as very small pimples that have since gotten bigger.  Their growth is what concerned me the most.  Do ARS rashes start off small and then get bigger?

When I first met my partner we did disclose our statuses, but I was just asking him again to make sure.  He can't remember if he'd brushed his teeth prior to meeting with the 4 guys in his past, but he never took their ejaculate in his mouth.

The number you've quoted (1 in 10,000) puts me at ease.  I hope the rash is not ARS related, and we're both going to get tested at the 3 month mark.

Thanks again,
J

[H. Hunter Handsfield, M.D.]

I'm glad you exchanged HIV infection information with your partner.  It didn't seem like it.  I post that "lecture" whenever I have the chance, as a message to all readers in addition to the current user.  In any case, his confidence that he doesn't have HIV is additional reassurance that you were not exposed.

I gave you several reasons why your rash and other symptoms cannot be due to newly acquired HIV.  Please re-read my reply.  Whether the pimples get bigger obviously makes no difference.

Lots of people on this forum make comments about tooth brushing before or after oral exposures.  That's a theoretical concern that has never been proved to make any real difference in HIV transmission risk. That information has no bearing on my reply.

[Should_I_be_worried]

Thanks Doctor!

I have read that the rash can appear at 2-3 weeks after exposure.  This could be in the "danger zone" as far as timing is concerned, could it not?

Also, when I have posted a fever of more than 100, that doesn't last for more than 30 minutes.  After I've calmed down, the reading is in the 98 - 99 range again.

Also, when I said the pimples have gotten bigger, they've also "flattened".  Is this a symptom?

Your response about the tooth brushing is comforting, and will help me sleep better tonight.

Thanks again,
J

[Should_I_be_worried]

Thanks again, Doctor!

I've re-read my question (and your comments on here), and have realized that my partner is virtually risk-free.  I think I made myself crazy looking for symptoms!

Thanks for all you do!

J