Please advise

[welcomemark]

30 y/o hetero male
I had sex with prostitutes starting in March-Oct. of 2005 (maybe 30-40 occurrences). All vaginal sex was with a condom. I did have one instance where I received oral sex without a condom on July 1st. Five days following my unprotected oral encounter I broke out in a macular rash that was mainly on my trunk. The rash was a faint red and was not raised. It did not itch. I became worried and started to check the Internet. Over the next 2 weeks I woke up in the middle of the night 3-4 times feeling like I had night-sweats. The night sweats only seemed to be occurring on my head/neck area because the rest of my body did not feel wet. Only my pillow. Is this possible?? I also became nauseated one night and threw up. The rash lasted for about 7-10 days and then went away on its own. No sore throat or fever.
I felt fine for the next 6 months. I had a staph infection in Sept. around my groin where I used to shave. Doctor gave me antibiotics for one week and said caused by shaving. Then in January I started to notice something in my throat as I tried to swallow. This remained for 2 weeks, and then all of a sudden my nodes on my neck swelled up on both sides. My cervical nodes became enlarged, no other symptoms. Then about 3 weeks after my neck nodes became swollen, my groin nodes swelled as well. Then 1 week later I felt something in my armpit, I could not feel any swollen nodes but then 1 week later I could feel a small lump in the right armpit.
To this day my neck/armpit/groin nodes are slightly enlarged going up and down. Also my jaw gets somewhat tight sometimes. Also during this time I have had a transient rash on my arms, hands and my chest that seem to come and go. Also I have a little folliculitis on my chest. Currently I have been getting mosquito like red bumps on the arms that slightly itch. Only other symptoms that I have experienced are pimples in my nose folds with a little redness (seb derm?), feeling run down, tired, pain in my thigh area. Also have two small white spots in the mucosa (back of my mouth). They are slightly raised next to each other and do not hurt. They have not changed at all. Also I have a coated tongue most of the time.

1.would you be worried about HIV?
2.I have noticed red patches/spots on my hands, arms and chest. These areas do not itch and the skin does not get dry or peel or scale. Also the redness comes and goes (transient). any ideas?
3.With shaving the genital area would the cuts heal sufficiently in 24 hours? Would washing the area several times before engaging in sexual activities open the cuts up to infection?
4.The lymph nodes are the most worrisome for me. Can lymph nodes change in size throughout the day? Sometimes I fell like they are more swollen then other times. They seem to be going up and down over the last month or two.
5.The macular rash I had on my trunk, if it were caused by ARS would this have been accompanied by sore throat, swollen nodes, muscle aches, ect.
Thank

[H. Hunter Handsfield, M.D.]

As I have pointed out innumerable times on this forum, symptoms almost never are a reliable indicator for or against early HIV infection, even when the symptoms seem typical of various online descriptions of those that occur with HIV.  That's because "typical" symptoms are more frequently due to other things, all of which are more common than HIV.  And most of your symptom don't sound like HIV anyway.  I doubt your lymph nodes in fact are enlarged; self-determination of enlarged lymph nodes (i.e., other than by a health professional) is very unreliable.  Anyway, HIV-related lymphadenopathy does not "go up and down"; they enlarge (usually dramatically) and stay that way for 2-4 weeks.

1) The odds you have HIV are low, if your history of consistent condom use is accurate and you have no other risks like injection drug use.  The symptoms you describe don't mean anything one way or the other.  However, with your lifestyle--frequent commercial sex encounters, even with consistent condom use--you ought to have routine HIV and STD testing once a year or so.  So if you haven't been tested recently, this probably is a good time to do so.

2, 5) I cannot comment on the skin symptoms, except they do not suggest HIV.  Fever is just about always present in ARS; its absence is further evidence against you having HIV.

3) Shaving or not doesn't significantly affect HIV risk.  Washing shouldn't be harmful.

4) See above re lymph nodes.  They absolutely cannot change in size over the course of a day.

Bottom line:  Seeing a health care provider is the only way to check out your symptoms.  While you're there, get routine STD/HIV testing.  (Don't try to read between the lines.  This does not mean that I really think you have HIV.  I do not.)

HHH, MD

[confused516]

As long as all the vaginal sex was condom protected you will be fine.  DR. H will tell you that receiving unprotected oral sex is no risk and therefore your sypmtoms cannot be do to that episode.  Not to mention there has not been one documented case from this type of exposure in over 25 years!!!  You will not be the first.  You also dont even know if she had HIV.

[welcomemark]

Hi Dr. H,

Thanks for the quick reply. I know about symptoms not equalling infection but it seems like I progressed to having alot of them.

I do want to clarify that most of my symptoms have started at 6 months + after I had the possible ARS rash and night sweats. Do you still consider that early HIV symptoms?

As far as the lymph nodes go. I think you are right about them being improperly diagnosed at home, except in cases where true swelling takes place. Because once is swells its easy to see this and feel them once they return to normal.
you mentioned "Anyway, HIV-related lymphadenopathy does not "go up and down"; they enlarge (usually dramatically) and stay that way for 2-4 weeks." is this true for ARS as well as progressed HIV?

Anyway I will definately head in for a check up and continue to use condoms for sexual intercourse.

thank you

[H. Hunter Handsfield, M.D.]

All of my comments are equally valid for symptoms 6 weeks, 6 months, or any other time frame.

There is no disease that exists that can make lymph nodes enlarge and shrink in less than several days to a couple of weeks.

HHH,m MD

[petrus]

Don't rely too much on condoms. They slip off, etc... the more encounteres, the more probability... Prostitutes are just risky partners...

[nicechic]

Does anyone know wat a bump in the armpit means and is quite painfull, i dont have it at present but it usually comes and goes