Risky Encounter with TSW

[neveragain88]

Hello Doctors,

I’m a 24 year old circumcised African American male. 8 weeks ago I had insertive unprotected anal sex with ejaculation with an uncircumcised south Asian transgendered escort in Chicago. I identify as hetero and have only been with women & 1 trans (protected) before this partner. I was drunk and made a poor decision. I was the receptive partner for less than 1 minute (unprotected with lube, no ejaculation). I saw her before in January and she showed me her neg HIV result. After this recent experience I asked again, and she said she tests every 3 months and the latest was neg.

I've had a variety of symptoms starting at 4 days and lasting until 5 weeks. Not all at once and did not feel like the flu. My girlfriend also got the same after unprotected sex with her (muscle/joint aches, nausea, fatigue).

Around 3 weeks I noticed small spots of light discoloration (I’m dark skinned) on my body. My girlfriend has the same spots. They look similar to Idiopathic guttate hypomelanosis (IGH). I’m not sure if they were there before. Google shows 2 photos of HIV rash in African Americans that looked similar to the discoloration we have. Those were close together and well defined; mine are mostly faint & spaced apart.

Neg Oraquick mouth swab- 18, 25, 32, 40, & 56 days
Neg Chlamydia, gonorrhea, syphilis- 25 days
Reactive for Hep B antibodies, non reactive for antigens- 18 days

1. Are there differences in ARS rash between African Americans & caucasians?

2. I read I should've tested positive by now if symptoms were due to HIV. Is there any difference in the time period of seroconversion in African Americans?

3. If the control line on the Oraquick test was present does that mean I picked up the proper fluid for the test to work correctly?

4. The escort was South Asian, if she had a rare subtype of the virus would my tests catch that at 8 weeks?

[Edward W Hook, MD]

Welcome to the Forum. Before I address your specific questions, a few more general comments.  My sense is that you are playing Russian roulette here.  If your partner is a CSW who practices unprotected active and receptive anal intercourse the odds are that sooner or later she will get HIV.  That she tests is a good thing because it means that she (and thus her partners) will know when she gets infected but she is still taking lots of risks here.  My advice is to use condoms when you see her again for active or receptive rectal sex.

It is unlikely that the symptoms you developed are due to HIV- some of them are somewhat suggestive of the ARS but they started too soon (yours started at 5 days, typically ARS starts at about 14 days), lasted too long (the ARS typically lasts about a week), and most importantly, your test are negative (test are typically positive less than a week after the onset of symptoms and your negative HIV test at 56 days (about 8 weeks) is definitive evidence that you did not get HIV.

You should also believe your other test results.

As for your specific questions.

1. Are there differences in ARS rash between African Americans & caucasians?
In general rashes are missed in African Americans because the rash can be faint but otherwise I am not aware that the rash is particularly different.

2. I read I should've tested positive by now if symptoms were due to HIV. Is there any difference in the time period of seroconversion in African Americans?
Your reading is correct and there is no difference in time to seroconversion in African Americans.,

3. If the control line on the Oraquick test was present does that mean I picked up the proper fluid for the test to work correctly?
Yes, if the control line showed, you did the test correctly.

4. The escort was South Asian, if she had a rare subtype of the virus would my tests catch that at 8 weeks? .
concerns about rare subtypes are overblown.  I would not worry about rare subtypes.  If she had one however, you test would still most likely be positive.

You were lucky.  Please take more care in the future. EWH

[Edward W Hook, MD]

If your anxiety requires you to get tested, do so. Syphilis is a rare infection, even among men who have sex with other men or transexuals and most people would have a positve test three weeks after an exposure.  I would not be worried if I were you and would not get retested unless the bump you have noticed became a larger, painless ulcer.  EWH

[neveragain88]

Hello doctor. One more question. I am pretty informed about HIV and window periods since I was obsessing over it for the past two months. However I'm not as sure about other STDs (specifically syphilis). I tested at 3 weeks and it was negative, but I see alot of confusing info online about the window. Should I be comfortable with my 3 week test? I ask because today I noticed a small slightly raised area (not quite a bump or chancre yet) on the underside of my penis near the head. I should also add that I get very sweaty down there and it is not uncommon for me to get bumps in the pubic hair area especially after trimming (I have a couple in that area now even). However I only remember ever getting one on my actual shaft once. Should I get retested for syphilis? At this point it's been 9 weeks since the sexual experience described above and 3 weeks since the negative syphilis blood test. The "bump" near the head is only just now appearing.

[Edward W Hook, MD]

Glad to help.  Take care. EWH

[neveragain88]

Yes, I am hoping it was there before I began inspecting every single thing that seemed "off" about my body. You have been a tremendous help.Thank you very much doctor. Have a nice weekend!

[Edward W Hook, MD]

Correct, I see no reason for further testing based on your test results.  I suspect your rash is due to something else and could even be something that was there before your encounter but was unnoticed until you started to look more closely.

Take care. EWH

[neveragain88]

Thank you for your prompt and concise response Dr. Hook. This forum has absolutely provided me with a wealth of helpful information, and I will definitely be making safer choices in the future. This was the only time I have ever participated in unprotected receptive anal sex, and obviously it freaked me out upon learning how high-risk the act was.

So you recommend no further HIV testing, correct? I ask because I am worried about the small light-colored discoloration spots that I did not notice until after this experience. Like I said, it looks similar to IGH, but I read that IGH does not affect young men at the same rate it does older people, specifically older women. I have read that skin discoloration could be a sign of an underlying immune issue; that's why I remain slightly worried about HIV. Would you recommend visiting a dermatologist or ID doctor? I also experienced "water on the knee" for the first time ever for two days around 7 weeks after the experience. I know that is not an ARS symptom, but I also read it may be due to an immune issue (but could be just due to things such as exercise as well).  

I definitely want to put this behind me and begin seeking professional assessment of these strange health issues if there is no longer a chance that they are HIV related.