scared

Hi-I would like advice about HIV. I'm a 32 y.o. straight male. Five weeks ago, I did a very stupid thing: I went to a massage parlor. I’ve never done this before or since. I had brief, protected vaginal sex there with a sex worker with latex condom. She put the condom on me and I removed it after ejaculation.

About 2 weeks later, I experienced slightly swollen glands and general tiredness, followed by a two blisters on upper thigh. A few days later, another crop of blisters appeared on my penile shaft. The following week, I went to my doctor who said that it was likely a case of primary HSV II and other STDs. He ordered tests-is awaiting results. I can only assume that I got the herpes infection from her, as I do not recall experiencing genital herpes before. I’ve had jock itch and pimples on the thigh and buttocks before, but never noticed herpes-like blisters. My doctor gave me Valacyclovir 2X daily for 3 days said it should abate in few days. Pain, discomfort and most of blisters have dissipated but there is still one prominent sore remaining that was already starting to be inflamed when I began taking the medicine. I have the feeling that this sore will soon pop and crust over like the earlier ones did. Is it a sign of HIV that a. I had herpes outbreak? b. drug did not work immediately?

About 6 days ago, I developed mild rash/irritation on back of my neck w/ patches of dry and reddish-brown skin. Also had dry scalp that went away in a couple days.  My doc said it’s probably sunburn/heat rash. The rash has dissipated but not gone away.

I also had lack of appetite + diarrhea. I’ve read these can be symptoms of acute ARS. Hard to say whether or not due to stress. I’ve been a "mess" since suspecting HIV a few days ago. Am NOT currently having: fever, sore throat, thrush, tiredness or swollen nymph nodes. I had HIV antibody test on 6/30 (4 weeks after incident): result was negative. Will repeat in 2 months, but in meantime am very scared. Can you advise? Thx

[H. Hunter Handsfield, M.D.]

Welcome to the HIV forum.

Let's deal first with HIV, which will be quicker and easier than the herpes issues.  In the industrialized countries, the odds any particular commercial sex worker (which I how I would characterize your masseuse) has HIV average 1 in 1,000 or less; and if infected the risk of HIV transmission averages something like 1 in 1,000, even without a condom. With a condom, the chance you caught HIV much lower still.  On the other hand, if your herpes is due to HSV-2, or if you caught herpes during the same encounter, that raises the HIV risk, but only a little bit. Taking all the information into account, the chance you caught HIV is nearly zero.  And your negative HIV test result at 4 weeks is very reassuring, since 90+% of newly infected people would have positive results by then.  For final reassurance, have another HIV antibody test at the 6-8 week mark. You can expect it to remain negative.

Now to the herpes problem.  I'm going to assume you have genital herpes, based on your description and the doctor's opinion.  There are two main arguments against a new infection:  condoms are highly effective, although not perfect, in preventing genital HSV transmission; and 2 weeks is atypically long from exposure to symptoms.  It can happen, but most of the time symptoms start within a week to 10 days.

Having said that, condoms fail not because the virus passes through intact latex, but because they don't cover the entire penis.  If your penile lesions are high on the shaft, subject to skin-skin contact, that would be consistent with a new infection.  The other aspect that argues for a new infection is the apparently widespread lesions, i.e. both thigh and penis.  Some other clues that could help:  were the penile lesions in a fairly small cluster, perhaps only on one side of the shaft?  Or were they all over the penis?  The former would favor a recurrent outbreak, the latter a new infection.

The response you describe to Valtrex is entirely consistent with herpes.  It typically takes at least 2-3 days before an obvious effect is seen.  There is nothing in this that hints at HIV.

How to sort this out?  First, await the test from the lesions; if positive for HSV, that will nail the diagnosis.  Also, if blood tests were done for HSV-1 or HSV-2, that may help sort it out.  If negative early but becoming positive later for either virus type, it would indicate a new infection.

Bottom lines:  Almost certainly you did not catch HIV.  I'm on the fence about whether your herpes is likely new or just unlucky timing of an outbreak of an older infection.  I guess I slightly lean toward a new infection, but only slightly.  Please return to let me know when your HSV test results are available and we'll take it from there.

Regards--  HHH, MD

[DM78]

Sorry, I'm reading this over and realize that I meant to say that my doctor ORDERED tests for other STDs. He said he only SUSPECTED HSV-II based on exam (paragraph 2, sentence 3).

[H. Hunter Handsfield, M.D.]

I saw this before I replied above.

[DM78]

Dear Dr. HHH,

Thank you for your reply. I saw my doctor today and he told me that my lab worked showed that I am negative for HSV I & II, syphilis and gonereriah. I will retest for all stds in a few weeks. Am I safe to assume then that the genital lesions were a sign of a newly acquired infection. And, if so, what other medical conditions could case genital lesions. I recently had a mild rash on my upper thigh. My doctor took a look at it and said that it is probably jock itch. Still very worried that this may have been a symptom oh hiv.

Thank you for your help.

DM 78

[H. Hunter Handsfield, M.D.]

It's definitely not an HIV symptom.

[DM78]

Dear Dr. HHH,

Thank yo for your response. As I noted, the swab tests came back negative for herpes. My doctor thinks that this is probably because it is either a new infection or because of the swab. I asked him if he thought that the infection looks bacterial, and he said no, that it was probably herpes. As to the rash on my groin, it looked like razor burn rash. It is quite mild and convers the area leading from my groin to my thigh.  After looking on the internet, I thought that it might be molluscom, but my doctor said that he did not believe it to be the case. He thought it was just a normal rash/skin irritation.

I repeated the antibody test today using an oral test (37 days after possible exposure). Result was negative. I will also do a PCR and repeat the antibody tests in the next two weeks.

My question is: Given that the herpes appeared later than the normal time, and the fact that I have a rash, should I assume that I contracted HIV during the encounter mentioned above? Also, could the genital ulcers (there is only left that is still inflamed) be just a symptom of ars and not herpes. The other symptoms that I have been experiencing are lack of appetite and diarerah. I have experienced some weight loss during this period. In general, my appetite seems to return when I am calmer and my mind is off these worries. My doctor has perscribed me medication for anxiety and recommended me to both a psychiatrist and a psycologist. I do not have a fever, although my temperature was 99.0 yesterday when I saw the doctor. Also, I do not have a generalized body rash except for the one on groin.

I appreciate your help.

[H. Hunter Handsfield, M.D.]

Based on all you say, herpes is unlikely.  If your doctor disagrees and is still concerned about it, you could have another blood test 3 months after the exposure.  But I expect it to remain negative.

On this forum we don't speculate about causes of symptoms other than HIV -- or in this case, other STDs.

That will have to end this thread.  If you want to follow-up with more discussion of the possible herpes problem, you'll have to start a new thread on the STD or herpes forum.  But I suggest you not spend the additional posting fee; you might get a bit more detail in the replies, but the basic information will be the same.