HIV/STD Situation

[SouthernCalifornia]

I was in Pattaya, Thailand Jan 27 - Feb 18. had a couple drink and decided to take a go-go girl with me. She performed oral sex for about 5 min then had vaginal sex for about 5 minutes until condom broke, immediately ran to bathroom to rinse myself off with soap and water and stopped. This was February 5th 2012. A week later different girl condom stayed on but there was blood on it. I rinsed condom first then myself and left. I started feeling a bit odd on February 18th the night we were leaving, I was fine throughout the entire day. That weekend I was extremely sick, I was unable to move from my bed, I don't think I had a fever but I did have horrible diarrhea about 10 loose stools a day. I lost my appetite and literally just laid in bed sleeping for almost 3 days. I felt great on Tuesday morning just had mild diarrhea so went to our medical clinic on base (I'm navy) and they gave me doxycycline, naproxen and ondansetron for a 10 day cycle to clear the issue. later that night I noticed tiny cluster of painless bumps on penile glans. Penis feels dry, wrinkled. I was tested for Syphilis, Chlamydia, Herpes, gonorrhea all negative but HSV-1 positive, I was given Acyclovir 5 tablets a day for 5 days incase I had Herpes immediately following the doxycycine cycle. On February 15 tested for HIV, received results on the 21st negative, I don't know what method the military uses for HIV as far as generation but I'm worried since i read about the 3 month rule. I have a mildly swollen tongue with light white coating on back and stomach still feels odd. I have lost 10 pounds and have been stressing like crazy after reading about all the STD possibilities. What are the chances I have HIV or some other issue since I don't feel like myself. I also had a sore throat and mild night/day sweats around Feb 17th for a couple days which i think are due to weather. I also had a hot feeling in the genital area for about 2 weeks until I bought powder because it felt really moist in thighs

[Edward W Hook, MD]

Welcome to our Forum. I'll provide some information. It is most unlikely that you acquire an STD of any sort from the exposure you describe.  Most commercial sex workers do not have STD (including HIV) and most exposures to infected partners do not lea to infection.  In your case, only one of the partners (the first one) may have put you at risk- with the second partner, the fact that the condom remained intact means that you were protected even if there was blood on the condom.  With the first exposure, the broken condom means that you could have been exposed but as I explained above, it is unlikely on a statistical basis.   Between the antibiotics and tests you've had you can now be confident that you di not acquire  a bacterial STD or herpes.  

That leaves HIV.  For the reasons I mentioned, HIV remains unlikely.  It is not transmitted through oral sex and with vaginal sex, the risk of infection is only 1 infection in every 1000 sex acts.  Thus the odds are in your favor.  I would suggest that you re-test for HIV about 8 weeks after your Feb 5 exposure (i.e. about now).  I expect that the test will be negative and when it is, you can be confident that you did not get infected.  An 8 week HIV test results will be highly reliable.

As for your diarrheal illness, this does not sound like early HIV.  Rather it sounds like the sort of GI tract infection that travelers get all too frequently.

I hope these comments are helpful to you.  EWH

[Edward W Hook, MD]

No, HPV does not present as black specks.

End of thread  EWH

[SouthernCalifornia]

Dr Hook,

I know you said this thread had to end, I will exit out of here and repay in order to submit a new question.

I posted my results and from what you have said I am good to continue with my life correct? My fiancee and I plan on having a baby and would like to resume my sex life with her without condoms. I talked to my provider about all of the tests that I have taken and he said I should be fine. He brought up a question about HPV which is genital warts.. I don't think I have anything but do have to very small black specks near my urethra, one is flat and the other slightly raised. You have to stretch the skin to see them..

Thank you

Could this be a manifestation of HPV?

[SouthernCalifornia]

Good evening Dr,

These are my test results for 10 1/2 weeks after potential exposure with CSW:

HSV-1 IgG Test- Positive
Chlamydia Nucleic Acid Amplification Test (NAA)- Negative
Gonorrhea NAA Test - Negative
Hepatitis B Surface Antigen with Confirmation by Neutralization- Negative
Hepatitis C Surface Antibody Test (Anti-HCV) - Negative
HSV-2 IgG Test- Negative
HIV-1 Antibody Test with Reflex to Western Blot Confirmation- Negative
Syphilis Rapid Plasma Reagin (RPR) Test - Negative

I would just like to thank you again for your advice and reassurance. I understand you deal with a lot of people like myself because of us trying to self diagnose ourselves through the internet. The internet can be a horrible place to look at times like this.

With that being said I am good to continue living my life. Thank you Doctor Hook for your help once again.

[Edward W Hook, MD]

You are continuing to  worry more than you need to.  I am confident your tests for HIV will be negative.  Concerns about missing HIV-2 with standard tests offered for HIV are another internet-fueled urban myth.  When you get your negative tests, I hope that they will allow you to stop this unnecessary worry an move forward.

Time for this thread to end.  Feel free to post you results here when available.  EWH

[SouthernCalifornia]

Good morning Dr,

I have departed Okinawa, Japan and have found a STD testing center online which is located here in Virginia Beach, Va. I have an appointment this monday and am taking the 8-Test Panel which covers Chlamydia, Gonorrhea,Hepatitis B, Hepatitis C, HSV-1, HSV-2, Syphillis and HIV-1 (antibody test with reflex to western blot confirmation). I know that most of these have already returned negative but the package together would be cheaper than taking individual tests. These test will all be 10 weeks after potential exposure while in thailand. Should I be concerned that this testing center does not offer an HIV-2 test? or is this type of Virus isolated in certain areas of the world? I am feeling a lot more confident about these tests with your advice about a second HIV test coming back positive after the subsequent test 5 weeks after initial exposure. What last advice do you have or reassurance can you offer before I go in to the labs in 2 days??  Thank you for you quick responses as well Dr.

[Edward W Hook, MD]

The possiblity that this is a manifestion of HIV are close to zero.  The continuing symptoms you describe could be a manifestation of anxiety or some other medical process. To address these possibilities I would suggest that you sek evaluation by a trained clinician.  An Internal medicine specialist would be a good place to start.  EWH

[SouthernCalifornia]

Considering I have been tested for everything and everything has been negative. What could potentially be the cause of me feeling fatigue, body soreness, muscle ache. I have lost weight regardless of normal eating habits. It feels as if my body is burning more fat than usual because I have lost fatty weight as long as a bit of muscle mass although I continue to go to the gym and weight lifting. My original weight has always been stable around 195-200 pounds and currently stand at 185 pounds in the morning and 189 at night after a workout. This is very unusual to me. I have not changed my routine but cannot gain my weight back.. Could HIV symptoms be weight loss 7-8 weeks after potential exposure? or could it be something else.

[Edward W Hook, MD]

You are correct, if  your illness had been due to HIV (which as I sadi,I am confident was not the case), your subsequent test woul have been positive.

HIV testing in Japan, as well as by the Navy, is highly reliable.  I urge you not to worry.  HIV is most unlikely in your situation.  EWH

[SouthernCalifornia]

Yes I went online like most people do when I thought I might have exposed myself. The fact that I have been negative for everything else in a sense makes me feel better. My only concern is what generation tests does the Navy use. I have read numerous doctor responses in regards to HIV testing and their accuracy at 5-6 weeks exposure. from my understanding there should be detectable antibodies by then if one has already gotten sick like i did 2 weeks after correct? I am currently stationed in Japan and wonder if the HIV testing routine is the same here as in the states. I will be going to Virginia and plan on going to a medical clinic to be tested again just to be on the safe side.

[Edward W Hook, MD]

You inidcate you have been examined by a doctor who found nothing abnormal.  There are many normal "bumpy" structures on the penis.  Sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned.  This in turn leads to noticing what turn out to be normal stucturesa and sensations that might have been not noticed or ignored at other times.  i suspect that  this is a contributor to your situation.  EWH  

[SouthernCalifornia]

If I have tested negative for all of these tests then why would I have these tiny bumps on my penis? I just feel like I had many of these symptoms, but not right when I initially got sick. I had mild night sweats for a few days, this weird rash in my inner thigh that might have been to weather, it was really moist in inner thigh, cured it with powder after 2 weeks. Started developing these tiny black specks on my body. I had to look very closely in the mirror to notice them but then noticed a few on my chest and some on my back and legs. not many but they were there. I talked to my medical provider here on base and he told me that they might be fordyce spots because I also had these little white bumps on my testicles. I had hair loss there and I also have fordyce on my upper lip. I haven't develop any blisters or canker sores in my mouth, just have noticed my tongue is a bit swollen with teeth impressions and light white coating towards the back of the tongue. My body has also felt very dry, perhaps because of the sudden weight loss i had in a week and a half period. My main concern is that I don't want to go around spreading anything. If it is what my provider says it is then I will continue with my life. If you could please provide some feedback it'd be greatly appreciated.