Just worried about what this could be (HIV? other STD?)

[tom1989uk]

Approximately 3 months ago I had unprotected vaginal sex with a girl who is known to be very sexually active with multiple partners. She put the condom on and we started having sex but I found it wasn’t comfortable, so she took it off and put it on the right way round (inside out). Unfortunately I did not think of the implications of this until later. In the morning I noticed some small red dots on the head of my penis, and some redness around the bottom of the penis head and foreskin. These symptoms disappeared within 2 days. Worried, I then went for an STI test for Chlamydia, Syphilis and HIV. The doctor did not think it necessary for me to have a Gonorrhoea test as he did not believe I was symptomatic of it. All these tests came back negative and I stopped worrying until I noticed a reoccurrence in the small red dots. Obviously I was worried so I read up on many STD’s including HIV. Do the small red dots I have described sound anything like penile ulcerations which can be a symptom of HIV? I also noted that I had a sore throat, a cough, Diarrhoea and a small hickey like rash under one arm (which did not sound anything like the small red bumpy rash described by most sources on early HIV symptoms). Is there any other explanation for this rash? Perhaps abrasions or a mild allergic reaction to something or do you think this could be a symptom of HIV? I know the chances are fairly small but do you think that the symptoms and circumstances I have described warrant going for an HIV retest? As previously when I was tested I was in the “window period” where it would not have shown up. And if the small red dots and mild redness are not penile ulcerations then could you please suggest an alternative. Thank you very much for your time. I would be extremely appreciative if you could shed some light on my uncertainty and provide me with some advice as to my circumstances.

[Edward W Hook, MD]

Welcome to the Forum. I have several comments about the episode that you describe which I hope you will find helpful.

For starters, that your partner has had multiple partners does not mean that she had STDs or HIV.  In fact the chances are very good that she did not.  In addition, for most STDs, including HIV, even if a partner has an infection, most exposures do not lead to infection.  For instance, with HIV one 1 infection occurs for every 1000 exposures to infected partners.  For other STDs like gonorrhea and chlamydia the chances are considerably higher but even for the most effectively transmitted STDs the chances of infection with a single exposure are no greater than 1 in 5 (20%).  And remember, chances are that your partner was not infected.

Your exposure was essentially unprotected.  To start sex, then reverse the condom and continue places her genital secretions in direct contact with your skin and vis versa.  There may be some small element of protection but it is best to think of this exposure as unprotected.

The red dots and redness you noted are not due to STD or HIV.  None of these problems cause symptoms for at least 24-36 hours following exposure.  They may represent irritation that occurred during your exposure (and be related to the discomfort that lead to the condoms change).

The testing you had for chlamydia is accurate and should be believed. It really would have been better if your doctor had tested for gonorrhea as well however since 10% of gonorrhea is asymptomatic.  As for the blood tests for syphilis and HIV, it was too early.  These tests take several weeks for infection to become apparent in a blood test.  On the other hand, both of these infections are quite rare and your chance of having gotten one or the other is quite small.

Chances are that you did not get infected through the exposure that you describe - the statistics as well as the absence of symptoms since that time are in your favor.  However, if you wish to be sure based on testing, I would suggest repeat testing at this time for HIV.  It is up to you if you wish to be tested for gonorrhea and syphilis at that time - as I said, the chances that you got infected are quite small. I predict that the tests will be negative.

Finally, as for the red dots, I cannot venture a guess as to what they might be.  If they are still present or if they re-appear, I would suggest you have them examined discuss them with your doctor.  They really do not sound like an STD however and likely represent some other, non-STD dermatological process.

Hope this helps.  EWH

[tom1989uk]

Firstly I'd like to say thank you for such a calculated and helpful answer. I am very glad that I chose to consult you on this forum and I consider it to be money very well spent. I only have one query about the under arm rash that i described above. In your experience does it sound symptomatic of any form of STD?

I plan to go for a full STD retest for everything apart from chlamydia and I will go to the doctors if the red dots reapear.

Just to satisfy my curiosity I was just wondering why the probability of hiv infection due to unprotected sexual contact is so low? Not a problem if you don't have time. I'm sure you're a very busy man. Thanks again!

[Edward W Hook, MD]

No, the rash under your arm does not suggest any typical STD.

As for the probability of HIV transmission, or for that matter any other STD, the "efficiency" of transmission is a biological characteristic of the organism.  It may be modified by variables such as duration of intercourse, etc but basically it is a biological characteristic of the pathogen involved.  Take care.  EWH

[tom1989uk]

Last night i noticed that the red dots described previously have developed further with a deeper shade of red around the foreskin. They now seem to have a small white head at their tip but are still painless. This occured after having sex with my partner who has been tested for STI's. I will be going to see my doctor but wondered if you could shed any light on this development? Sorry but this has me worried.

[tom1989uk]

There is also a small red dot in my rectal area.

[Edward W Hook, MD]

No change in my opinion that this is not an STD.  STDs do not appear immediately following sex, typically taking more than a day or two to develop.  Perhaps the could be vascular (blood vessels).  I think you are doing the right thing by discussing this with your cdoctor.  EWH