Possible ARS Symptoms

[perhan6113]

I am a 46 year-old single man who met a young female college student online and subsequently spent the weekend of July 1st together having what can easily be described as wild unprotected sex.  I spoke with her online several times afterwards, but the conversation ended on the 23rd when I informed her that I had broken out in a measles-like rash and had no explanation for why.  Both my metabolism and energy level has always been high; my health, excellent.  Unfortunately, I believe my good health days are over.  I have reason to suspect that this college student may have infected me with HIV.

This is day 15 of my rash.  It completely covers my trunk, with a several spots extending down my limbs.  I also have a few on my neck, both palms, a significant number on the soles of my feet, and a couple on the head of my penis.  There are none on my face.  Here's a photo of the rash:

http://image55.webshots.com/455/1/8/2/2468108020101909590dybrXq_fs.jpg?track_pagetag=/page/photo/goodtimes/friendsfun&track_action=/Owner/ViewActions/FullSize

There is absolutely no discomfort associated with this rash, and it hasn't slowed me down.  I work 16-hour days, 7 days a week.  I've experienced no fever, no swollen lymph nodes, no sore throat, and no pharyngitis.  If I feel like I've experienced anything associated with ARS aside from the rash it would have to be that I have felt more tired than usual.  I also have an itchy scalp.  Not the entire scalp really; rather, 7-8 small red lesions.  Upon a close look I can best describe them as an extension of the rash.  

My questions are: Is it possible for me to have only the rash and fatigue as possible HIV infection?  Could I be experiencing fever in my sleep and be unaware?

Incidentally, I order 2 Home Access testing kits.  I'm somewhat hesitant to visit my neighbor doctor for testing because I live in a small community.

[H. Hunter Handsfield, M.D.]

An ID consultation is a good idea.  But the first thing s/he is going to recommend is a repeat HIV test.  You might save time and stress by having that done by your current provider while waiting to see the ID doc.

[perhan6113]

There was no mention of bands on the lab report, at least not on my copy.  All I know is that I did test positive on the ELISA and indeterminate on the western blot and was told that I need more tests.  I could be getting indeterminate results because of the syphilis, or, the tests could have been taken too early.  I'm trying to get an appointment with an infectious disease specialist.

[H. Hunter Handsfield, M.D.]

You don't provide the most important information.  What does the result itself read, before the "interpretation"?

This sounds like you might have an indeterminate Western blot.  Most of thsoe turn out to be HIV negative, but it depends in part on exactly which "bands" were positive on WB.

The provider who did the test is the one you should be asking.

[anxiouswreck]

It sounds like you tested positive on the ELISA and indeterminate on the western blot, which would mean an indeterminate test, and more testing is required. Would this be correct doctor H?

[perhan6113]

My HIV test results came back today and I don’t understand any of it, and I’m very worried.  

The interpretation reads:

“In conjunction with a repeatedly reactive HIV 1/2 Screening test, this result may represent an incomplete HIV antibody response or a nonspecific reactivity.  Patients with a positive HIV 1/2 screening test and an initial indeterminate HIV-1 western blot should be retested for HIV 1/2 infection at least one month later.  A nucleic acid amplification test (HIV DNA/RNA) may detect virus prior to seroconversion.  The laboratory will proceed with HIV-2 antibody testing and a subsequent report of those results will be issued.  Patient Results: Indeterminate”

I believe my worst fears are coming true.

[perhan6113]

Ironically, I did a google search on my symptoms at the time the rash exploded and the first two pages of results were on Jarisch-Herxheimer.  I was a little worried at first, but the doctor at the health clinic said not to be overly concerned about all of the nasty side effects of the massive dose of penicillin unless I experienced prolonged fever.  No prolonged fever, but the massive rash was unnerving.

[H. Hunter Handsfield, M.D.]

You had a Jarisch-Herxheimer reaction.  I could copy your message to teach medical students about the classic manifestations:  fever, muscle aches, chills, increased prominence of the syphilitic skin rash, etc.  (Jarhisch and Herxheimer were the docs who first described the reaction 100 years ago.)  The penicillin killed billions of syphilis bacteria within the first 1-2 hours, and those dying bugs stimulated a reaction of your immune system.  J-H reactions are uncomfortable, but not dangerous except rarely in frail or elderly persons or those with certain complications, such as syphilis of the central nervous system.  As you found, the reaction clears up in 1-3 days.  It isn't due to penicillin allergy--some docs mistakenly tell people to avoid penicillin in the future.

HHH, MD

[perhan6113]

Thank you for your confirmation.  Yes, I have secondary syphilis.  I received two penicillin shots from the health department this past Friday at 2:00 pm.  Two hours later I experienced horrible, teeth chattering chills for almost an hour.  They were so bad that I literally had to go outside and sit in the 100-degree heat to get them to stop.  They eventually did.  Then by 7:00 pm I my rash tripled itself.  I had spots everywhere.  The good news is that there was no fever.  The next morning the rash returned to its normal state.  Almost 72 hours later now and I feel much better.  My strength has returned and my head has stopped itching.  I still have the rash (day 22) but it is slowly disappearing.  In fact, when I lay down it diminishes by 50-percent.  The results of the HIV test are still not back from the state lab.  I remain optimistic, but still worried.

[H. Hunter Handsfield, M.D.]

Based on your symptoms, you probably have the secondary stage of syphilis.  Statistically, that definitely raises the odds of also having HIV.  Still, most people with syphilis don't have HIV.

Assuming you indeed have secondary syphilis, be sure you are treated properly; if your own doc is not very experienced with the disease, consider getting a second evaluation from an infectious diseases specialist or from your local health department STD clinic.  Don't mess with this disease.

Also make sure the health department knows who your college partner is (as well as anybody else you have had sex with in the past 3-6 months); they will need treatment as well.

[brandy 57]

Perhan, keep us updated on your results

[perhan6113]

I took your advice and located a doctor in a neighboring town who examined me and ordered blood work to be done in order to isolate the infection.  Half of the results came back this morning.  I tested negative for hepatitis, but positive for syphilis.  The doctor asked that I return to his office to get a penicillin shot.  In the meantime, the results for the HIV test won't be in until tomorrow afternoon at the earliest.  So, my question is this:  since I've tested positive for syphilis, what is the likelihood that I'll test positive for HIV as well?

[H. Hunter Handsfield, M.D.]

Sorry, I do not examine posted photos.  To my thinking, it comes to close to practicing medicine from a distance.  I'll just say that having only a rash, without other symptoms, is strong evidence against HIV.  Just about everyone with acute HIV infection with rash also has fever, multiple enlarged lymph nodes, and other symptoms--not just tiredness.  There are innumerable potential causes of measles-like rashes, and you didn't necessarily catch it from the partner you describe.

Some rashes can be signs of serious health problems.  Regardless of your HIV concerns, it is a BIG mistake to be trying to figure this out on your own, with self-directed HIV testing, or with distant online advice from me or anyone else.  Go to your primary care provider, small community or not; as I said, this isn't necessarily related in any way to your wild weekend.  Or go to the next town over and find another provider.  One way or the other, see someone right away.

Good luck--  HHH, MD