Exposure and symptoms

[Ofsoworried]

Hi doctor
I am male,  In early February i met a lady in a bar we ended up having sex I gave her oral, and she did the same. I inserted my penis once without a condom and panicked pulled out.... I subsequently found out she is a working girl. (S.EAsia! Where I am based)

On 15 march I had a heavy drinking night with my friends mixed drinks wine whiskey, vodka, beer.. Even a few cigars. The following day of course a bad hangover. But also a rash on my face, raised red around chin under lips but mainly on my cheeks and forehead. Not spotty just raised and red, I felt extremely tired for two days thereafter and extremely weird, not felt that bad.  The rash subsided, but I have general aches and pains since, in my left base of neck and left arm. No swollen glands, no headaches, no vomiting or loose stools. Usual tiredness but no fever.  Took anti-histamine and it went down but still visible.
Some history on the rash, I have had it before every year, and doctors can find no root cause it does not really resemble butterfly rash... but this was the first time it was so intense, not itchy as I say afterwards felt so fatigued, never like that!!.

No fever or night sweats, flu symptoms, or swollen glands anywhere.. Oh felt a twinge in my groin and hot right testicle, but that is it.  I did have I pain right side lower back for about a week 18th to 20th,  thought I had trapped a nerve but doctor gave a clear after an x- Ray. No pain since.
Anyway the aches and pains left side of neck and arm persist and are Uncomfortable not painful.now 28th march. Even had ache in my armpit but no swollen glands, just ache and stiff neck (left side)
Face Rash returned 27th not so prominent and again anti-histamine tablets  and it has subsided, still there but so really visible.

Sleeping ok...

I have not been drinking and have stopped smoking since the 16th March because felt so bad after my night out

Welcome your advice
Thanks
Worried

[Edward W Hook, MD]

I cannot make more precise recommendations beyond what I've already said.  Both beyond the scope of this Forum and inappropriate without the opportunity to examine you.  Sorry.  EWH

[Ofsoworried]

Dear doctor thanks anyway
If you can see nothing that poses an immediate concern, my concerns was really related to the wbc and neutrophil which are high and may suggest bacterial infection.
But wondering if other resultant CBC data is demed low and could indicate potentially something more serious.

I have 4 weeks working before can follow up with a doctor, and therefore just seeking some assurance that results do no seem over concerning.

Thanks

[Edward W Hook, MD]

There's not much I can say from these labs. Clearly you do not have HIV, acute hepatitis B or syphilis from the exposure you describe.  To sort out your continuuing symptoms you need to be examined by a trained clinician.  Since your symptoms appear to be improving this may not be emergent or a major concern but again,. This is nothing more than an educated guess made without the benefit of an examination.  EWH

[Ofsoworried]

My neck has reduced but still aches intermittently under jaw line and left and right.
Would very much welcome advice on results as I cannot see a doctor for another 4 weeks and had to undertake some teasing separately. I realize for my blood work need to consider all elements to make an informed decision whether normal or not. Therefore al results below, thank you in anticipation of your guidance.

HIV, VDRL, HBS ag all non-reactive
Exercise stress normal
Cholesterol high hdl 33 low and LDL 197  high
Chol HDL  7.4 high
LDL /HDL 6.0 high
Fatty liver (had for 4 years)
SGPT 88  high
Mch 31.2 norm
Mchc 36.5 high
RBC normochromic normocytic RBC

WBC 11.63 high
Neutrophil 70.8%  and 8.23 high
Lymphocyte 23% and 2.67 norm
Monocyte 5.9% and 0.69 (border limit)
Eas 0.2% 'and 0.02
Basophil 0.1% and 0.01
Platelet count 196
MVP 10.3
Platelet smear adequate
ANA screening negative

Look forward to you advice
Thanks

[Edward W Hook, MD]

Glad I could help.  I'm afraind I cannot answer your question about the causes of other symptoms. To do that required I complete histor ad physical examination as  starting point.  It sounds like you may be going in that direction with your company doctor.  Take care. EWH

[Ofsoworried]

Thank you ...put my thoughts a rest, I am due a full medical next month which includes blood work HiV, HPV etc..

How about the aches and pains stiff neck and shoulders ... persist without swollen glands and the rash, and the immediate tiredness (worse ever felt, like I was not me!!... if that makes sense) could these be allergy related? Oh I had white tongue but have been using electronic ciggerates....

Company doctor mentioned LSE and maybe ANA test profile.

Also local doctor prescribed antibiotics a week ago, Zithromax

[Edward W Hook, MD]

Welcome to our Forum. Following a single exposure to a sex partner of unknown status there is some risk for acquiring HIV and a higher risk for acquiring other STIs such as chlamydia but fortunately that risk is quite low.  Most CSWs (in Thailand and elsewhere) do not have HIV or STIs and most transmissions do not lead to infection.  Your major risk is from your vaginal penetration, even though that was brief and IF she was infected with HIV (unlikely) the average risk for infection is less than 1 infection per 1000 exposures (your risk is, if anything lower than average given the brevity of exposure).   The risk form your receipt or giving oral sex is lower still.

As for the rash and other symptoms you mention, there is little chance that they are in any way related to the exposure you describe.  Your rash has occurred before this making it unrelated and your other symptoms are quite unrelated and are just the sorts of things folks tend o notice when they take inventory and are on increased alert for possible symptoms of STI.  Thy are non-specific however and there is very little chance they are a manifestation of HIV or any other STI.

My advice is to go and get checked.,   At this time a DUO (4th generation, combination HIV p24 antigen/HIV antibody) test will provide conclusive results to allow you to prove that you did not get HIV.  At the same time, I suggest you also get a urine test for other STIs such as chlamydia so you can go forward with a clean bill of health. In the interim however I would not worry.

I hope these comments are helpful. EWH