hiv?

[thanksforyourhelp123]

hello,
i had one encounter with a sex worker who i believe recently was diagnosed as positive with hiv. she had a noticible rash around her mouth and i had a small cut on my penis. She gave me  fellatio unprotected, and we had brief vaginal sex with a condom. i did not ejaculate in her mouth. i felt a slight painful  sensation 2 hrs after the encounter. I began to get worried, and 3 days later i noticed two blisters on my penis. i was then tested for herpes (blood, culture) , gon.., chyl..., and syphillis and they all came back negative. they put me on 7 days of valtrex just in case. After two weeks or so the blisters on my penis slowly turned into a red rash on my penis head that resembles contact darmatits, and this rash is still present after 18 days.  the rash is on the head of my penis. i went to a dr. again yesterday, and he thought my spleen may be enlarged but he was not 100% because i am very skinny and muscular. So, he wanted me to come back next week for a sonogram of my liver. I have no other noticeable symptons at this time( again, 18 days since contact)

i have been very anxious since my encounter with the sex worker.

thoughts for probability of HIV? thank you

[Edward W Hook, MD]

Welcome to our Forum.  I wonder why you think you partner was recently diagnosed with HIV?

The exposure you describe is not an exposure associated with known risks for HIV. Condom protected sex is safe sex, virtually eliminating the 1 in 1000 change of acquiring HIV that occurs from unprotected sex with an HIV infected partner. There are no known cases in which someone has acquired HIV from receipt of unprotected fellatio.  Thus there is no known risk from the exposure you describe.

The appearance of blisters on your penis 3 days following your exposure is worrisome for herpes and the rash on her mouth adds to the worry about this possibility.  Your negative cultures make this diagnosis less likely but do not totally rule out the possibility of HSV.  The residual red marks you mention sound like the normal health process.  If the rash or blisters recur I suggest a repeat culture or, better yet, a PCR test.    

Isolated splenomegaly from recently acquired HIV would also be unusual.

My advice- try not to worry.  See if you can arrange for testing with a combined HIV p24 antigen/HIV antibody test (these are sometimes called "DUO" or "combo" tests) at 4 weeks,  If this result is negative, you can be confident that you do not have HIV.

I hope these comments are helpful. EWH

[Edward W Hook, MD]

Hepatitis C is not transmitted through heterosexual intercourse with any meaningful frequency.  EWH

[thanksforyourhelp123]

Okay, thanks. Only lingering pain is in my abdomen. Could Hepatitis C or any other virus be a possibility?

[Edward W Hook, MD]

Your risk, as I said earlier, was low to start with. You have now spent money that you did not need to spend to gather evidence which supports what I have already told you.  There was no medical reason for testing to start with.  Nor is there any reason for further testing.  EWH

[thanksforyourhelp123]

Thanks, I was experiencing terrible symptoms (rash, sore throat, muscle and joint pains, stomach pains, could not focus etc), which i thought were from acute HIV. So, I decided to pay a lot of money, and get tested at day 21 with two PCR tests while I was experiencing those symptoms.

Result was negative.  How would you quantify the accuracy of these results? If my symptoms really were from acute HIV would the test have been positive? Any reason for further tests?

Thanks

[Edward W Hook, MD]

I suggest testing only for the peace of mind that it would give you- your questions sounded a bit worried.  I didn't mean to imply anything else.  

There is no reason to stop your work outs related to this exposure.  EWH

[thanksforyourhelp123]

Thanks, very helpful.

She told me that she has been in and out of the hospital recently and has been very tired. She told me it is due to a  heart problem but I do not believe her since she is only 21 etc..

Why do you think I should get tested if my exposures are not associated with HIV?

I lift heavy weights at the gym . Can I continue to do this?

Thank You.