HIV Concern

[johnsmith04201948]

Hello Doctor,

I am a Uncircumcised man. On Aug 31st during my business trip to India, I had unprotected vaginal sex with a CSW. The girl was from Russian federation countries (from Turkmenistan).

I came back to US on September 10th. On September 12th I developed a scratchy throat (NO Fever, No runny nose, NO Sore throat), it was like a post nasal drip and little fatigue but no fever at all but some feverish feeling. I felt the same for 13th and 14th and 15th -- fatigue, very very light cough and some feverish feeling but no fever (max fever was 98.9 F). Still no fever. On 15th I also developed very light unproductive cough and started producing some yellow color Phlegm but very little.

On 16th I was okay and last evening on 18th I finally visited doctor. Doctor prescribed me 7 day course of Amoxillyn and gave me 1200 mg Mucinex D. As per doctor it can be a mild bacterial sinus or bronchitic infection. I still have some scratchy throat and have to cough to clear the throat before speaking. I did not mention anything about my exposure to the doctor.

I read numerous posts and read that if its a ARS I should have high fever (which I did not get) and sore throat along with rash which again I did not get. Also, I have no idea if that CSW was infected or not with HIV.

My question is do you think it was ARS and if I was your patient, will you recommend testing? Should I go for testing as being a Uncircumcised man it increase my chances to 1 in 1000 (provided she was infected which we dont know). I understand all this is based on assumption if CSW was infected.

[johnsmith04201948]

Dr. Hook,

I just wanted to post my results. I received results back yesterday (HIV antibodies test was done 47 days after exposure) and all tests were negative. Thanks for your help and time. I will repeat HIV and Syphilis test after 1 month. Thanks.

[johnsmith04201948]

Dr. Hook,

I applied Cortizone 10 cream on the area which was red and redness is almost hone with in 24 hours. Thanks.

[johnsmith04201948]

Thanks Doctor. No further questions. I will just come back to post the results. Thanks again.

[johnsmith04201948]

Also, this rash / redness happened 40 days after exposure.

[Edward W Hook, MD]

Fianl answer.  All further questions will be deleted without comment.  

This does not sound like HSV or syphilis.  You may be traumatizing yourself with your repetetitive self-examination.  You need to keep you hands off of your penis and stop worrying.  EWH

[johnsmith04201948]

Dr. Hook,

I am still waiting for results. I wanted to ask one more question. I know its a anxiety driven question. Will really appreciate if you choose to answer.

The red patch has decreased in area and size but still there in the skin on one side of penis below the shaft, when I pull my foreskin all the way back. I still do not see any sore or open mouth ulcer but its still very red and dry. I can see red lines and I think its little swollen too. Still no bumps. I am checking it after every 30 minutes and some times it seems its reducing in size but next time looks the same. Its very very red like a patch of red rash. Does Syphilis or Herpes causes open mouth sores or lesions only? I checked on google images for pictures of Syphilis lesion which I think looks more like a open mouth like sore. Mine is more of a red dry swollen rash spread on a skin below the shaft but no open skin or wet ulcer or bump. Does this change your assessment? Thank you so much. I promise no more questions till I get my results back.

[johnsmith04201948]

Thank you, Dr. Hook. Your comments are very reassuring. I will post my results next week once I get them.

Thanks. R.

[Edward W Hook, MD]

Redness of the sort you decribe is not suggestive of any STI. If you had syphilis or herpes, the redness would quickly become sores or lesions.  The relationship of the redness to your recent masturbation makes this the most likely cause of the redness.    

Time for this thread to end and for you to stop worrying. I am confident your test results will be negative. EWH

[johnsmith04201948]

Dr. Hook,

I went for testing today at Labcorp for full panel std test. I could not go earlier as I was travelling. My doctor will call me for appointment once they receive the results as they do not give out std results on phone as a policy.

In the meantime, last night I noticed a redness on my penis. Its a red patch starting at edge of penis shaft and ending on the under skin. Its a big patch, very red, No bumps or sores or blisters and no itching but very red spread over the under skin. I can see when I pull back my foreskin that its very red. I am now dying with anxiety what it can be as I will not get my results back till next week. I noticed  it last night while urinating. Also, I masturbated last night 1 hour before I noticed the red patch. after 16 hours its still there. Can it be primary syphilis or herpes breakout?

[Edward W Hook, MD]

If you had gonorrhea, which I am confident you do not, the amoxicillin might make the test negative.  As i said before, I would not worry.  EWH

[johnsmith04201948]

Also, one more thing...I have no symptoms like painful urination or discharge from penis.

[johnsmith04201948]

I am going for testing tomorrow. One question before testing - as I mentioned in my first post that doctor prescribed me amoxicillin (875mg) for 7 days. I am taking that since Thursday morning twice a day. So when I give my urine or blood sample tomorrow, I would have taken 9 tablets of 875 mg of amoxicillin.
is there any chance that it can influence test results for bacterial infections?

[Edward W Hook, MD]

This is a decision you will have to make, Your risk for infection is low but not zero.  Your risk for HIV is less than a small fraction of 1%.  Your risk fo other STIs is a little higher but still les than 1%.  EWH

[johnsmith04201948]

Should I wait to resume normal sexual activity with my spouse till I get test results. The reason I am asking this question is we are trying to plan for our second child and next 2-3 days are important. Or its okay to resume?

Thanks in advance.

[Edward W Hook, MD]

Estimates of what proporton of patients develop ARS vary but most experts feel it occurs in less than half of persons who acquire HIV. EWH

[johnsmith04201948]

Doctor,

I will go for the testing tomorrow and post my results. One last question - in your opinion or as per the studies conducted on ARS -

What percentage of newly infected HIV patients develop ARS?

[Edward W Hook, MD]

Thanks for your question and thanks for your reading to inform yourself following this exposure.  I think you have things right.  You are correct that if your partner had HIV, your risk for infection is a bit higher than if you were not circumcised with the right magnitude of risk- IF she is infected (unlikely) being about 1 in 1000.  The symptoms you describe do not match well with the ARS for all of the reasons you mention as well and are more compatible with the sort of upper respiratory tract infection many people get after air travel than ARS. The absence of high fever, severe muscle and joint aches, diarrhea and rash all make the ARS not a consideration.  further, cough is not part of the ARS.

That said, testing, not only for HIV but for other, far more common STIs like chlamydia is reasonable following unprotected sex with a CSW in India.  Screening for other STIs can be done at this time and testing for HIV with a combination p24 antigen/HIV antibody test at 28 days will be conclusive for HIV.  In the meantime, I would not worry, your risk for infection is quite low.

I hope these comments are helpful. EWH