Risk Assessment

[illuminate]

Hi Doc,

I had several instances of unprotected oral sex (receiving) from 2 different CSW’s in India on a single day which were lengthy and rough in duration

Day 3:  Took a 3 day course of 2 gms Azithromycin and 600 mg cefixime daily as prophylaxis
Day 4:  Started getting severe upper back pains, stiff lower back, tender/painful muscles in shoulders, and arthralgia in right hand.  In addition, just did not feel well at different times throughout the day.  All this lasted about a week.
Day 9:  Woke up to find a red rash on my chest, the size of my hand, and 3 large red papules on my neck area.  The red rash resolved by the evening (not the papules which are still there), but I’m not sure if the rash was there prior to this as I wasn’t really checking.  Also, noticed 3 nodes in my back (vertically around lower/mid back, and horizontally more towards the side) of which 2 were on the right side and 1 on the left.
Day 10:  Tender/painful shoulder still continuing along with lower back stiffness and pain.  In addition, suddenly developed a painful and tender inner right thigh and lifting my heel to my butt made it feel like it was swollen and uncomfortable.
Day 12:  Today, the inner thigh seems to be a bit better and I would say that the muscle pains are about 70% better, but back nodes and neck papules still present.

My questions:

1. I know oral sex has no risk, but something is definitely going on.  What is your assessment and do I need to test for HIV?
2. I drank quite a bit of alcohol 24 hrs. after I finished the 3 day course of antibiotics.  Would this decrease the potency in any way?  Any other potential bacterial STD that these antibiotics would not cover (even the rare ones)?
3. Is it possible to have lymph nodes in the back or could it be something else?
4. Does this rash sound like HIV?
5. Is it possible that ARS can start sooner especially considering I was partying hard without any sleep that night or next day when I had the risk?

Thx!

[H. Hunter Handsfield, M.D.]

Do not have a syphilis blood test, neither RPR nor VDRL.  The antibiotics you took would not merely delay positive results, they would have aborted syphilis, if you had been inoculated.  Therefore, your blood test would never turn positive, even if you were infected.  Testing would be a waste of money.

Given the nature of the exposure, I see no need for testing for any STD.  Just go on with your life, as if this event had never happened.  From an STD standpoint, it did not in fact happen at all.

[illuminate]

Hi. Thanks for your comments. Sorry for my late reply as I was travelling. I will get tested at the 6 week mark.

Can you pls advise the soonest I can get tested for syphilis and if the RPR or VDRL test is better?  Also, by taking the antibiotics, will it delay the test of cure for any bacterial std's?  Any other std's I should test for or am I in the clear?

Thanks!

[H. Hunter Handsfield, M.D.]

I saw these comments before I replied above. They don't change my opinion or advice.

[H. Hunter Handsfield, M.D.]

Welcome back to the forum.  I'll try to help.

You seem to be aware that oral sex is safe sex with respect to HIV.  Symptoms of the kind sometimes seen in ARS of course are among the most common symptoms experience by human beings and are caused by innumerable conditions, most of them much more common than ARS -- even in people with high risk exposures.  In any case, there is nothing in your symptoms that suggests to me that you have ARS; and I doubt they are related in any way to the sexual exposure a few days earlier, just a coincidence.

Those comments cover question 1.  To the others:

2) I would not have recommended the antibiotics, but they did no harm.  Alcohol does not reduce their potency or interfere with them in any way.

3) This seems an atypical location for enlarged lymph nodes, and other things can explain lumps under the skin.  Even if they are lymph nodes, that would not suggest HIV as the cause.

4) The rash associated with ARS always is accompanied by fever, usually quite high; and is a body-wide rash, not patchy in the way you describe.

5) Partying, poor sleep, etc can be associated with their own symptoms, but would not accelerate symptoms of ARS.  And as you imply yourself, your symptoms started much too soon to be ARS from the exposure only 3-4 days earlier.

In summary, I am quite certain you don't have HIV and your symptoms are unrelated to the sexual exposure.  The remaining question is whether or not you should be tested for HIV.  From a strictly risk assessment or medical perspective, it really isn't necessary.  However, you would not have come to this forum if you weren't nervous about the possibility, and most persons in your situation probably require more than just an expert's words to resolve all doubt.  In other words, if you find yourself continuing to be concerned about HIV despite my opinion, feel free to be tested.  This is not "code" to imply I really believe you might have it; I do not and am confident the result would be negative.

Finally, of course if your symptoms continue, see a doctor.  But I doubt they are at all related to your sexual exposures 2 weeks ago.

Best wishes--  HHH, MD

[illuminate]

Sorry for the extra comments, but am trying to add everything I remember.  Also, on day 10, I woke up at night feeling very hot and uncomfortable.  Did not seem to have a fever, but maybe a night sweat?

[illuminate]

I forgot to add, I also developed a bad case of jock itch on the left inguinal fold a few days after the exposure and it had reached the stage of having a red line with the skin cracking and having a bed smell.  I did have some discomfort/dryness (though not to this level) prior to the exposure, so I did not give it much thought.  But wanted to give you the details in case it affects your assessment in any way.