Most likely HIV?

[neilh]

Hi, about a month ago I had sex with a prostitute in my car.  It was a hot day, in the mid 90s, and it was hot in the car.  She performed oral sex and I used the same condom for vaginal sex.  I used lube on my penis but not on the outer part of the condom because she said lube plugs up her vagina and that she gets wet enough without it.  When I first penetrated her she recoiled in pain and I withdrew, which probably meant her vagina was dry/tight. I orgasmed and then forcefully pumped several more times. After I withdrew, the condom had a thin streak of blood on it and the semen was not at the tip, it was spread throughout (meaning the condom might have been compromised?).  Seeing the blood, she nonchalantly said that she was coming off her period.  We were both hot and there was probably a lot of friction because of the temperature, lack of lube, and possibly a dry/tight vagina.

A couple weeks later I noticed a single genital sore with pus just above my penis.  A week after that I noticed swollen, painless lymph nodes in the axillary, inguinal, and cervical regions.  Also, there are feelings of malaise/fatigue, mild thrush, subtle redness on my skin, loss of appetite, nausea, a low-grade fever that's off and on, sore muscles--especially the legs (and lower back for a day or two), easily chilled, and night sweats.  I took an STD test yesterday and today I took a PCR test.  The doctor I saw yesterday gave me Azithromycin and Suprax meds. in case it's chlamydia or syphilis and this morning I was feeling a little better but have gradually returned to the symptoms, which probably means the antibiotics killed off much of the bacteria that was taking advantage of my weakened immune system caused by the HIV.  What are the chances that I'm infected and are there more likely possibilities for the symptoms I'm experiencing?

[Edward W Hook, MD]

Gald to hear of results but, to be hoinest, not too suprised.  There really is no need for a 6 month test.  Any test at 8 weeks post exposure or beyond is proof that you do not have HIV.  Take care. EWH

[neilh]

DNA PCR test 25 days after exposure came back negative.  Combined with the oraquick mouth swab antibody test done 28 days after exposure, it's looking a little better, but I'm not out of the woods just yet.  Still waiting on the blood antibody test taken 24 days after exposure (ELISA, I'm guessing), as well as the syph, gonorrhea, chlamydia, and mono tests.  Also, I plan on taking another ELISA test 3 months and 6 months after exposure.

[Edward W Hook, MD]

At 4 weeks the test you had would be expected to detect over 90% of HIV infections acquired 4 weeks earlier.  More evidence that you do not have HIV.  EWH

[neilh]

I went to a local HIV center today and had an oraquick swab done in my mouth. It came back negative.  How accurate is the test at 4 weeks post exposure? Thanks, and this is the last time I'll post until I have definitive results. 

[Edward W Hook, MD]

You and I have come to different conclusions.  Most people who have molluscum do not have HIV.  In persons with HIV the infection is more aggressive bu tthat is only in persons who have had HIV for years.  I have nothing more to say.  Please let us know about your test results as they become available.  I remain confident they will be negative.  EWH

[neilh]

Hi, sorry to post again, but I just remembered something.  After starting intercourse I remember hearing a popping sound, but I thought she had just farted, and didn't think anything of it.  When I pulled out the front of the condom was not on my penis but I unrolled it and didn't inspect it.  Right now I feel 100% confident that I have HIV but have to wait until the end of the week for results.  It's scary.

[neilh]

Okay, I've pieced it all together.  The sore was molluscum contagiosum, which is quite common in people infected with HIV.  There was a dimple in the center and it itched slightly--eventually I was able to pop it.  The rash is diffuse maculopapular, and doesn't look like the characteristic syphilis rash.  The only STD that all of the symptoms (and there are many) indicate it being is HIV.  The encounter was the only time that the semen was not at the tip of the condom, and thinking back I'm almost 100% sure the tip was broken.  She was bleeding and the condom had blood on it.  She is a very active sex worker and she does anal.  I know the odds of 1 in 1000 are low, but once blood is involved it's even lower, and tens of thousands of people are infected every year.  

[Edward W Hook, MD]

No, this is no way changes my assessment or advice.  EWH

[neilh]

Thank you Dr. Hook, these forums are a wonderful resource.  The genital sore looked like it might have been molluscum contagiosum and it was at the base of the penis, not on the penis itself.  Is it possible that there was a small enough tear, even microscopic, for the virus to have entered through? The PCR test results will come in 3-5 business days.  I really hope it is syphilis but all the signs point to ARS.  

[Edward W Hook, MD]

Welcome to the forum.  Your risk for HIV from this exposure was negligible and this is not a concern.  Your condom did not fail.  When condoms fail they burst wide open.  The lesion and symptoms you describe are suggestive of multiple problems including syphilis or herpes.  Alternatively, this could be a skin infection which has coincidentally occurred at this time.   If it is syphilis, your test will be positive and you may need more therapy.  The therapy you received was recommended therapy for gonorrhea and chlamydia.

Your PCR test will almost certainly be negative. When this is the case it will be strong but not absolute proof that you did not get HIV.  You will still need an HIV antibody test 6-8 weeks after your exposure.  I anticipate that those results will be negative.  EWH