Cotton wool spot Part 2

[Swat_valley]

Dear Dr

Few months ago, I asked you about the finding of a possible retinal cotton wool spot by an opthalmologist on 11 July 08. I was seen by two other opthalmologists (one saw me on 27 June o8) and the other saw me on 25 June 08 and then on 23 July 08 (i.e. after the finding of cotton woll spot by the 3rd opthalmologist and he specifically looked for cotton wool spot, but he did not find any and told me that it has disappeared (he was seeing me as a follow up patient as the cotton wool spot was seen by the other opthalmologist).

I read on internet and found that HIV can cause a cotton wool spot(s). I had multiple exposures (protected intercourse but unprotected oral both ways) mainly with female escorts.

The eye finding was on 11 July 08 and I had a negative finger stick whole blood HIV1/2 rapid test (recognised test in the UK).
Sadly I had another exposure on 18 Aug 08 with a female escort in terms of protected intercourse but unprotected oral (she gave me oral).

I had another negative HIV1/2 rapid finger stick whole blood test (recognised in the UK) on 11 Nov 08, which was >17 weeks after that possible eye finding and >12 weeks (85 days) post last exposure.

Atl least 25 days before the test (about 2 months post last exposure), I started having quite itchy severe red flat and bumpy chest rash. It lasted at least all those 25 days prior to the test (with variable intensity) and was present even on the day of my test on 11 Nov 08.

I still get worried about that possible cotton wool spot (internet says a lot about HIV and cotton wool spots) and then development of chest rash, which is still present until today, but significantly improved since I started taking antihistamine and applying E45 itch creame one day before the test.

Will you advise any further HIV test, especially considering the onset of rash? I have said good bye to escorts from 18 Aug 08.

Thanks.

[Edward W Hook, MD]

Last time.  Believe the tests.  No further testing is needed.  EWH

[Swat_valley]

Sorry to bother you again, but I will NOT ask any further questions.

My exposures were multiple protected intercourse BUT multiple unprotected oral both ways with female escorts, BUT the last exposure 85 days before the HIV1/2 rapid blood test on was protected intercourse BUT UNPROTECTED oral sex with a female escort (she gave me).

My last question is that considering UNPROTECTED oral sex, would you maintain your statement?

Thanks ( and I really mean that I will NOT ask further question)

[Swat_valley]

Thank you very much.

[Edward W Hook, MD]

Your fixation on the supposed cotton wool spot which only one person MAY have seen is remarkable to me.  As we have discussed, your exposures have been protected and therefore low risk and you have repeatedly tested negative for HIV, most recently 12 weeks after your last exposure to a CSW. That is a time when virtually all HIV tests would be expected to be positive.  There is NO evidence whatsoever that you have HIV.  One doctor MAY have (and thus may not have) seen a finding which is non-specific and associated with MANY processes including HIV.  It is time for you to stop worrying about HIV.  In fact it is far past that time.

As for your rash, it is not due to HIV from any of the exposures you describe.  Your tests prove this.  Please, get over your concerns about HIV- you do not have it.  You do not need any more testing for the exposures you have described.  EWH