An urgent question for Dr. Hook or Dr. Hansfield

[naraj]

From 2001 - Feb, 2004, I had protected & unprotected sex w/ appr. 35 African-American women, unprotected oral sex with almost all of them, and 2 that were on their period.  Many of them were strippers, crack-smokers, or very promiscous.  No needle-users as far as I know, but I didn't know many of them, so I can't be sure about their HIV statuses.  I slept with some of them many times, some only once.  I had 1 live-in girlfiend during all of that time, with whom I had unprotected sex with every day, but we haven't slept together since Dec, 2003.  I took an HIV test in Mar, 2003 and she took an HIV test 2 years ago and they were negative.  I had protected and unprotected sex, and always unprotected oral sex with 2 -3 women between Dec, 2003 - Feb, 2004, and 2 - 3 women between Apr, 2007 - Jun, 2007, most of whom were promiscous inner-city women.  Between 5 - 8 months ago, the lymph glands under my arms swelled up 2 - 3 times for the only times I remember, though I had no apparent infection.  I asked my Dr. about it afterward, but he said it was probably nothing.  6 weeks ago, I had unprotected oral sex many times, unprotected anal sex twice, and protected vaginal sex once, with an African woman, in a country where the HIV rate is around 4 - 6%.  She had sex only 1 time prior to me, 2 - 3 years ago.  2 weeks ago, I got an oval area of what my doctor told me was folliculitis on my back.  It consisted of 8 - 9 large acne-like bumps in a 2" x 4" oval area, which was also very itchy and red.  It has since almost disappeared.  I've never had folliculitis before, but I've always had acne and seborrheic dermatitis since I was a teenager.  I have colds, sore throats, fever, etc, occasionally, but nothing unusual.  Does that type of folliculitis or lymph swelling sound HIV related, and what are my statistical odds of now being HIV positive?

[naraj]

Sorry.  Thanks.  Do you mean the HIV Prevention community forum?  Can I ask doctors questions there?

[H. Hunter Handsfield, M.D.]

I cannot comment on the odds you are infected with either HIV or any other STD.  Just get tested.  Most people with HIV survive many years, but it depends a lot on how long someone has been infected and the status of his or her immune system when treatment is started.  So I can make no prediction of your prognosis if you are infected.

This thread should have been in the HIV forum.  MNormally such questions are deleted without response, but it was my fault in replying before I noticed.  However, no further discussion will be permitted.

[naraj]

Thanks, doc.  I definitely have finally completely stopped my stupid behavior.  Even though I obviously did some high-risk things, I've read here in the forums you telling other people that even if they slept with an HIV-positive person, statistically, the odds are very low they would receive it.  I take it you think my risk is much higher than that.  Why, because of the amount of times involved?  Are my odds greater than 5% that I have it?  Could I have those other STDs with no symptoms, or is that unlikely?  I've decided to get an HIV test immediately, but please give me my odds in the meanwhile.  Thanks for the help, and sorry for being so stupid, I just recently learned you can get HIV from oral and anal sex, but I won't be doing any risky things again.  I hope I'm not too late to change my life.  If I turn out to be HIV positive, how long could I expect to live a normal life if I take the medicine?

[H. Hunter Handsfield, M.D.]

You describe a sexual lifestyle that certainly has put you at risk for HIV and other STDs.  You obviously were not infected during the most "busy" time of your sex life in 2001-2003, as shown by the negative HIV tests about 5 years ago.  However, if I correctly understand the rest of your message, you haven't been tested recently.  Even though your sexual exposures more often were condom protected in more recent years, the nature of your partners and the overall circumstances suggests a pretty good chance you could have been exposed.  Your symptoms don't give a clue one way or th other.  The acne-like bumps, folliculitis, and so on don't sound like anything related to HIV; and when HIV causes lymph node enlargements, they are more widespread than you describe -- i.e. occuring in many areas of hte body at once, not just a lump here and there.

You definitely need HIV testing.  Statistically, the odds are it will be negative.  But there seems at least a fair chance you could be infected.  If so, you need to know it as soon as possible in order to start life-saving treatment,  You should also be tested for the common STDs, like gonorrhea, chlamydia, syphilis, and perhaps HSV (the cause of genital herpes).

Finally, it's time to get serious about safe sex.  If you haven't caught HIV yet, there is a good chance it is in your future unless and until you start getting more cautious in your choice of sex partners and consistent condomn use.

Best wishes--  HHH, MD