Concerened about HIV/ To Dr. HHH

[samsclub77]

30 y/o Heterosexual, Male, North east Tn. I have had multiple sexual partners (6-7) X 1 yr. Mostly random women/ escorts, I wasnt sure of the HIV status. I have always used protection ( latex condoms ), vaginal & oral sex only, with lubricants. Condoms have remained intact, always checked them after. No h/o drug use. Have chronic sinusitis. Had flu like illness with fatigue in Dec, requring Abx, Levofloxacin X5 days, which left me drained, with chronic fatigue lasting months. I have a very busy schedule at work, with months where I work from 5am to 5pm.
Was have lower urinary burning & frequency for 10-15 days in May this year, when I got a UA/Chlamydia/Gon, all negative was given bactrim, which helped but lead to a maculopapular rash on my back. Had a sinus infection in the mean time X 1 week, f/b, evening rise of Fevers (Max 102) X 3-4 days, with riggors, was given Kayflex, & the next day lead to a itchy rash involving back, Palm & sole. I had never taken Kayflex before. Got CBC, BMP, RPR, MONOSPOT, HIV ELISA. CBC sig for WBC 12, with slight monocytosis, else fine. All other tests normal. Rx Levofloxacin which resolved symptoms in the nxt 2-3 days. Also had sore throat, severe sinusitis at that time. Rash resolved in 12 days with antihistanamics & on holding kayflex. Physical was wnl.
Physician told me could be mononucleosis. I am a health professional, with no needle stick etc.
My Q: Considering my sexual history, recent symtopms, especially the palm & sole rash, pharyngitis etc, do you think I shd get a HIV Dna test? My last sexual exposure was Mid of May which was followed by my symptoms of pharyngitis & fevers. I have had 4 HIV antibody tests in the last 1 year, all Non reactive.
Q: Does Condom protected sex, with high risk partners ( we dont know the sexual status ),put you at risk for HIV? Have you seen any cases who acquired HIV or other STds with protected sex? In general how would you assess my situation? I would be happy to provide details.

[Edward W Hook, MD]

I'm sorry that you are continuing to have discomfort.  I cannot tell you what this might be other than to be confident that it is not an STD.  Sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned.  This in turn leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times.  Perhaps this is a contributor.

Alternatively, perhaps this is the Chronic Pelvic Pain Syndrome (CPPS), a recently recognized syndrome of unknown etiology.  You can find a good description of CPPS on Wikipedia.

At this time, know that this is not an STD, it is time for this thread to end.  I suggest you continue to work with your own doctor to address other possible causes.  

Take care. EWH

[shaken2core]

This sounds like urethritis which is what I have.  

[samsclub77]

Thanks Dr. Hook. I had one more question. I have had some lower urinary discomfort ( burning ), tip of penis off and on since about a month. It stops whenever I am on antibiotics & then comes back a week after I have completed a course. I think it also precipitated by sexual activity at times. I have had 2 UAs & workup for chlamydia and Gonn negative.
I dont see any signs of trauma. I fail to understand what might be causing this?

[Edward W Hook, MD]

Mono tests, as well as CMV and EBV antibodies may not be positive throughout.  I really do not think you need to test.  You have ruled out HIV. what woud you do if you had + EBV or CMV.  

Yes, drug rash can involve palms and soles and if this had been syphilis your RPR would have been positve.  Same for HIV.

There are many studies which evaluated HIV in CSWs.  In the U.S., unless the CSW is a drug user, the figure is consistently less than 10% and usually less than 5%.

EWH

[samsclub77]

Thanks you so much for your response.
I went to urgent care for most of my labs. The family practice physician, advised me further serologic tests regards mononucleosis, for EBV/CMV, as the monospot test could be nagative with those. What is your advise on that? Do you think it would change the plan even if I were to be positive for them.
I do believe my rash to be drug induced as they came the very next day I took the medications. I was more worried about the distribution being palm & sole. Would drug rashes involve those areas?
I have also read physicians missing HIV as a diagnosis with similar complaints.Just to be sure, would you advise a repeat HIV Elisa in the next 2-3 months as my last exposure was around May 15th, followed by my sickness in later that month, when I was tested for HIV.
I have read quite a few of your posts stating that most CSWs are not HIV positive. How can you be so sure of that?
I have had fatigue & malaise symptoms for a while now, but its partly to my mono & my work schedule.
Thanks again.

[Edward W Hook, MD]

Welcome to the Forum.  Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.  I'll be pleased to address your questions.  Before I do however, a few important points.  The sorts of exposures you describe do not put you at risk for HIV.  Despite the fact that your recent sex partners have been commercial sex workers, the fact is that most CSWs do not have HIV.  Even if one of them did, your risk for HIV would be low if your exposures were unprotected, the average risk of getting HIV if one has unprotected sex with an infected partner being less than 1 in 1000.  In your own case, condoms were used correctly, consistently and without breakage making this safe, virtually no risk sex.  Thus, from your report of exposures, I see no reason for concern that you might have acquired HIV from the exposures you describe.  

Q1.  No, a HIV PCR ( DNA) test i would be a waste of time and money. the PCR tests may be helpful in detecting very early HIV but how much help is unknown. Virtually everyone who acquired HIV will have a positive antibody test within 8 weeks of exposure.  Your negative antibody tests are proof that you did not get infected through your no risk exposures.

Q2.  No, consistent and correct condom use is protective against HIV, even if your partners did happen to be infected with HIV.

Bottom line, it sounds like you've had some bad luck. manifested as drug reactions and mono in the recent past but I see no reason for you to be worried about HIV.  I hope my s are helpful to you.  EWH

[samsclub77]

Sorry for the error: rash resolved in 2-3 days on holding Kflex, on loratidine & ranitidine. Took a few days off work as well. In general have lost 5-6 lbs over the last 6months, some anorexia off & on, but I am working more than ever since the last 1 year.
Iam majorly worried because of my sexual practices, recent episode of fevers & rash, which ould have been mono, but acute HIV could have been a possibility. As already said sex has beeen protected.