[Question #1013] don't know where to turn.

scaredtodeath
49 months ago
I'm in my 40s and married.  2 weeks ago, I presented to my doctor with a rash on my lower leg (next to my kneecap) She immediately gave a Dx of shingles but decided to culture.  I called for a follow up & she told me it wasn't shingles  but was herpes (she didn't say what type)& ordered a full STD panel & HIV test.  I went to the lab & got all tests done with the exception of the HIV-because I live somewhere that a + result would mean reporting to public health.  I know it's the responsible thing to do to get tested-I have participated in unprotected sex in the late 90's, early 2000s. So I've just purchased an online HIV kit and had to jump through some hoops to get it sent to me here discreetly.  My question(s) are-wouldn't I be in full blown AIDS by now based on my history?   wouldn't I be experiencing OI's?  On top of this, I'm distraught and only come out of the bedroom to toilet & microwave something.  I'm off my anxiety  meds 1 month now. I have no one to talk to, don't know where to turn.  If I do end up +, the guilt would be too much (my partner is a great guy)-should I suck it up & go to the lab & get the nominal test knowing I'll be shamed out of my life the way it is now?  
Edward W. Hook M.D.
Edward W. Hook M.D.
49 months ago
Welcome to our Forum.  I'll try to help.  Before we talk about HIV let me comment on your herpes diagnosis.  Could you describe the rash a bit more in terms of location, number of lesions, how they changed over time, etc.  the reason I ask is that while HSV-1 or -2  can resemble shingle (it is related - herpes zoster virus is the virus that causes shingles) lesions on the knee are quite unusual.  I would also ask you Dr. what type of virus was isolated.  More information may help.

Second, if you have HSV, this is not a particularly big deal. While I am not sure where you are located, in the U.S. About 1 in 8 adults has HSV-2, the virus most associated with genital herpes and over half of adults have HSV-1, the. Iris that. A uses virtually all cold sores and a proportion of genital herpes.  Although the infection is common, most people who have these viruses do not know it.  Having your infection diagnosed (whatever virus is causing it), has more to do with ( good or bad) luck than anything else.

Finally, I am not sure how you made the leap from having a herpes virus infection of some type to having HIV.  Herpes virus infections are common and HIV is not. Unless your experiences 20 years ago were quite extraordinary.  Further, as you point out, if you has acquired HIV 20 years ago, you would almost certainly have Clinical AIDs by now and you do not.  Thus testing, whether a home test or at a clinic will almost certainly only provide you with reassuring information.

I hope these comments are helpful to you.  EWH

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scaredtodeath
49 months ago
Honestly I should've pressed the doctor more  for the culture results but was very upset with her about ordering every single STD test in the world (although good protocol? This doctor is very young-so I did talk to her re: bedside manner and making patients upset)  My rash was approximately 3 inches in diameter, lesions-about 6-8, blister type.  It felt like a burn and itched a bit-noticed it after a meeting. I originally thought it was a spider bite.There are 2 specific things that happened the week I got this rash.  First, the Tuesday of the week I noticed, I went to a VERY dirty warehouse for work and cleaned out a storage unit (capri pants, open toed shoes, bare hands, etc).  Secondly, the Thursday evening of the week I noticed (Friday afternoon the rash appeared), I got lip injections (and they hurt a lot, never doing that again-I know certain products can trigger herpetic reactions but Ive only seen that at point of trauma/injection). Friday afternoon, the rash appeared. That was an incredibly stressful week at work.  Went to the doctor Saturday morning, started anti-virals and prednisone for 1 week.  Rash was dried up the next Wednesday, crusted off and left me with a small scar. my younger sister gets shingles constantly (she lives in the US)-and has had it 4 times.  Mother has never had it, don't know about Father-haven't seen him in over 20 years.   You're right, HSV dx wouldn't bother me.  My fear/paranoia comes from the HIV test. I've had 2 in the past, 1 when I was in the military (negative) and one when I got married (8 years ago) and to come to the country I live in now (negative).  Or I could just feel guilty about my past?  Ever since I got the rash, I've been sleeping in the spare room. too afraid I could pass something on to my husband.  My only other 'nagging worry' is that I now have a sore throat but am (possibly) attributing this to being in the country over the weekend-no plaques or anything strange on the tongue or the back of the throat.  I also have been waking up very early in the a.m. (since rash appeared) with night sweats but nothing severe, no bed soaking just sweaty.  no fever either.  Experiences back then? Not extraordinary-just unprotected.  My other experience that could potentially worry me was over 10 years ago -again, unprotected but I didn't know a lot about that person's history.  thanks.
Edward W. Hook M.D.
Edward W. Hook M.D.
49 months ago

Thanks for the additional information.  The rash you describe could be HSV but the location is certainly unusual.  I would add that the time course, healing in just 4 days is more suggestive of a recurrence than a first episode of HSV.  Give the unusual nature of all that is going on, it would be nice to know what type of virus caused it.  This is one of the few situations where, if you cannot get more information about the culture result from your doctor, it may be helpful to get a type specific, IgG (not IgM!!!!) blood test for HSV.  Irrespective however, I see no reason for you to not be sleeping with your husband  

As far as HIV is concerned, if you had a negative blood test 8 years ago and have not had partners other than your husband (or for that matter, even if you may have had another partner since your last test), I am confident that an HIV blood test would still be negative.  Your symptoms are far more consistent with  anxiety =/- a little bit of what sounds like misplaced guilt than anything else.  EWH

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scaredtodeath
49 months ago
Dr. Hook -so because I'm a 'take charge kind of gal', I drove myself down to the clinic and picked up my results-all of them actually.  All the bloodwork that I had done was THERE!  My culture result (Varicella Zoster Virus Shell Vial Culture) was 'Herpes simplex 2 virus isolated'  -interesting (and somewhat relieving at the same time).  My HIV1/2 Ag/Ab screen was no reactive with no HIV p24 antigen and no antibodies detected.  Also negative for HepB, HepC, Syphillis, Gonorrhea,Chlamydia.  So I am taking a huge sigh (for now) but wonder.....where did the HSV 2 on my leg come from? you nailed the anxiety/guilt -so I'll be addressing that separately (in the form of counselling and getting back on my anti-anxiety meds).  I'll assume from your last response and my results, I do not have to take another HIV test?  
Edward W. Hook M.D.
Edward W. Hook M.D.
49 months ago

Thanks for your follow-up.  You did all the right things.  You now know that you have HSV-2 on your leg.  Still not something to worry about.  Since HSV is transmitted through direct contact, you may have acquired this infection through contact with a partner's genitals at some time in the past.  You may never know where it came from.  The good news is that you now know about the infection and should a lesion occur in the future, you know that the occurrence can be managed with antiviral therapy of the sort you took and which will reduce infectivity and shorten the duration of lesions (but not prevent future recurrence).

With respect to HIV, you are out of the woods,.  No reason for concern, no reason for future testing.

This is my third response to you questions and, as a result, this thread will be closed in a few hours,.  If you have additional questions, you will need to start a new thread.  Take care- I think you are approaching things in just the right way.  EWH



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