[Question #11015] Follow up to #10666

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17 months ago

Dr Handsfield, Previous question sent, had an emergency, missed follow ups, when i tried, it was closed.Paid for another in hopes of getting those follow ups, hope that's alright.I did see an eye specialist and they diagnosed dry eye. Already done their treatment,using eye drops. Has helped a bit but still the skin around the eyes can get very itchy and dry,which is getting annoying. Allergy appt Scheduled in a month. Didn't mention in first post that in the ARS window, 3 weeks post exposures stated,I did get sick with flu symptoms, sore throat, fever, congestion, aches.The fever came and went in only a day and then a small itchy rash did come just in one spot below my rip cage. isolated and was gone quickly. Thought flu and knowing congestion is not part of ARS, I moved on. Since then, that rash has come again twice, went away quite quickly both times and stays away for long periods. Did see a skin doctor, thought eczema and prescribed a cream. Rash has not been around since to apply to, so who knows. Are headaches are an HIV symptom? I seem to remember reading a case with headaches the symptom that led to diagnosis. I believe they were said to be severe almost migraine like though.  The last few weeks I've had some mild but odd head discomfort, thinking maybe stemming from a neck or tooth issue as it hasn't even been enough for me to be taking advil for. But still, a few lingering things that have me worried

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Edward W. Hook M.D.
17 months ago
Welcome back to the forum. As you know, we provide up to three responses to each clients questions or after 30 days have passed, close questions in order to keep them from accumulating and to be able to keep things current. On this occasion, I happened to pick up your follow up questions and will  be responding. In preparing to reply, I read your interaction with Dr. Handsfield two months ago and agree with all that he said. The encounters that you described were absolutely no risk for acquisition of any STI, including HIV. 

Like your previous symptoms, the symptoms you describe are non-specific and certainly do not suggest any STI. Despite the fact that they occurred during the timeframe when the ARS might occur, they are not suggestive of the ARS in any way.  The ARS is a combination of symptoms which occur at about the same time, most typically 10 to 20 days following an exposure and never more than 30 days after an encounter.  The ARS is characterized by the simultaneous presence of a severe sore throat, high fever, widespread muscle, or joint aches, sometimes accompanied by other symptoms, such as diarrhea or skin rash. Itchy eyes, transient skin rashes, and headache are nonspecific and do not suggest the ARS . 

I think that you are on the right track in seeing an allergy specialist. Itchy eyes and eczematous dermatitis are all manifestations of allergic processes. I would not worry about STI and see no reason for STI testing related to the symptoms you describe.

I hope this information is helpful. EWH.
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17 months ago
Thanks Doc and understand on the response time. I will continue with the allergy path on those two things. The headaches are more reccently occuring(1 year post stated exposures), so not ARS period, but like I said, very mild, sometimes nothing.  I will use these responses to gain further education too. I had started thinking back to any exposures other than those stated since my last blood sti test. Those would be the 2 stated, my current GF(know she is clear) and then a few(3) flings 2.5-3 years ago with heterosexual females aged 24-30. Just frottage and reciept of oral(once each) there, so no penetration either. Given no signs of herpes or anything that would look like a sphilis rash since then, and then two fairly recent urine tests that rule out the more likely bacterial ones, would you be recommeding the need for a blood test off that? I grew up under the understanding that frottage and oral might be a small risk on herpes and some bacterial but not when it comes to say HIV. The internet though can create doubt on this. I certainly didn't think it was practical all these years for people to be running for HIV testing after every heterosexual encounter.  Thoughts?
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Edward W. Hook M.D.
17 months ago
You’ve summarized things well. I see no reason for additional blood tests. As you point out frottage is a no risk activity and receipt of oral sex is, in general, very, very low risk.  There are no proven cases of HIV acquired from of oral sex frottage.  The only herpes infections are required through receipt of oral sex are due to herpes simplex type one, the “ cold sore” viral infection that most people have acquired long before they become sexually active.

I see no reason for testing for HIV after every casual sexual encounter. Remember, HIV is transmitted only through penetrative sexual contact and even then more than 99.9% of encounters with untreated, infected persons do not result an infection.  When you combine this with the fact that most people are not infected, routine testing is largely a waste of resources and time.  If you use condoms correctly and consistently for penetrative sexual contacts, you translate, very, very low risk encounters to encounters that are essentially no risk.

Finally, I would urge you to stay off the Internet. The Internet is not your friend for matters of healthcare. Much of what has found there is out of date, taken out of context, or just plain wrong. EWH.
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