[Question #1448] Follow up

45 months ago
I had another encounter with the same csw same unprotected oral both ways and protected vaginal coitus. Two weeks after first encounter got hives bilateral buttcheeks very itchy took Benadryl they were gone haven't returned. Next day had one day of diarrhea not real diarrhea just very loose stools. Never had fever nor soreness of joints. My head tells me that this was a zero risk encounter for HIV but now my wife is sick upper respiratory symptoms slight fever and body aches.  I am not at 4 weeks from first encounter to take accurate test. But I am freaking out. Csw denies HIV showed me card from Health Department 2 weeks old showing negative test.
45 months ago
Csw did have unprotected sex w male of unknown status on October 31st
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome back. However, I'm sorry to see you find it necessary -- more about which below.

As we have discussed previously, you are going about your CSW exposures carefully and safely. Condoms work, and oral sex is always low risk. More important, there are no STDs likely to cause the symptoms you describe. My guess is you had some sort of non-STD viral infection -- probably not from your CSW partner, more likely from a family member, co-worker, or any of the other contacts you had with other people during this time. And now it seems likely your wife has caught that virus from you.

And your symptoms don't sound at all like HIV, which doesn't behave this way. (Never make the mistake of reading lists of symptoms and concluding that because you have some, you might have HIV -- or whatever medical condition you are researching. It's always the pattern of symptoms, and various combinations of them, that make symptoms point to any particuIar cause. This is especially true for HIV and ARS.) I will also point out that people rarely lie or falsify their HIV status, especially when asked directly. And as discussed previously, in the 3+ decades of the known worldwide HIV/AIDS pandemic, there have been no proved cases of HIV transmission by fellatio (oral to penis) or cunnilingus (in either direction). 

Should you be tested? If I understand the timing, it is now 2+ weeks since the exposure, maybe 3 weeks? So you only have 1-2 weeks to wait for a definitive 4th gen HIV blood test (conclusive at 4 weeks). Or you could see a doctor -- in the event s/he thinks your symptoms are more consistent with ARS than I do, you could have a DNA test for the virus, which pick up almost 100% of infections by 2 weeks. But I doubt this is really necessary. 

Finally, your email address apparently says a lot about what's going on here. (Don't worry, only the moderators see that, not web administrators or forum users.) Perhaps my main advice is that you should be getting counseling, if you aren't yet doing so. But as I said last time, you're going about your CSW adventures with good attention to sexual safety. In any case, you should not expect to come to this forum for reassurance for every exposure or symptoms that make you nervous. Repetative, anxiety driven questions are not permitted, and eventually such questions are deleted without reply and without refund. It's a policy designed both to protect users from themselves (not tempted to spend good money to keep hearing the same answers) and because such questions have limited educational value for other readers, one of the main purposes of the forum.

I hope these comments have been helpful. Let me know if anything isn't clear. You'll notice I have closed your other thread; one thread at a time, please.

HHH, MD

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45 months ago
I see a lot of HIV where I work as you can imagine, which doesn't help.   I did see a Dr, he wasn't worried, but wrote me a script for blood work for which I am waiting out the window.  I only opened a new thread b/c of the hives which are out of the ordinary for me and then the wife's symptoms (I had unprotected with her several times right after my adventures, so the timeline is right).  as you can see from my screen name I am not your typical "kook"  but I guess anxiety can affect anyone.    Please keep this thread open and I will return with the good news in a week or two and then I'll get out of your hair and think about my choices and maybe get help for my proclivities.  

thanks again Dr. with my deepest sincerity.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
From your writing and questions, I always had confidence you are intelligent and insightful, definitely not a kook. But indeed anxiety is universal, affecting everyone from time to time and some people all the time.

If you have an opportunity to interact with the HIV infected persons where you work and ask how they believe they were infected, almost certainly you would find that none acquired it from exposures like yours. We just dont see such patients in busy HIV/AIDS clinics.

That comment and this reply won't count against your follow-up questions and replies. ;-)
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45 months ago
I gave blood for my tests today however I started azithromycin 250 bid yesterday (so I've taken 2 doses biD 250) I don't know when my results will be in but my question is let's say I was infected with syphilis, chlamydia , or gonorrhea- will that 2 dose of 250 be enough to show a clean test or would that not be enough or too soon to mask it? I only need to know in case my wife was infected. would i still test positive if infected with one day of zpack yesterday?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
*Sigh*

Taking azithromycin was a mistake. The tests you took at about the same time willl remain reliable, and we already discussed why you weren't at risk anyway. If the current tests are negative for gonorrhea or chlamydia, they will be conclusive, so no worries there. If you had been infected, the dose of azithro was exactly wrong:  too low to cure them but high enough to make future testing unreliable if negative. And if I correctly understand the timing, this could screw the ability to accurately diagnose syphilis. Although that risk was also almost zero, you could have had a conclusive syphilis blood test 6 weeks after the exposure. Having taken azithromycin, you will need to wait an extra month or so for a conclusive blood test.

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45 months ago
The z pack was for upper respiratory symptoms and cough not  any presumed vd. I have asthma and can't play around when it comes to respiratory infection .  I only wanted to know if it would queer my tests for the reasons explained.  If you keep my thread open I'll post my results. thanks again Doc.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Thanks for clarifying. Of course it was reasonable to take azithromycin in that circumstance. How long has it been since you took 500 mg AZM? If within a day or two, take another 500 mg, total 1 g. Or if more than a few days ago, take a 1 g dose now. The extra treatment won't hurt your asthma and would be no less effective in respiratory prophylaxis, so no harm on that front. In the exceedingly unlikely chance you had acquired syphilis, 1 g is enough to abort incubating syphilis. Some syphilis strains are entirely resistant to AZM -- but at least testing will remain accurate in a few weeks, whether negative or positive.

Be clear that I still believe your risk is nil, and if I were in your situation I would not take any more AZM and would have no more tests of any kind. But I'm assuming you're looking for 100% assurance regardless of the virtually nil chance you're infected.

That will have to end this thread. There's no need to post your negative results; I'll just symbolically nod and say "Yup, negative, move on". In the extraordinarily unlikely chance something is positive, the issues will be sufficiently complex that you'd need to start a new thread anyway. However, please do not start a new thread if your results or negative, or for further clarifications on your risk from this exposure. There's nothing you can add that would change the advice you've had, so don't spend the money or energy on it.

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