[Question #246] Hope I can move on

94 months ago
Good day doctor. I am in fact unsure as to whether I had an exposure in Russia 3 months ago. A masseuse at an erotic massage parlor sat on to of me while she masturbated me. It was all a bit of a blur, and I am unsure whether I penetrated her at any point. If I did, it was brief. 

Since then, I have had multiple negative HIV tests - a PCR DNA at 23 days, combi tests at 15 days, 21 days, 28 days and 42 days, and a 3rd generation test at 79 days. I have also had multiple negative  STD tests including chlamydia, herpes 1 and 2 and syphilis. I have also had various CBC's, and was quite alarmed when at 6 weeks after (potential) exposure my lymphocytes were down to 11%. They however rebounded a week later. 

The reason I am consulting you is that there is so much (mis)information on the Internet, and I don't know what to believe. I have developed redness of my forehead and face (not bumps or macules) 10 weeks after (potential) exposure. The dermatologist thinks it is rosacea, and it has now been present for almost 3 weeks. 

At 12 weeks post exposure, I came down with a sore throat (no fever) and a pretty bad headache, which the doctor diagnosed as a viral throat infection. The next day, other symptoms developed, including bronchitis (coughing up yellow/brown phlegm), and a runny nose. Also, a general feeling of malaise. I have had a headache for 3 days (intensity varying at times) in spite of multiple types of painkillers. I also have some tenderness in the lymph node areas of my underarms and elbows, but I can't feel any nodes. I have had no fever at any time. 

I would appreciate your assessment, and specifically:
1. Is there a chance that my persistent forehead and face redness (rosacea?) is a symptom of ARS?
2. Do you know of any cases where ARS symptoms started at 12 weeks?
3. Should I do another test, or can I move on?
H. Hunter Handsfield, MD
94 months ago
Welcome to the forum and thanks for your question.

The internet indeed can be daunting, especially for anxious persons. Nate Silver, the now famous statistician who predicted the 2012 US presidential election results almost exactly, state by state, wrote a book called The Signal and the Noise. In it he wrote something like this:  "Give an anxious person internet access in a dark room, and he'll soon convince himself that his cold is the bubonic plague" (not an exact quote). However, you can limit confusion by sticking with professionally run or moderated sites, like those of health departments, universities, the CDC, and the American Sexual Health Association (www.ashasexualhealth.org); and avoiding sites run or dominated by infected persons or those at risk, which are particularly likely to have inaccurate or biased information.

In reply to your concerns, just a few minutes ago I replied to the question immediately before yours (#245) and wrote this:  "The HIV tests are among the most accurate diagnostic tests ever developed, for any medical condition. The results are never wrong as long as HIV testing is done sufficiently long after the last possible exposure (4-12 weeks, depending on the particular test or combination of tests). Symptoms of HIV, by contrast, are the very worst way to judge whether or not someone is infected. A hundred or more conditions cause some or all the symptoms commonly associated with a new HIV infection. Your results prove without doubt that you did not acquire HIV...."

The same reply exactly responds to your question. I will add that your symptoms were not suggestive of an HIV infection anyway. Your doctor undoubtedly is right:  you caught a cold, nothing more. In addition to symptoms, test results also overrule any and all exposures. No matter now high the risk of HIV at the time of exposure, your test results prove you were not infected. And your exposure was zero risk anyway, or close to it. You cannot catch HIV from massage, hand-genital contact, etc. If indeed there was penile-vaginal penetration, there was perhaps slight risk -- but exceedingly low for such brief contact. Had you asked me at the time, I would have advised against any HIV testing at all.

In addition, your other STD tests were conclusive. The CBC was useless; a little variation in lymphocyte counts is meaningless.

On balance, it seems clear you have seriously overreacted to some normal life events, perhaps because of guilt or shame over a sexual decision you regret. But don't confuse that with health risks from the event; they aren't the same. Deal with the former as you need to, but disregard the latter.

I think those comments respond to all three of your questions. But to be explicity, the answers are 1) No. 2) No, this is much too late and your symptoms are not typical of ARS anyway (ARS doesn't cause runny nose, cough, or headache.) and  3) Don't have any more tests; move on for sure!

I hope this has helped. Best wishes and stay safe--  HHH, MD

94 months ago
Thanks very much for your informative and comprehensive reply Doctor Handsfield. I appreciate you "telling it like it is" which is contrary to some of the very conservative advice I have seen on the Internet. For example, some so-called experts claim that a headache and runny nose are ARS symptoms! Also, some claim that ARS at 12 weeks is possible. I therefore really appreciate your clarifications on these issues. As far as I am concerned, your experience is unparalleled. 

I think there is a lot of anxiety involved in my case, and of course if would have been easier to move on earlier if I had not developed this damn rosacea, sore throat, persistent headache, etc. Basically, I need to get over this virus/bronchitis (headache now in its 4th day) and move on with my life. 

Thanks again Doctor. 
H. Hunter Handsfield, MD
94 months ago
I'm glad to have helped. You can expect your cold/bronchitis symptoms to continue to improve.

In regard to symptoms, I can't say that runny nose or cough would never occur with ARS. But they're not part of the typical picture. So a legitimate response to "Could it possibly be"" is yes. But the response to "Is it likely?" is no. And it's the pattern of symptoms that matters, not any individual one. Worrying about HIV in this situation is similar to someone who has been hit over the head with a baseball bat worrying his headache might be from a brain tumor. Sure, it's possible. But is it likely?

And the combination of your symptoms is absolutely typical for a common cold and absolutely atypical for ARS. And an ARS rash probably would never mimic rosacea. When you combine that with an exposure that almost certainly couldn't have transmitted HIV anyway AND with the negative tests you had, it is mathematically virtually impossible you have HIV from that event. We're talking odds lower than the probability you'll be struck by a meteorite. That may happen someday, but I would advise you not to worry about it or take precautions against it.

Does this make sense?
94 months ago
Yes it does Doctor, thank you. I take comfort that the symptoms themselves and the onset pattern make no sense in terms of HIV.  

So just to confirm regarding the timeline - you haven't heard of or seen cases where ARS symptoms develop after 12 weeks? And lastly, the absence of a fever is also a good thing, as I understand that ARS symptoms nearly always include a fever?

Thanks again for all your guidance. 
H. Hunter Handsfield, MD
94 months ago
Correct on both counts.

Thanks for the thanks. That will end this thread. Take care and don't worry about this!