[Question #2680] Follow up to hep

41 months ago
Hey doc.  You answered a hep question for me a few weeks ago.  I wanted to follow up about hiv risk.  Since my last question, I have gotten these little bumps a few on back arms and leg about 8 or 9.  They start off red and itch for a day or so. Some flatten and turn dark. The stay red.  In both cars I forget they are there unless they rub against something.  I thought at first related to lichen but then saw some pics of puritic papular eruption and wonder if they could be those.

I had an hiv test 3 years since then been with about dozen girls all protected except had 10 min bj uncovered.  All others were covered and I switched condom  before sex.   I do have herpes but the part where I get the outbreak in on daft close to top.  Sometimes there is some mutual stimulation and if vaginal liud on hand from removing condom or fingering got rubbed in.  

Do you think I need to get tested again.   Could bumps be hiv ppe


Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago
Welcome back to the Forum.  I'll be answering this time and have reviewed your earlier interaction with Dr. Handsfield.  I agree with his comments. 

The rash you describe is not something that would make me feel strongly that HIV or other STD testing is needed.  You and Dr. Handsfield have already discussed lichen planus so I will not repeat this.  Illnesses and rashes occur in persons with HIV but most rashes, including LP are not related to HIV.  Further, your risk for HIV is very low.  Condoms remain the most effective means of reducing risk for HIV or other STIs if exposed and since you conscientiously practice condom-protected sex (good job!) and you do not mention any condom failures (when condoms break, it is obvious) your risk for HIV is close to zero.  As for receipt of unprotected oral sex, there are no cases in which HIV has been proven to be due to receipt of oral sex.  Thus, on the basis of your history, I see little risk for HIV and little indication for testing.

On the other and, clearly this is on your mind and you had had a number of sexual encounters since your last test several years ago.  Hence there is no reason not to test, particularly if it would reassure you and let you stop worrying.  If you do decide to test, I have complete confidence that the test will show that you do not have HIV. EWH
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41 months ago
last question.... I did think of one other risk.  I had a pretty deep cut on my finger (cut it eating crab).  I then had an encounter with it and it was still open.  I took off condon and then masterbated with the same hand.  afterwards, I l put some alcohol on it and it burned quite a bit indicating that it was open.  does that warrant testing.  I probably will go get tested anyway but this will help reduce my anxiety.  I just am baffled why I all of sudden have so many skin issues over the last year -, lichen planus leg and mouth, these things that look like ppe and more frequest herpes outbreak and wards.
Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago
No STIs, including HIV are transmitted through wounds of the sort you describe.  While I suppose it is theoretically possible that a person could be infected through such a wound, just as it is theoretically possible you could be struck by a meteorite today, I have neither heard or seen a patient being infected in this way.  I would not worry that you were infected in this way.

As for your increased dermatological issues, including HSV, anxiety can certainly heighten all of these things.  I am not saying this is the cause but I can assure you there is really no reason to worry about an STI related to the exposures you have described.  EWH
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41 months ago
Hi,

Thanks for your help. I went ahead and got the test and it was negative.   not sure why all the derm issues.  I will head back and look at allergies. I read that can cause problems. no need to reply back to this just wanted to update in case someone in similar situation reads post.
Edward W. Hook M.D.
Edward W. Hook M.D.
41 months ago
Thanks for the follow-up.  I would point out that the skin and its underlying tissue is filled with tissues which react to emotion (think about blushing as the most obvious example).  While I doubt that anxiety and your concerns are the entire problem, they, combined with a degree of "hyper-awareness" may be contributing.  Take care.  EWH
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