[Question #5487] Oral and rash

22 months ago

Docs -Thanks for all of your service.

I had an unfaithful exposure awhile back. I was tested with RNA at 25 days and 4th generation at 36 -undetectable and negative.My wife then, over 50 days after my last test (and over 30 from our last relations) had her own 4th gen and was also negative.I figured we were all in the clear. Still our relationship was only reparing and I still had a mental block and sex life wasnt great.

Anyway- one evening after a particularly good night out she performed oral to completion on me. Exactly one month after that she came down with a nasty sinus infection. Very bad stuffed nose, bad sinus pressure, very painful. Headache.  Also achey back of neck and upper back. Also a bad cough presumably from the drip.2 days into the infection she went to dr and got an antibiotic, not sure which one I think it started with a d. Either way, that began to make her feel better but 3 days after that (if you can keep up ha) she developed a weird rash on her thighs. It looked like red dimes across both thighs, and the weirdest part was the timing. At 20/30 mins it probably reached its peak, then stayed and got better over the next 40 or so minutes. Cleared up in under 2 hours. It didnt seem to both her and frankly it could have been more of her body but she was wearing clothes. Definitely thighs.Questions:

1. Unprotected oral. I guess I know the numbers. She had no cuts. I wouldnt have let her if I thought I was at risk but I figured we were both clear. How serious is that risk?

2. ARS - do her symptoms sound typical?

3. The rash...I understand it can be very difficult to pinpoint, but I can;t get it out of my mind. Does this sound like a possible rash brought on by ARS? Just thighs (maybe elsewhere under shorts/underwear) and that short of a time period? Is there any guideline for how long they last? I've heard Dr. H say ‘trunk’ and I didn’t see her trunk. So I’m worried.

Thank you

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome and thanks for your question.

Your worries are over. What you apparently have not understood is that the HIV tests overrule all other considerations. If done sufficiently long after the last possible exposure, they absolutely prove HIV infecstion is not present -- regardless of symptoms and no matter how high the risk of infection at the time of exposure. In addition, it is impossible to have HIV symptoms more than a few days and have negative test results. In other words, even in the extremely unlikely chance you or your wife have HIV, the test results show that HIV is not the cause of your symptoms.  Your negative test results prove you did not catch HIV. Period, full stop, no exceptions.

To your specific questions:

1) No risk at all. There has never been a proved case of HIV transmission oral to penis. Not one. You are not likely to be the first in history, after 4 decades of the known HIV epidemic and millions of infected people. (Whether or not someone has "cuts" is irrelevant however.)

2) No, your wife's symptoms do not even hint at HIV, which does not cause stuffy nose or other sinus symptoms. She caught a cold, that's all. And as already implied, even if her symptoms were typical for HIV, it wouldn't matter. You do not have HIV and so could not have infected your wife.

3) You have made the common mistake of looking at lists of HIV symptoms and seeing something -- in this case a rash -- that is on the list. The problem is that no single symptom, by itself, EVER suggests HIV. It is only the pattern and timing of symptoms that matters. Rash can occur with HIV, but rash alone never indicates HIV. In any case, it still remains the case that your tests prove you are in the clear -- as well as having had a zero risk exposure.

So all is well. Don't confuse your likely embarrassment or shame over a sexual decision you regret with infection risk from that event. They aren't the same. Deal with the former however you need to, but you can move on with no worries about HIV.

I hope this information is helpful. Let me know if anything isn't clear.

22 months ago
Thanks Dr.

A few follow ups. 

1. I meant risk from her performing on me. Risk for her. She swallowed, to be blunt. 

2. Her sinus infection was almost a month after this (and that was our first and last relations after her negative test and before this brief illness). The rash would have come on roughly 6 days later. Would the timing be consistent with Ars? 

3. It would be a big help to me psychologically to address the rash itself, and I’m sorry if that’s thick headed. Lasting only about 1-2 hours...would that be in line with the ars rash or unusual? In the 20 years I’ve lnown her she never, ever had a rash. Or just in a medical opinion is it possible that could have been from the antibiotic she was taking, for example? 
22 months ago
So again to be clear her negative test was before the ‘bj’ she gave and also before this illness that happened one month later. 
22 months ago
Sorry - new development:

I have my standard physical today and I go a week early to get blood drawn so Dr can review before my exam which.

I’m having a tough time sleeping tonight and got an automated email that my CBC and other blood results are in. My wbc and lymph counts are low side of average (I know I can’t rely on that for HIV) but they texted me for something I never was tested for before and the levels were essentially double what they should be. Google that and it says hiv is one of the main contributors: 

WBC - 5.95
Lymph - 1.8/30.3%
Neut - 3.74 /62%
NEW TEST - IPF -13.2% (cutoff 7%)

I read up on IPF and they use it to determine low platelet count or why there is one but my platelet count is 191 (150-400). 

I’m not googling for HIV. What I’m googling keeps coming up hiv. Thoughts on this IPf which I haven’t heard about before today? 
22 months ago
And my vitamin D was very low, FYI. 

I tested hiv out to one year since last exposure and it was negative. Sorry for all the responses trying to process everything with this blood work. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
You're way overthinking it. Of course your wife was not at risk by having sex with you (oral or otherwise), since your tests PROVE you did not catch HIV. All my other advice flows from that fact.  And I see no rationale for me to take any more time to assess either your wife's symptoms, which do not even hint at HIV, or a rash that is proved not due to HIV. On this forum we are happy to address potential causes of symptoms likely (even only slightly likely) due to HIV or other STDs, but not symptoms caused by other things, i.e. proved not due to HIV/STD. Same for your lab work. I'm also not up on "IPF" as a newer CBC outcome, but since you don't have HIV, I'll have no more to say about it. I'll point out that the rest of your CBC looks entirely normal, and one item out of range usually is not significant. This is a question for your doctor, who presumably ordered the tests as part of your general medical evaluation.

And now we learn that your negative HIV tests were a year ago! It is well past time for you to move on without further worry or concern about your sexual indiscretion and any past or current symptoms you or your wife might have. You can be confident that neither of you has (or has had) any infection whatsoever from the low risk exposure you have described.  Best wishes in "processing" the blood work -- but it's obviously irrelevant to this forum. As noted above, your doctor can help.
22 months ago
Thanks for the reassurance. So - for timeline...I received my ONE YEAR 4th generation test from regular dr office (from vein, sent to lab) this past December. I loosened up greatly after that. My wife's rash got me a little uneasy but I put it out of my mind...then I saw this platelet thing on this test and googled it and everything I read stated that it's one of the earlier markers for HIV (they say shows up in the middle-stage)...real medical journal entries too. So, I figured now I'm at about 18 months post exposure so I could definitely be at middle-stage. That led to panic which you can see in all of my posts at 4am my time.

I will discuss with my PCP today...a few hours actually. So I will discuss this more with him of course...but I have a few last follow ups.

1. I had a lot of lab tests (and even more oraquicks) and all haveand been negative. I am staring at another oraquick now and am afraid to take it. My tests were as mentioned RNA at 25 days, 4th gen at 36. Also another full labcorp panel at 93 days and then this 4th generation at a little over a year. Question: the last 4th gen was done on Friday evening as the dr. office was closing and the results werent ran until the next Monday. I have no idea when they were picked up by the lab, but is there a timeline on when it would have to be refrigerated? I guess you'll say it's irrational, but in a worst case scenario if it sat for over 24 hours or something is this something that could throw the test off?

2. My wife tested negative this march, 4th generation. we had one intimate night after that, the unprotected oral her to me, and she had the illness and rash after that. I trusted  her test but the exposure was after her test. Of course I did not have any dalliances after my december 4th gen test. Just wanted to make sure i was clear that the exposure was after her test.

3. Besides everything discussing autoimmune and HIV with high IPF, they mention it generally comes with thromo whatever it's called. My platelet count is not low and I haven't noticed any bleeding or marks under skin so I have no idea what to think!? Do you know any other reasons for high IPF?

4. Is low vitamin D something that could be an HIV marker?

22 months ago
5. Also have a purplish dot on lip. I remember having a scab there a few days ago. But that could be petechae and more sign of thrombo whatever....still do not believe I should be retested for HIV?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
1) There is no "worst case scenario" that could make your test results unreliable.

2) Your wife didn't need testing. I don't care when she had sex with you, since you don't have HIV. You shouldn't care either.

3) I already said I don't understand IPF or what it means and suggested you ask your doctor. Sorry.

4) Of course not.

Are you OCD? You're sure obsessed with all this, at a level that suggests a potentially significant underlying mental health issue. I raise this from compassion, not criticism -- but if these issues are dominating your life to the extent I suspect, professional counseling may be in order. Your level of concern is way beyond rational, especially in light of the reasoned, science based reassurance you have had, probably from your own doctors as well as here.

That makes two follow-up comments and replies and so concludes this thread. I hope the discussion has been helpful.