[Question #6468] Petechiae, high fever, and cough - HIV Concerned

14 months ago
Hello again, and happy new year. My question is related partly to a new exposure and the old exposure that I previously asked in this forum (w/ the Romanian CSW). As I mentioned before, my main worry is the Petechiae that I've had for 2 years straight in my palms and feet, which happened about a few weeks after having protected vaginal sex w/ the CSW. Since I have never had Petechiae before, I assumed it was due to this exposure. Ever since this exposure, I've had vaginal sex w/ two other girls (both college girls). The sex is always using a condom for vaginal sex, but we never use a condom for oral sex. What worries me, is that one time one of them was giving me oral sex, and since I am not circumcised, she accidentally bit a fragile part of my penis and it started bleeding a lot; some blood entered her mouth, but she quickly washed it off and brushed her teeth (I had to go to the ER). Now, I am worried that if I had HIV, I could have infected her. Also, right now I have a high fever with a lot of coughing and mucus w/ a sore throat, and the Petechiae has somewhat increased in my palms. So now I am worried that this fever is due to chronic HIV or AIDS from the event that happened 2 yrs ago w/ the CSW. So here are some questions:
1: Should I be concerned about possibly infecting her w/ my blood in her mouth?
2: Are my symptoms consistent w/ chronic HIV infection or AIDS?
3: In the rare chance that the college girl already had HIV, could my symptoms be due to ARS? I last had sex w/ her like 2-3 weeks ago.  
4: Since the Petechiae occurred right after my exposure w/ the CSW, does that raise HIV concern? (I know Dr. Handsfield once said in the forum that low platelets can happen as a result of ARS, and Petechiae is a symptom of that). Thanks!
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Welcome back to the Forum although I must say that I am saddened that I have been unsuccessful in getting you to accept that you do not have HIV.  As I told your previously "Petechiae are a non-specific finding with multiple causes which include medicines, trauma, and other illnesses."  You have described your petechia and now a bleeding tendency which may or may not be pathological.  If it is pathological, you have no reason whatsoever to worry about it being due to HIV and should instead be looking for reasons for this tendency elsewhere.  My advice would be to seek the advice of a hematologist who can work you up for one of the numerous potential causes of abnormal bleeding tendencies. 

During our last interaction I asked you to not return with further unwarranted concerns about HIV.  Taking that to mind, these responses will be brief.

Fever is non-specific and cough is not typically a sign of HIV unless it is far advanced.  When we last interacted you note that your test for HIV (OraQuik I believe) was negative.  thus from what I know there is no credible reason to think that you have HIV at this time.

1.  This is a speculative question since there is no evidence that you have HIV.  That said, swallowing HIV containing blood does not appear to put persons at risk for infection.

2. No

3. No, cough is not a sign of the ARS. The ARS is a syndrome of HIGH fever, severe sore throat, and intense muscle aches.  It is a flu-like illness and when persons at risk for HIV with flu-like illnesses have been studied, 99% of them have something other than the ARS.   Further, receipt of oral sex has never been associated with risk for HIV. 

4.  No, aswe have discussed this before.  The petechia you experienced do not raise any concern for HIV


I hope these comments are helpful. EWH

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14 months ago
Thanks for the reply. I just got concerned since I have a really high fever at the moment, accompanied w/ coughing and sore throat. So maybe I thought this was a sign of advanced HIV/AIDS. So I just have a few more questions:
1. Could far advanced infection occur 2 years after exposure, and if so, are my symptoms suggestive of advanced HIV/AIDS (like AIDS related pneumonia or something)
2. What do you mean by pathological? 
3. If my Petechiae were due to thrombocytopenia or ITP, would that be a sign of HIV?
4. If I always have vaginal sex using a condom, how could HIV theoretically be transmitted, assuming no breakage? I remember when I had sex w/ the CSW, at one point my penis went soft. Could this increase the risk? 
5. If HIV is so difficult to transmit, why is the HIV rate so high in places like Swaziland, where 1 in 3 people have the virus?
Thank you. 
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Again, I think you are over reacting and making unfounded assumptions.  There is NO evidence that you have HIV and, in contrast, there is evidence that you do not..  Brief answers will follow as there is no evidence that they have any relevance to you:

1.  No, on average, it takes about ten years for HIV to advance to the state in which persons become more susceptible to the opportunistic infections that define AIDS. Even in so-called "rapid progressors" it take at least 4-5 years for progression to occur.

2.  By "pathological" I mean that your perceived bleeding tendency (including petechiae formation may (or may not) reflect a defined medical condition.  If it does, you have a "pathological" condition.  Alternatively, you may be hyper aware and sensitized to evidence of bleeding.

3.  No, most people with thrombocytopenia or ITP have other conditions.

4.  A soft, condom covered penis does not increase risk for HIV.  Correct and regular condom use of the sort you suggest is highly protective for acquisition of HIV.

5.  People have lots of sex and over time infections occur. 

Hope this helps.  No change in my advice or suggestions.  EWH

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14 months ago
Thanks for the reply. Just to clarify, if my petechiae were not due to something pathological, would that suggest HIV? Because you say: "If it is pathological, you have no reason whatsoever to worry about it being due to HIV". Thanks for all your help.
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

I continue to fail to understand why you remain focused on HIV.  Is it because of some misinformation you saw on the internet.  As per prior discussions, there is nothing suggestive about HIV in the symptoms you report, there is no reason to think that you are at high risk for HIV and you have at least one, and perhaps more, test(s) which was negative for HIV.  There is simply no reason to continue to worry about HIV.

You should see a trained medical professional to determine if you indeed do have a verifiable tendency towards bleeding.  If you do, you need to address it.  If you do not have a verifiable bleeding tendency, you need to figure out how to move on. Either way, there is no reason to worry about HIV.

EWH

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14 months ago
Thanks for all your help and expertise, I feel much better about my situation now. 
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago
Thank you. The thread will be closed now. EWH
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