[Question #6680] hiv risk with rash

14 months ago
Hello Drs,

Today I totally freaked out because I found some hermorrhagic rashs on my side body. Here are the information,

37 years old, heterosexual male, with hypertension(well managed by drugs) in S. Korea.

1. Exposures
Day 0 - naked apposition of genital area and frottage, also brief insertive oral and handjob

Day 5 - genital frottage with brief clothing of woman side but naked on my side and vigorous open mouth kissing and handjob

Day 12 - naked apposition of genital area and frottage, also brief insertive oral and handjob

Day 33 - handjob with massage, no genital contact

Day 34 - handjob with massage, no genital contact

Day 35 - touching woman's genital area on panty(I felt some secretion), after that, she rubbed her genital area briefly. And hugging, close mouth kissing, finally I masturbated by myself with the hand which had touched her panty.

All women are commercial sex workers in massage parlours.

2. Tests

Day 33 - rapid 3rd gen. antibody and Abbot 4th gen. ag/ab, both came back negative.

Day 36 - rapid 3rd gen. antibody came back negative.

Day 37 - 4th gen. ag/ab came back negative. rt-PCR, still waiting for the result.

Day 38 - 4th gen. ag/ab came back negative.

And the woman on exposure Day 35 got negative on 4th gen ag/ab on Day 36.

3. Drugs

Day 37 - got pep from emergency just for one day and took them(1 truvada and 2 Isentris). but the next day, doctor of infection disease stop prescribing, so I stopped. I had dark urine and nausea during 1-2 days after takinf pep.

4. Symptoms

no high fever(always under 37 degree celsius, no swollen lymph nodes, but had some allergic reactions during some weeks which come and go on neck and chest, and found some hemorrhagic rashs on body side just below my left arm which are gathered in isolated area on Day 41(today).  The color of  rashs not change with pushing them.

Please assess my hiv risk and explain hiv ars rash's features and the possibility of rash due to the one day pep. Thank you.
14 months ago
I just checked the rashs once again. They are three and not raised. And not circle or oval. They are square and triangle little bit long to one direction and the length is about 0.5cm. And very thin pink line exist just after the rash on length's direction.
14 months ago
And during the whole exposures, there were no penetration at all.
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Welcome to the Forum and thanks for your detailed description of your exposures.  I'll be glad to comment.  The exposures that you describe did not put you at risk for HIV.  There is no risk from frottage/apposition,, other forms of touching, receipt of masturbation, open mouth kissing, or receipt of oral sex.  Further, your test results are more than 99% conclusive that you did not acquire HIV and when your RNA PCR test comes back as negative as I am confident it will, your results will be entirely conclusive. 

FYI, the ARS when it occurs consists of high fever (you are not febrile), severe muscle or joint aches (which you do not report), a painful sore throat (also not mentioned by you) and at the time of these symptoms combination tests for HIV are typically positive (yours are negative).  Less than half of persons with the ARS have a rash and when it occurs it tends to cover much of the chest and back.  It is not hemorrhagic. 

If the rash you have noted were due to PEP, it would have occurred sooner- it appears that more than 30 days has passed since you took the single dose of PEP (I agree with your doctor that you r exposures did not warrant PEP).

Bottom line, the rash you have noted is likely due to something other than HIV and the sexual encounters that you describe.  If it progresses I suggest that you speak with a health care provider but I would not worry that it is an STI.  EWH

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14 months ago
Thank you very much, Sir,

I think I mistook to explain the timeline. Please see that all days are on the same timeline. As such, Day 37 is just 2 days after the Day 35 exposure.

I want to ask two more question.

1. Can I rule out Day 12 exposure when I get negative result on Day 37 RT-PCR as a channel of infection of HIV?

2. Are frottage, apposition, mutual masturbation still have no risk of HIV when the genital secretion exchanged during those activities?
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Thank for the clarification.  This does not change my assessment however- still no risk events and confidence that the rash you are experiencing is NOT the ARS.  In answer to your other two questions:

1. Yes, absolutely.

2. Correct.  Frottage, apposition,  and mutual masturbation are no risk events even when partner get each others genital secretions on one another.

EWH

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14 months ago
Thank you very much, Sir,

Your advice is really helpful to make me stop smoking with worrying.

I want to ask the final question. Do you recommend further testing to me to exclude Day 35 exposure?

Actually S. Korea is struggling with the epidemic of COVID-19. Therefore, government recommend to do not go to hospital or clinic without severe symptoms to avoid the infection of that virus. So I'm reluctant to go to medical facilities for several weeks. 

But if you think that I have to take further test, I shall have some discussion with hospital for arranging the testing schedule.

Thank you one again in advance.
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

Based n the history you provide and your test results, I see no need whatsoever for additional testing related to the exposures you described.  You are in the clear.

As you know, we provide up to three responses to each question.  This will complete this thread.  Take care and please don't worry.  EWH 

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