[Question #6713] Drs Hook & HHH risk assess, testing and questions

13 months ago

I live riskfree but 45 days ago massage parlour in India Thai masseuse age 40, on top suddenly rubs naked vagina against my erect penis for 10 secs. Twice, I felt penis head touches very wet vagina lips and opening. It felt fleshy as if the lips embraced the penis head. Potential worst case: twice minimal penetration for 2 seconds. I pushed her away bcs I didn’t ask for extra service.

symptoms before: 4 weeks bronchitis, took antibiotics; symptoms afterwards start from 2 weeks: fatigue, weakness, muscleache, low appetite, for few days 5-10 pimples on upper left chest for a few days, burning sensation on skin, sweating; 5th and 6th week afterwards: diarrhea; I discovered four pearly penile papules on each side of penis head. I slept twice with my wife unprotected approx after 10&15 days of incident. 10-15 days later my wife fell sick with cold and cough, and one week later suddenly high fever, severe sorethroat and wholebody pain (esp. elbows, like 'beaten up'). She was not sick for years this was first time she experienced this. She took antibiotics, and fever left after 2 days, muscle pain after 1 day, sore throat remained. cough and running nose returned and sometimes briefly chills and light fever. She is still sick and weak. She breastfeeds 7 months baby. Two days ago, baby got for the first time one red pimple on her face, a 2nd one appeared yesterday, today two more, they look maculopapular. no other symptoms so far. Wife also has four such bumps in face.

Tests: 34th day: rapid HIV ICT – negative; 34th day: HIV Duo ECLIA – negative; 41st day: rapid HIV ICT - negative; in second lab: HIV Duo Architect – negative

 

Is this all coincidence? Does HIV rash start slowly like that? I am going crazy.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
Welcome to the forum. Thanks for your confidence in our services.

There are three aspects to your quesitons. First, potential risk from the masssage events described; second, the meaning of your and your wife's symptoms; and third (and by far the most important), is the reliability of the HIV tests you had. I will address the last one first.

The modern HIV blood tests, including the ones you had, are among the most accurate diagnostic tests ever developed, for any medical condition. If done sufficiently long after the last possible exposure, they are 100% reliable. Your tests prove with virtually 100% certainty you did not catch HIV during the events described and that HIV is not a possible cause of your symptoms. If you feel you need a truly 100% conclusive proof, have another AgAb (4th generation) test --i.e. either the Duo ECLIA or Architect test -- 6 weeks or more after the massage.

The exposure you describe was low risk because any penile-vaginal penetration was so brief. Your symptoms are not suggestive of HIV, because the symptoms of acute retroviral syndrome (ARS, i.e. new HIV infection symptoms) generally start 7-10 days after exposure; 2 weeks is on the long side, and 5-6 weeks is impossible. And in any case, you describe no symptoms that suggest HIV. The HIV rash is not pimple  like. It sounds like your wife has had a garden variety respiratory virus or perhaps strep throat, or perhaps influenza -- but not HIV. But even if the exposure were very high risk, and even if you or your wife's symptoms were typical for ARS, the rest results overrule them. They prove 100% that your and your wife's symptoms aren't HIV; and are 99% conclusive that you don't have HIV at all.

Therefore, in reply to your closing question, indeed all this is just a coincidence with the massage events. You're fine and so is your wife. If I were in your situation, I would not feel any need to have any additional testing. But it's up to you if you would find it reassuring to have another negative test at 6+ weeks. I do not suggest it because It hink there is any chance you have HIV; I do not. Any further testing is strictly for reassurance. If you do it, stay relaxed in the meantime. For sure a repeat test would also be negative.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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13 months ago
Thank you very much Dr Handsfield for your time! It is a great relief to read your message. Since I have been reading on HIV for the last two weeks nonstop, every second day I came to the same conclusion as you, but then the next day I would freak out again about the unbelievable coincidence and extraordinariness of the unfolding events. There are still some uncertainties I would like to clarify with your help, and I hope that there will be no repetitions involved. Thank you very much in advance!

1. I remember that I read one risk assessment of yours or Dr Hook in medhelp, written probably years ago. There, you advise someone that the moment of testing is always dependent on the underlying risk: If I was exposed to extremely high risk, then I should not necessarily trust the results of a test after eight weeks but rather test after three months. If I was exposed to low risk, a test after six or even four weeks might be highly reliable. But in another newer post here in ASHA you tell someone that whatever the risk - if low or extremely high such as injecting HIV+ blood in my veins - a DUO test at six weeks is 100% conclusive. To me these two answers seem to be based on two different ways of dealing with risk. Could you tell me where I am mistaken or which of the two is the correct one according to the scientific state-of-the-art? Basically with a negative DUO test at exactly 45 days, there is 0% chance that someone will turn positive only after f.e. 11 weeks?

2. By now, I know that we should not discuss about ARS since most experts seem to agree that its symptoms are often non-existent/undetectable, or its manifestations are so manifold that one has no chance to find out if a rash is ARS or not. I have found photos online who represent either heavy ARS rashes - hundreds of bumps over the whole upper body or rather mild forms - 20-30 in a particular spot like the neck or the face. Based on this finding, I thought that my wife's 5 unfamiliar maculopapular bumps who appeared after the onset of the fever, severe sore throat and body ache might be a mild form of ARS rash. Equally the similar-looking 4-5 bumps in our baby's face who might become more in the next days. Could you tell me - if possible -  what the typical range of ARS rash is? Is it from let's say face-only and 30 bumps to whole body with hundreds of bumps or could a very mild form even be just the aforementioned five bumps in the face? And does the rash literally erupt from one day to the other or does it slowly build up? Does it usually start before the fever and sore throat, exactly at the same time, or rather after the fever and sore throat began? Or are all the variants possible? Last, why do some online sources - including professional HIV sites - say that ARS rashes predominantly appear in the face and upper torso area? I remember you were saying somewhere that the rash is spread over the whole body.
Could it be that the antibiotics my wife took are somehow related to the bumps in her face and - through breastfeeding - also related to the bumps in our baby's face?

3. As far as I understood, if any of my early symptoms were due to ARS, then the tests I have made would be positive, correct? So if I had no ARS then, is it more likely that antigens and consecutively antibodies are produced later, maybe even right now that I started to have diarrhea? I was wondering to what extent diarrhea could be in any way related to HIV dynamics in my body - either to the emerging antigens or to the antibodies.

4. Some sources state that ARS symptoms such as fever and sore throat react to medicine - such as lowering the fever or healing the throat - others say that ARS symptoms do not react to medicine at all. What is true? And in case they react to medicine, then ARS fever, body ache and sore throat could disappear very quickly with the right medication, but would they return again after a short while, like in my wife's case, where the fever and the sore throat returned in less severe forms again and again? How do ARS symptoms react to antibiotics in general?

5. Are the duo test forms Architect Abbot CMIA and the ECLIA are of the exactly same quality and accuracy? Second, I remember that the first lab told me the ECLIA test will require five days. However, on the report it stated that it was done at the next day in the course of a few hours. The other lab told me in late morning when I gave blood , that i could collect the Architect result the same day at night. At the same time, the Rapid Hiv antibodies Tests (vein-blood-drawn) I did, could also be collected at night after giving blood in the morning.  So it seems these Duo tests are as 'rapid' as the Rapid tests. But they aren't Rapid tests and more precise, right? what then is the difference between let's say a Rapid Antibodies test that uses blood drawn from a vein, and a normal Antibodies test who requires five days according to the lab. Are the results more differentiated?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
1. You have misunderstood those comments on MedHelp. But if you follow that line of reasoning, it should be reassuring. Let's say your risk of HIV from the exposure described was 1 chance in 100,000. With a test that is not not quite conclusvie but "only" 99% reliable, the negative result drops your chance of having HIV from 1 in 100,000 to 1 chance in 10 million. I hope you would agree that's zero for all practical purposes.

2,3) Correct, I am not going to address ARS symptoms. Your statement in question 3 is correct:  everybody with HIV symptoms has a positive AgAb (duo) test, no exeptions. Therefore, whatever symptoms you have don't matter and I will not spend time analyzing or advising about them.

4) Also irrelevant, for the same reason.

5) Those two tests have never been directly compared with one another, i.e. conducted in large numbers of the same patients. But it is believed that all AgAb blood tests, both rapid and lab based, are equivalent in performance.

Final advice: stop searching the internet about all this. Like many anxious persons, you are being drawn to information that inflames your fears and deemphasizing the reassuring bits. It isn't worth it. Just accept the fact that you don't have HIV and move on with your life (with or without another test at 6+ weeks).
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13 months ago
Dear Dr Handsfield,

thank you very much for your reply. I did another Combo test on day 48 and having received the negative results today (including negative results for all tests in a comprehensive STD panel) , I will rest my case and will now put the focus of my probability neglect on the corona virus.

However, I think that it would definitely enrich the treasure of knowledge that this expert forum creates, if you could provide your expertise with regard to the ARS rash questions I had. I feel that there is too much contradictory information online and people would benefit greatly from your answers. Here again my questions:
1. What is the typical quantitative range of ARS rash? Is it from let's say face-only and 30 bumps to whole body with hundreds of bumps or could a very mild form even be just five bumps/lesions in the face? 
2. And does the rash literally erupt from one day to the other or does it slowly build up? 
3. Does it usually start before the fever and sore throat, exactly at the same time, or rather after the fever and sore throat began? Or are all the variants possible? 
4. Last, why do some online sources - including professional HIV sites - say that ARS rashes predominantly appear in the face and upper torso area? Isn't it supposed to be a whole-body rash?

I herewith thank you for your great support and wish you all the best! This thread can be closed.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
13 months ago
Your 48 day test result is conclusive. ARS rash doesn't cause "bumps", mostly flat red spots, generally body wide, but often most prominent on the face and torso; I doubt only 5 spots on the face would occur; it's uusally more or less simultaneously with fever, but a day or two variation could occur. The main point is that rash alone never suggests HIV, and even the most typical ARS-type rash almost always is due to something else. In any case, your test proves you don't have HIV. If you still have any sort of skin problem, for sure it's not HIV. Those comments address all 4 ofr your questions.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Thanks for the thanks!
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