[Question #6890] HIV/ STD risk

63 months ago

Exposure: Massage parlour handjob, person seemed malicious, don't think she washed her hands or what she had done with her hands. Have quite bad jock itch and sore area around external back passage might be pile or skin tag which was sore at time which she rubbed vigorously and was uncomfortable. Developed rash in upper groin within 72 hours a bit sore, red.

Negative HIV RNA test at day 12-13. On day of test had fevers and chlls for about 5 days, with a bit of mild diarrhoea, uncomfortable lymph glands in armpits (definite), and possible groin glands

Negative HIV DUO test day 31, with negative syphillis test. Feeling fine except did have period with really bad itching of hands and shins

Then about week 5 and a bit developed sore throat gradually came on , bit feverish and sore to swallow at times, 1-2 mouth ulcers, sore tongue, felt like back of tongue getting very irritated by teeth. Couldnt shake it off for 3 weeks so got Penicillin V for 5 days, aso wondered about a bit of thrush at back of tongue and scrubbed off with toothbrush and took warm salt gargles which helped, but now lips and corners of mouth sore (ongoing).

Got another Negative HIV DUO test day 53: negative, with negative hepatitis B testing. Specialist advised 3 month HIV test (said he wouldnt do but worthwhile as need repeat syphilis test.

Still have groin rash, sore mouth and and at angles of mouth. But otherwise well now.

Questions

1) How acurate is syphillis test at about 4 weeks , and is it possible to get this, do any symptoms sound like syphillis. Would the antibiotics affect the result.

2) How necessary is the HIV test, has it not been 100% ruled out

3) Is negative hepatitis B testing (including core antibody) at just after 7 weeks accurate

4) Any other STDs I should tested for

5) Groin rash which was thought to be tinea has not been relieved by 4 weeks of clotrimazole

63 months ago

Apologies I was worried about word count and forgot to say thank you for your expert help in the first thread!

Edward W. Hook M.D.

63 months ago

Thanks for your question, your confidence in our site and your thanks. I'll be glad to comment. This sounds like a most unpleasant experience and while I will completely understand that you will probably not return to this masseuse, I am please to tell you that despite her unpleasant behavior, she did not put you at risk for HIV or other STIs. As a rule, if there is no penetration, there is no risk, even if the person has their own genital secretions or an open sore on their hands.

Further the results of your 4th generation HIV test were more than 99% reliable at day 31 and conclusive at day 53. Your HIV RNA test is likewise strong evidence that you were not infected although even experts debate as to exactly when such results are entirely conclusive (more would agree that an negative HIV PCR at day 12 is virtually conclusive). With respect to your symptoms, the ARS does not occur more than 30 days after an exposure, no matter what sort of misinformation you might have seen on the internet. Thus, you are in the clear. In answer to your specific questions:

1) How acurate is syphillis test at about 4 weeks , and is it possible to get this, do any symptoms sound like syphillis. Would the antibiotics affect the result.

None of these symptoms suggest syphilis. While the text books sometimes say it can take longer for a blood test to become positive, that is likely overly conservative. Your 4 week result rules out the possibility of syphilis.

2) How necessary is the HIV test, has it not been 100% ruled out

See above. HIV is completely ruled out.

3) Is negative hepatitis B testing (including core antibody) at just after 7 weeks accurate

Yes, believe the result. No further testing is needed.

4) Any other STDs I should tested for

No.

5) Groin rash which was thought to be tinea has not been relieved by 4 weeks of clotrimazole.

The rash at the angle of your mouth may be a fungal infection called angular cheilitis. It can also be mimicked by too much licking of the lips. As for the "jock itch" clotrimazole occasionally does not work (presuming that you have used it twice a day for at least ten days. You may need a different type of anti-fungal. I would suggest you check with your doctor (p.s. both the oral thrush/angular cheilitis and the tinea cruris (jock itch) are more likely to be related to the penicillin you took than the massage).

I hope that these comments help. If anything is unclear, please use your up to two follow-ups for clarification. EWH

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63 months ago

Hi Dr Hook. Firstly thank you for your comprehensive and undeservedly compassionate answer. I accept all that is said about the hepatitis B , syphillis, no need for other STD tests.

I feel embarrassed to ask about HIV when you provide such a helpfully definitive answer. It has been a tough time for me and what I have struggled to get my head round is ongoing symptoms that keep cropping up. Although my sore throat is better with antibiotics one of my tonsils is much larger than the other. Along with sore angles at the mouth, the back of my tongue is irritated like it is too big for my mouth (this keeps happening periodically for 4-5 days since the incident and gets sore on back right side of my tongue, today there was small amount of blood ooze from those little pimply bits) today. Along with this prominent circular groin rash that started 48 hours after the incident, its unsightly but not uncomfortable but persists, red 3x3 cm, I just can't help but worry . I plan to see ENT doctors to get an opinion on my mouth and continue to try whatever creams my family doctor recommends for the rash (only tried clotrimazole for 4 weeks, which may have made a marginal improvement).

I guess the only question I have (sorry for rambling!) is really if my skin/perineum was sore and abraded and there was lots of friction on the skin tag during the incident (there was no bleeding afterwards) but the area was sore and tender , with theoretically whatever was on her hands cuts/ sores etc this would remain a low/ no risk event? I appreciate it seems a moot question given the test results but just seeking as much reassurance as possible. Also, can you see anything concerning in my descriptions , when I came back with a sore throat that my specialist recommended having a test in 3 months just because I was having other blood tests?

Edward W. Hook M.D.

63 months ago

Thanks for your follow up. I completely understand your continuing concerns. When we search the Internet we see reports of how sores, abrasions, etc. might serve as entry points for HIV. Fortunately for all of us, this is only theoretical. The only proven access points for infection due to open sores is with infectious diseases such as syphilis and herpes for which the inflammation occurring at the base of the sore brings more target cells to the surface where they might be exposed to HIV. Skin’s, folliculitis, abrasions of all sorts are extraordinarily, yet there is no proof and association between these sorts of lesions at increased risk for HIV. I urge you not to worry.

One of the great challenges in dealing with HIV at all stages in the infection is that it’s manifestations are similar to the manifestations of many, many other infections and problems. That is where testing becomes so very important. Testing for HIV has effectively eliminated the guesswork. Current day HIV tests are among the most reliable laboratory tests in all of medicine. They were thoroughly tested before they came to the market and since then have been used millions and millions of times. The testing for HIV that you have reported completely rules out any possibility that you have HIV from the encounter you describe. Your ENT specialist’s advice to repeat the test in another three months is overly conservative. Well I am not a betting man, I would bet you a years salary that the test will be negative, Although as he or she said, if you are having your blood tested anyway the confirmation is sometimes reassuring.

We don’t worry. I understand your concern. I also know that when we are concerned we have a tendency to over analyze and to make associations between unrelated observations. Be confident that you do not have HIV or any other STI from the encounter you have described. I hope this, it is helpful. EWH

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63 months ago

Hi Dr Hook

Thank you for your helpful reply and sorry for my lengthy messages

It was an HIV /STD specialist who recommended 3 months and I have not seen ENT yet.

The exposure really was a traumatising event. The person spoke good English and seemed resentful of me.She also changed the music to jeff Buckley hallelujah on her phone , which if you know the song or read the lyrics was very spooky. I really think she meant to do me harm at the time (I know may be anxiety , guilt etc) but I came out frightened. And especially now both sides of the back of my tongue are abraded and sore has happened repeatedly in these 2 months makes me panic and worry about leukoplakia I keep waiting for symptoms to settle , which it intermitently does , and then something else crops up.

The seven and a half week test was about 2 weeks into symptoms of sore throat etc. This would Definetely be positive if it were hiv?

My last question is I have been taking multivitamins that have 50 micrograms biotin which I'm sure I took a few hours before the 7 week test. I'm really worried this could have made a false negative. I have seen you both previously comment on biotin have your views changed? I only picked up on biotin when the laboratories website made a mention of it.

Thank you for your detailed an helpful comments again. After your final reply could you kindly leave the thread open and I will post results?

Edward W. Hook M.D.

63 months ago

Thank you for the clarification regarding The sort of specialist you saw. I note however that when repeat testing as mentioned, it was qualified that it could be done because blood will be drawn anyway. As I said, I remain confident that any follow up test results will be negative.

I am saddened to hear about the nature of your interaction with the masseuse. It was obviously Trumatic and unnecessary.

Regarding your question about your symptoms, with symptoms are due to HIV infection the fourth generation tests are invariably positive. Since you were tested well into your symptomatic., I am confident that your symptoms were not due to HIV. I should also add that , as a symptom of HIV, sore throat is part of the acute retroviral syndrome )ARS) which never occurs more than a month after acquisition of infection. I believe that you’re sore throat is coincidental.

There are no medications, other than medication specifically designed to treat HIV, which cause false negative tests. The data, as well as my own opinion, regarding biotin are unchanged. You can have complete confidence in your test results. Your vitamins, even when taking shortly before testing, would not interfere with the accuracy of your test results.

As you point out, as this is my third response to your questions, the thread would normally be closed. I will make every effort to leave the thread open for up to 30 days following this response however, there will be no further responses. Take care. Please don’t worry. EWH

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63 months ago

Dear Dr Hook,

After having symptoms from week 5 and a bit till about week 10

- Sore throat with intermittent fevers

- Repeatedly sore ears like an ear infection , even got my ears micro suctioned , but felt like eustachian tube dysfunction had to chew lots of gum to clear as kept getting blocked

- Candida right at the back of my tongue which Ive had to scrape off, with this angular cheilitis

- Sore sides of tongue, the foliate papilla have become eroded and sore

- Doctor saying my tonsils enlarged

- course of penicillin V and then course of azithromycin

- Admittedly no joint aches, muscle aches, or convincing rash

Summary of tests

DAY 13 HIV RNA negative

DAY 31 HIV DUO negative

DAY 53 HIV DUO negative

DAY 80 HIV DUO negative

I now just have the sore sides of tongue problem at back, looks like foliate papillitis as well as what I think is thrush.

I have just gone for a day 80 HIV DUO test and have been off biotin multivitamins for 2 weeks so certainly no chance of biotin interference (I believe Roche Cobas, all tests at same place). The result was negative... I am in shock, you may not be! I'm not sure what to say.

My specialist who is eminent in the field had always said do it at day 90 otherwise, may need to do another test. What do you think? I have been in a state of heightened anxiety for 3 months I have not slept in the same bed as my wife!!

1) Can I stop having tests, still in shock!

2) My symptoms seemed so like ARS but late starting? Convincing enough to do a test after 90 days?.

3) I had held off an ENT referral as I was so scared they would take one look and say you need HIV testing.

4) This biotin business is interesting , FDA has asked all manufacturers to change their assays so that they will not have interference at 1200ng/ml as I believe all combo assays are reliant on the biotin-streptavidin bonding. My specialist was not aware of this interaction and I only picked it up as the lab I had it done with had a warning. Needs publicising surely??

Thank you for all your time, help and consideration. This can be an incredibly lonely time where you have very few people you can confide in and speak to and it is maddening. I will never be an idiot again and put my health in the hands of strangers.

Edward W. Hook M.D.

63 months ago

Thanks for the follow-up information. with all due respect to your doctor I disagree and am confident that you did not acquire HIV from the exposure you described. From and medical and scientific perspective, I see no need for further tests and worry that the anxiety you are experiencing will only be worse if you are still worrying that another test is needed. Your tests will not turn positive. In answer to your follow-up questions:

1. Yes, you have tested more than enough to prove that you do not have HIV. there is no need for additional testing.

2. See above. No need for more testing. Please note that in studies of persons seeking care for flu-like symptoms of the ARS, over 99% do not have HIV but have other problems. Testing is what we do to determine if symptoms are due to HIV. Your tests PROVE that you did not acquire HIV from the exposure you described.

I see no reason to avoid the ENT. You have PROVEN you do not have HIV.

4. The biotin concerns are overblown. I would not worry. The internet has blown this out of proportion.

Thanks for your thanks. I am glad you found my comments helpful. This will complete this thread which will be closed shortly. Take care. EWH

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63 months ago

Thanks again!