[Question #778] Follow up on my recent hiv/std question

88 months ago
Hi Dr. HHH - apologies for the follow up, but touching base with you has been the most helpful in allaying fears.

Today marks two full days of taking valacyclovir.  The macupopular rash concentrated on the left side of my back was spreading to my upper back, but the spreading has stopped and the red dots are smaller and have faded in color since beginning of the treatment.

If this rash was caused by ARS, would such a rash also shrink and respond to   valacyclovir? Or is the fact that the rash has responded to valacyclovir prove that the rash was not ARS? 

Sorry to beleaguer the rash point (I recall you mention that an ARS rash is body wide and pink), but I have read too many articles on the ARS rash being nonitchy macupopular (which would describe my rash).

Finally, the dhiarrhea has been gone for 2-3 days now, but my throat was scratchy when I woke up today. 

From reading your other forum posts, it sounds like ARS (if it is possible to generalize) would materialize as a fever, sore throat, rash, all at once and could last a week or so. That is, if I truly had ARS, i would know something was truly off with my body (like having the flu). Although i have been a little lethargic since exposure (9 days ago), I was never bed ridden or intensely ill.

Thanks again for counseling me through this tough time.  I am looking forward to taking a duo at the 2 week mark, but in the meantime, your counseling has been invaluable.

Edward W. Hook M.D.
88 months ago

Welcome to the Forum.  As you may know, Dr. Handsfield and I answer questions interchangeably and today I happened to pick up your follow-up question.  This may be a good thing as now you will get a 2nd opinion from us.  And that opinion is to reinforce what Dr. Handsfield has said- there is NOTHING in your description of rash that in any way suggests the ARS.  The response you describe ins not atypical for the response of herpes zoster to valacyclovir or the natural history of the sorts of ill-defined, non-ARS "traveler's rash" that persons traveling the world get from time to time. 

If you had the ARS, you would be quite sick with high fevers, body aches, and severe sore throat, non of which you have described.

From your post, I would guess that you are spending too much time (actually, any time is too much) trying to sort things out through internet searches.  This is a bad idea.  We spend much of our time trying to correct mis-understandings that come from the internet where descriptions are not uncommonly incorrect or presented out of context.  I am completely confident that your two week duo test will be negative. 

I urge you to accept the counsel that Dr. Handsfield give to you in his initial response and that I endorse 100%.  Work to move on.  Don't let your guilt and anxiety related to this (no risk) exposure get to you.  EWH

88 months ago
Hi Dr. Hook,

Thank you for your reply -- it is appreciated.  I want to follow up on my previous post.

2 weeks post exposure, I received the HIV 1/2 Ag/Ab 4th generation test, which came back negative. 

1.  The technician that gave my results was confused when I asked whether this test was the "combo test that tests for antigens and antibodies"?  Can you confirm that such test is the combo/duo test that you and Dr. HHH recommend on the site?  The pamphlet regarding the test notes the following: "This test was performed using Bio-Rad Evolis GS HIV Combo Ag/Ab EIA system." I ask because the technician told me I should wait 4-6 weeks for testing because the antibodies will not form until that time, and she looked puzzled when I asked about the antigen component of the test. 

2. I recall that you or Dr. HHH mentioned that the Duo test is approximately 60% accurate after 2 weeks (acknowledging there is less data on accuracy at this time interval).  Is that a fair characterization of your assessment on tests 2 weeks post-exposure?

3.  To refresh your memory, I had dhiarhea, fatigue, a localized maculopapular rash (diagnosed as shingles) about 3-4 days after the incident.  I was concerned these symptoms could be ARS.  I recall that you or Dr. HHH have advised that a negative combo test 1 week after alleged ARS symptoms rule out the possibility that such symptoms are actually due to ARS.  Is that correct and would you say that my symptoms could be ruled out as ARS as a result of this negative test 10 days after the onset of the symptoms?

4.  At this point, the rash and dhiarhea has cleared up, and a sore/scratchy throat and moderate fatigue remain.  I am trying to get to the bottom with my Doctor about what is going on with me, and she recommended against bloodwork.  Do you agree?  I generally do not get sick for up to 2 weeks at a time and am uncertain what steps I should take to resolve this issues.  I figured bloodwork would provide some data on whether I could have a viral or bacterial infection, but I am curious your thoughts. One could say all the symptoms relate to shingles, but my sense is shingles generally does not manifest itself with these other symptoms for this period of time. 

As always, thank you for your services. 

Edward W. Hook M.D.
88 months ago

1.  The test you describe is a 4th generation, combination HIV antigen/antibody test.  It sounds as though the technician was simply reading the package instructions as to the time frame for results.

2.  Yes

3.  When persons are symptomatic with the ARS, the 4th generation combo tests are positive.  The symptoms are a manifestation of the high concentrations of virus present.

4.  I do agree with your doctor.  If you had a bacterial infection you world likely still be getting sicker.  Your illness sounds like the sort of viral illness that many travelers get and for which there are not good tests.  I see no benefit to you from additional testing.

Hoping you will be able to relax soon.  EWH