[Question #7997] HIV risk
 |
50 months ago
|
I recently visited an Asian massage parlour in Australia and initially received manual stimulation from a sex worker. I then engaged in protected penetrative vaginal sex for no greater than 5 minutes. The condom appeared to be intact upon completion and was removed and I immediately cleaned my genital area with wet wipes. My concern is three days after this event, I began developing a pruritic rash in the vicinity of my upper right elbow. The rash has erupted in several localised areas on the upper surface of both arms over the course of two weeks. I would characterise it as maculopapular in nature but the severity tends to fluctuate throughout the day. I have no other symptoms. Should I be concerned about HIV or any other STI? Additionally, I am going through a severely stressful episode in life and I'm not sure if that is contributory to the rash or if STI exposure should be the primary consideration.
|
50 months ago
|
I see that all other questions have been responded to except mine. I'm just curious if it is an oversight. I'm having a lot of anxiety over my situation which I know tends to be the case on this forum.
 |
H. Hunter Handsfield, MD
50 months ago
|
My apology -- very sorry for the long delayed reply. Thanks for the reminder.
As I think you know, this was a near-zero risk exposure. Condoms work, so the vaginal sex carried essentially no risk for HIV and very low risk for other STIs. Hand-genital contact is always zero risk. In addition, the frequency of HIV in se workers in Australia is very low.
And your symptoms do not suggest either HIV or any STIs; none can possibly cause a localized itchy or maculopapular rash, especially as soon as 3 days after exposure. I am very confident that the rash has nothing to do with the sexual exposure, just a coincidence in timing. If it continues, it would make sense to see a physician, but not on account of HIV or other STI.
I hope this information is helpful. Let me know if anything isn't clear. Apologies again for the delay in responding.
HHH, MD
--- |
50 months ago
|
Dr. H,
Thank you for the response. Do you recommend getting tested in this scenario and if so, in what time window?
|
H. Hunter Handsfield, MD
50 months ago
|
In general, I do not recommend testing after any single exposure unless the risk is a lot higher than yours. Personally, if I were in your situation, I wouldn't be tested and would continue unprotected sex with my wife without worry. However, some people are more reassured by negative test results than by professional advice, no matter how expert. If so, consider testing for gonorrhea and chlamydia (urine test) at any time, and for HIV and syphilis after 6 weeks. Your choice!---
|
49 months ago
|
Dr. HHH,
I'm still dealing with the rash. It is still located on both arms and varies in intensity throughout the day. At times it seems to nearly disappear and at other in becomes raised and itchy. It is also now appearing in a few spots on my lower legs. No other symptoms. My biggest concern is ARS rash. Does this change your initial assessment in any way? I realise this is my second follow up but if you keep the thread open I will relay the results of testing when it comes available. Thanks.
|
H. Hunter Handsfield, MD
49 months ago
|
I remain confident your rash is not due to ARS. The skin rash of ARS generally consistes of red spots on the trunk, and it does not itch.
---
I'm not sure I understand the time since exposure and how long you have had the rash. A negative HIV test now would not necessarily prove you did not catch HIV -- but it would confirm your rash or other symptoms are not caused by ARS. All HIV antibody tests always are positive within 2-3 days after onset of ARS symptoms. (It is the immune response to the virus, not HIV itself, that causes symptoms.) I'll leave the thread open for one more cycle so you can report an HIV test result, whenever you have it.
I would also recommend you visit your nearest federal government sexual health centre. Collectively, Australia's SHCs are among the world's best resources for expert STI/HIV diagnosis and care. (If you happen to be in Melbourne or Sydney, you have access to the best of the best. But all the country's SHCs are excellent.)
------
|
49 months ago
|
Dr. HHH,
Just to clarify, I noticed the initial onset of the rash 3 days after my possible exposure. I realise this is early for ARS. The rash initially started on my right arm and then some days later started appearing on my left arm. It tends to develop in one area of the arm, then subsides, and then starts to develop in another area. I am now 27 days into the rash and in the past several days it has started appearing in a few isolated spots on my lower legs. No other symptoms have presented.
I did visit my local SHC for testing. I tested 18 days after the initial symptoms of the rash which was 21 days after my possible exposure. All STI's screened for have returned a negative result. The STI screening assay that the SHC conducts only tests for antibodies for HIV detection. As I understand from you and the SHC, if the rash were ARS related enough antibodies should be present for detection so a negative result excludes ARS. The SHC recommends testing again at 6 and 12 weeks which I intend to do.
I know this is my third submission to you and I appreciate your patience. Please let me know if I misunderstood anything. Thank you.
|
H. Hunter Handsfield, MD
49 months ago
|
This additional information does not change my my professional opinion or advice. I'm glad to hear you've in the care of your local SHC. If you don't mind, which one?
You've made me question policies at most (or all?) Australia SHCs about HIV tests. Researchers there have published data indicating that AgAb (4th generation) HIV blood tests are routine, which also was my personal understanding. However, I'm currently in an email discussion with the leaders of the Melbourne SHC; I'll ask them. (That they recommend testing as late as 12 weeks does suggest maybe your particular clinic is using standalone antibody tests. However, even those are conclusive by 6-8 weeks; and your negative results so far do prove your rash is not possibly due to HIV.) I'll leave the thread open until I hear back from my Melbourne colleagues about their routine HIV tests.
--- |
49 months ago
|
Dr HHH,
I am utilising the Darwin, NT SHC. They submit to Royal Darwin Hospital. I’m unsure as to the specific test they utilise but I was told that any positive result would then have to be verified by Melbourne testing.