[Question #8014] High risk exposure

49 months ago

Hello Doctors,

Thank you for your service and dedication to health and medicine.

I’m a woman and on June 1st I had a risky exposure. I’m normally very careful and rarely sexually active when I’m not in a committed relationship.

The exposure was unprotected vaginal intercourse without internal ejaculation (pull out method) with a self identified heterosexual male, non IV drug user. I realize this was very risky especially because this person is non-monogamous. He shared that he was very confident he did not have any STDs and shared a test result which was negative for chlamydia, gonohrrea, syphillis, and HIV.

I got in touch with my PMD for PEP and her staff gave me conflicting information. Initially, they thought it wasn’t necessary. Finally, she approved PEP but it was too late and she didn’t submit a prior authorization, so it was approved after 72 hours. I didn’t take it as a result.

I have been having symptoms. In less than a week, I had a canker sore in my mouth, a swollen lymph node in the right side of my neck, and general feeling of malaise. I don’t know if I had a fever. I also had an ache in my left groin on and off and that went away in a week.

Most concerning is about a week ago (3 weeks after the exposure) I started to have a rash on my feet. They were small red lesions and they left after a day. Now it’s been a week and it appears to be spreading, mainly on my hands and feet. Now it’s more pale colored. All other symptoms were gone but now I’m feeling a bit unwell again.

It sounds to me like I might have acquired HIV. I’m trying not to panic. I’m abstaining from sex. I’m reading everything I can about it and trying to understand what to prepare for. I’m planning to get tested tomorrow.

My questions are:

How can I take care of this rash? It’s a bit painful and it’s bothersome.
How does the rash go away?
What are the best HIV treatments for women?
Are injectable ARVs an option?
How can I take care of myself while I wait for the results of the HIV test in case it’s positive and the virus is attacking my immune system? I’m avoiding alcohol. Should I also avoid exercise and physical exertion? What can I do to prevent further damage?
How long after beginning treatment does someone start to feel well again?
Any hope you can share about treatments or potential cures would be great.

Thank you again.

H. Hunter Handsfield, MD

49 months ago

Welcome to the forum. Thank you for your question and your kind words about our services.

You don't say where you are -- but if in the US or western Europe, or most industrialized countries, this was a much less risky exposure than you imply. In those countries, the odds a particular heterosexual, non-injection-drug using male migth have HIV is well under one chance in a thousand, and probably a lot lower than that. I would have strongly recommended against PEP and am glad you didn't get it arranged in time!

As for your symptoms, they really don't sound like those of a new hIV infection. Among other things, HIV certainly would not cause an itchy rash limited to the feet.And although oral ulcers and malaise can result, these along are not highly suggestive of HIV.

Rather than speculating on whether you need ARV treatment or the best drugs to consider, or how quickly they might improve your symptoms, I strongly advise you to have an antigen-antibody (AgAb, "4th generation") HIV blood test right away. You're now 4 weeks since iexposure, and a negative result will be 98-99% conclusive. And it will be 100% conclusive that your symptoms are not caused by HIV: it is impossible to have HIV symptoms and have a negative HIV AgAb test.

Andother options would be to contact your partner and ask him to be tested. If negative (with any kind of HIV test), it would prove you were not exposed.

I'll be happy to comment further if you'd like to get tested and let me know the result. In the meantime, do your best to relax: almost certainly it will be negative. Perhaps it will also help you to know that in the 15 years of this and Dr. Hook's and my preceding forum, with thousands of questions from people concerned about having acquired HIV, not one person has yet turned out to have been infected. If and when that happens, undoubtedly it will be in someone with a truly high risk exposure. In the meantime, I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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49 months ago

Hello Dr. Hunter Handsfield,

Thank you so much for your reply and reassurance.

I'm in the US in California.

The rash is actually not at all itchy, it's mostly tingly and bothersome. It's mainly on my feet, and on the palms of my hands.

It's circular, flat, and white. I was wondering if it's hives (which I've never had) but it's not itchy, so sounds unlikely.

It's very strange, I've never had my skin react this way in my life.

Does it still not sounds typical of ARS?

I plan to get tested tomorrow.

Best regards

H. Hunter Handsfield, MD

49 months ago

Thanks for the follow-up clarifications. It makes ARS even less likely. Sorry I misunderstood the details of the rash, but it doesn't sound at all like the rash of ARS.

However, I have to say that the rash of secondary syphilis comes to mind: few skin conditions cause rash on the palms and soles, but syphilis is one of them; and "circular, flat and white" also fits with syphilis. That said, secondary syphilis typically occurs 2-6 months after onset of infection, and so would have to go back to some earlier sexual exposure. But for sure play it safe and include a syphilis blood test along with your HIV test tomorrow. Let me know the results of both. (Threads nomrally are closed after two follow-up exchanges, so let's hold off on further discussion until you have the test results.)

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