[Question #9683] HIV risk - ARS symptoms

30 months ago

Hi Dr,5.5 weeks ago had intercourse w/ CSW Montreal, not the cheap street sort protected & condom didnt fail (not when i looked after but didnt look at the tip & I keep getting told that when it breaks its obvious - as in not just the tip). had 2 small shaft shaving nicks 4 hours prior. 2-3 weeks after, some muscle pain, very mild sore throat for 2 days, one time I shivered in bed for secs (didn't feel cold), 2 small neck nodes (after checking for a 1M times),& more importantly rash on both arms, mainly one-no idea how to describe- few light red patches close to each other w/ sort of reddish raised kind of hair follicles like dots. no itch-you cant tell theres a rash w/o looking close. No fever. I will to test but freaking out now.I also have sarcoidosis so had rashes before but not like this one. Had severe covid end of Dec. Asked on forums & keep getting told shaving nicks even if uncovered & in opening of the vagina (inside) no concern-on other forums Dr Handfield & Dr Hook say same. Also, Dr Hook on Medhelp says ARS symptoms last for around a week & rash for few days but Dr Handsfield says few weeks- my rash for 2.5 weeks now, not improving. Last, CBC (routine sarcoidosis) shows low Lymphs (I take Methotrexate so not sure) & elevated Neutrophils (still in range just higher than last CBC). Also dont know what to attribute to anxiety like cant sleep -im on forums day & night & told not to worry.Appreciate your thoughts

30 months ago

Sorry but just to add: today I got new red spots (look different than the ones on my arms - just red not raised), like 5-10 under my chest and few on my nose. Does ARS rash evolve after 2.5 weeks of onset or could this actually be the one after 5.5 weeks?

H. Hunter Handsfield, MD

30 months ago

Welcome to the forum. Thanks for your confidence in our services; I'm happy to help.

The bottom line is that it is exceedingly unlikely you have HIV; something else explains your symptoms. First, as you seem to understand (intellectually if not in your gut), this was a very low risk exposure. Such CSWs are unlikely to have HIV; they tend to be health conscious, use condoms, get tested often, and have low risk clients -- men like you). Second, with an intact condom, your risk was a hundred-fold lower than it would have been otherwise. And I agree (still) that superficial penile cuts like shaving nicks do not significantly raise the risk of HIV. Third, your symptoms are not typical for ARS. The onset was too late (usually 8-10 days, always within 2 weeks); no fever; minimal if any lymph node enlargement; and the rash doesn't sound typical. Your CBC results don't provide clues one way or the other. I don't recall previously discussing the duration of the rash of ARS; it can fade in a couple of days or stick around for at least a couple of weeks.

I'm glad you're planning to have an HIV test, but you could have done it as long as 2-3 weeks ago. Perhaps you have some common misunderstandings about HIV test performance and timing. First, although it takes up to 6 weeks for the now-standard antigen-antibody (AgAb, "4th generation") blood tests to become positive, usually they are positive much sooner; a negative result at 3-4 weeks, for example, is very strong evidence someone wasn't infected. Second, and perhaps most important in your situation, the AbAb tests (or the antibody tests, i.e. third generation) always is positive if symptoms are caused by HIV. (It isn't HIV itself that causes symptoms of ARS, but the immune response to the virus -- reflected in the antibody test.) So now, 5.5 weeks after your exposure, a negative AgAb test would be at least 98% proof you don't have HIV, and 100% that your symptoms aren't due to HIV.

For those reasons, I agree with the doctors who have reassured you so far, and I'm happy to add my own confidence you don't have HIV. Go ahead and have an HIV test, ideally an AgAb test. You definitely can expect negative results. Please return and let me know the result when it's done.

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

HHH, MD

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30 months ago

Honestly i'm too scared to test as well but i'll do it. Anyway im moving to the uae and they will test me regardless. Last few questions: would the ARS rash evolve after 2 weeks (my point around new spots of different look showing up on face and trunk), and this one is silly as if you are the condom expert :) but do they clearly show if they break of could it be jusg the tip? Last, would the rash stay for 3 weeks+?

H. Hunter Handsfield, MD

30 months ago

You're over-focused on the rash. I've given several reasons why you don't have HIV and your rash is the least important of all of them. There are so many causes of skin rash, it's really not appropriate to ever consider it an important indicator of HIV. It means nothing one way or the other.

As for testing, here comes a mini-lecture. I have no patience with avoiding or delaying testing for fear of the result -- and I'm sure you understand it's irrational. It isn't the test that gives someone HIV: you have it or you don't, and if you do, you have an absolute responsibility to yourself, your partners, and your significant others to know and take appropriate steps. And when someone has delayed testing and finally pull the trigger, anxiety always declines, even with a positive result. The stress and anxiety before testing is always worse than the relief of knowing, even if it's bad news, i.e. clearing the air. Same deal with other tests for dangerous conditions, like delaying colonoscopy for colon cancer, mammography for a breast lump, and so on.

Let me know your test result, if you would like. It's the only important additional information you can possibly add, so I will have no further comments or advice until and unless you let me know your test result. OK? Stay mellow in the meantime: in the nearly 20 years of this and our previous forum, with thousands of questions from HIV-worried users, not one has yet turned out to have HIV. You won't be the first! If and when it happens, I'm confident it will be from a far higher risk exposure than yours.

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30 months ago

Thank you Dr, appreciate the help.

29 months ago

Hello again Dr.

Thanks for keeping the question active. I took the test (no idea which one - I'm in Canada) and it's negative, but still was told to come back at 3 months.

I trust you when you say this is pretty much a confirmation but please bear with me without getting upset and help me by answering just one question: can the rash persist when all other symptoms are gone (except for cervical lymph nodes)? I know you told me to stop focusing on the rash, but it's no longer just the not so typical one on my arms, now it's literally raised and flat pink circular 'buttons' on my trunk. It's been 7 weeks since my potential exposure. I just want to know if it can persist on its own (when muscle aches are gone) or whether all symptoms go together like they come together. Thank you very much Dr.

29 months ago

Sorry, also red blotches around my nose too so now 3 different types of rashes on arms trunk and face…. I know I should see a healthcare provider and I am seeing my sarcoidosis specialist but only in couple of weeks (thank our healthcare system)…

H. Hunter Handsfield, MD

29 months ago

Hey -- congratulations for biting the bullet and being tested!

In Canada, it is likely you had an AgAb (4th generation) test. It proves two things: 1) You do not have HIV. (Anyone recommending another test at 3 months is just being hyper-conservative. Nobody in the world ever was positive at 3 months if negative 6+ weeks or after exposure. It never happens. 2) Your symptoms are not from HIV. It is impossible to have symptoms from HIV (rash or any other) with negative HIV antibody. It isn't HIV itself that causes symptoms, but the immune response to the virus, which is reflected in the antibody portion of the AgAb tests.

So all is well. That concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe!

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