Slightly worried about rash after potential exposure + PEP

[superr]

Hi,

On June 8 I had receptive anal with another man of unknown HIV status, initially there was a condom, but somewhere during the late night and early morning hours a condom wasn't being used, and I didn't notice, when I did I immediately told the guy to put one on.

Unfortunately the whole incident was a stupid, drunken mistake on my part and totally out of character for me, the whole situation left me feeling terrible about myself. Back to the incident itself though, I am quite confident no ejaculation occurred anally (the alcohol muddies my memory but I am certain I would have noticed if there was), so as a precaution I decided to take myself to my local hospital the next day where they promptly went into a frenzy, worrying me more than I initially was, and urged me to begin PEP (which I had never heard of) for a month along with doing a Day 1 baseline STI screen.

I completed PEP (which was one dose of Combivir every 12 hours) on about July 8. I was screened again for all STI's by the hospital on Week 5, which came back all negative. I am due to be screened again at 3 months (early Sep) and 6 months (early Dec).

I saw a counselor as part of the program to ease my anxiety and discuss my feelings about the whole thing. Until this point everything has been quite alright, initially the Combivir made me quite ill (stomach upset, constant nausea, lethargy and loss of appetite) but nothing truly serious has occurred.

I have not had fever, sore throat, myalgia or bad malaise (besides the lethargy in the first few days of Combivir). Nor is there any rash on my chest or abdomen. I did at one point convince myself I had thrush but after talking with a pharmacist and a course of Nystatin, turns out I thankfully didn't. I've always been a dreadful hypochondriac, the counselor helped with this though.

However, over the last few weeks since the Week 5 test, the blood test site on my left arm (on the elbow pit area) became itchy and dry to the point where a few days ago it was about the size of a bottle cap and very red and very itchy, I was getting looks in the street it was so bad looking. A few similar but much milder and smaller patches appeared on my right elbow pit as well and on the folds of skin on both my armpits, more acute itchy dry and red patches like the left arm also appeared on on the backs of my knees.

All of these patches on my body are incredibly exacerbated by hot showers and fabric.

Now, for context, this isn't entirely unusual for me as I have suffered from permanent hand eczema and hayfever all my life and am known to occasionally get pretty bad dermatitis, although I have not had anything as simultaneously spread across different body parts like this for a few years. Dermatitis of the legs is very common for me in these winter months with hot showers, in fact I have often ended up with viral and fungal infections from scratching my legs in winter. However the arm rash is not very usual for me.

A few days ago I began applying my eczema treatment of strong moisturizer, zinc oxide and betamethasone to all the patches. The less aggressive patches on the right elbow pit and both armpits have vanished completely, albeit for some slight flaky skin on my armpits. The more aggressive patch on the left arm has not yet faded though and appears more stubborn, although it has improved marvelously over the last few days since using my treatment. The patches on the backs of my knees are very red still, but improving and are no longer very dry or itchy but then today I've noticed a small strip of skin on my right forearm appeared slightly red, bumpy and itchy (it's not dry but it has tiny raised bumps which all the other patches have not had, and I mean 'slightly', it's not very noticeable), the itching stopped with betamethasone cream and the redness decreased, however it is still there tonight.

Typically any dermatitis I've had has cleared up faster than this, usually over 2 or so days, not the 5 or so that I'm at now.

All of this has undone some of the progress I made on my anxiety as I know about the so-called 'ARS/HIV rash'. I've read conflicting information about what the rash is supposed to appear like and where on the body it is most common. I am not ridiculously concerned as I have not had any other symptoms other than a single tiny mouth ulcer which disappeared after one day and I'm sure was caused by hot food or accidentally biting my gum or my nightly dental plate (I'm prone to occasional mouth ulcers that heal overnight like that); and numerically I'm aware my odds are very good, however this has shaken me up slightly and I would like some advice or opinion as to whether these rashes are a worrying sign or not.

Thanks so much for your time.

[Ann]

superr,

Your five week post-PEP negative is unlikely to change when you confirm at three months post-PEP. You do NOT need to test out to six months. Three months post-PEP is conclusive.

The rash that sometimes accompanies hiv seroconversion is NOT itchy. Whatever is going on with your skin has nothing to do with hiv. If you skin continues to worry you, see a doctor about it.

I fully expect you to come out of this ok. Please learn from it and make sure condoms are being used each and every time you have anal or vaginal intercourse.

Here's what you need to know in order to avoid hiv infection:

You need to be using condoms for anal or vaginal intercourse, every time, no exceptions until such time as you are in a securely monogamous relationship where you have both tested for ALL sexually transmitted infections together.

To agree to have unprotected intercourse is to consent to the possibility of being infected with an STI. Sex without a condom lasts only a matter of minutes, but hiv is forever.

Have a look through the condom and lube links in my signature line so you can use condoms with confidence.

Anyone who is sexually active should be having a full sexual health care check-up, including but not limited to hiv testing, at least once a year and more often if unprotected intercourse occurs.

If you aren't already having regular, routine check-ups, now is the time to start. As long as you make sure condoms are being used for intercourse, you can fully expect your routine hiv tests to return with negative results.

Don't forget to always get checked for all the other sexually transmitted infections as well, because they are MUCH easier to transmit than hiv. Some of the other STIs can be present with no obvious symptoms, so the only way to know for sure is to test.

Use condoms for anal or vaginal intercourse, correctly and consistently, and you will avoid hiv infection. It really is that simple!

Ann

[superr]

Thanks for the reassurance, by the way by 'Week 5 test' I mean post-exposure not post-PEP, however at this point I'm only a fortnight from 5 weeks post-PEP. That last test I had done was only 1 week post-PEP. However at the 5 week post-PEP point I could use a referral I've had lying around for a HIV test, external from the hospital (the hospital really only want to test me at 1 Day, 2 Weeks, 5 Weeks, 3 Months and 6 months post-exposure).  The red patches are looking even better today again, looks like it's clearing up for good.

Thanks for the help. 

[Ann]

superr,

You're welcome.

Again, you do NOT need to test out to six months post-PEP. The guidelines in your country have recently changed and they explicitly state that six month testing is NO LONGER recommended - because it's not needed.

(I know what country you're posting from because as an admin, I can see your IP address. I've not named your country as it's a confidentiality issue - you didn't name it yourself.)

A three month post-PEP negative result is conclusive, so don't think you have to sweat this out for three months more than you actually have to.

If your health care providers insist you need to test out to six months, tell them to read the new PEP guidelines. They've just come out of the consultation phase, but I can tell you that dropping the six month testing is not going to change. In fact, by the time six months rolls around for you, the new draft guidelines will probably be the official guidelines, as they are currently written.

The post-PEP testing guidelines have already been changed to three months in the UK and Europe, and it was changed several years ago. And the sky didn't fall in and they weren't missing infections.

I'd like to remind you at this time that you have one free post left - please use it wisely.

Ann

[superr]

Hi Ann,
I've just read the new guidelines and you're right, 6 month testing is no longer recommended. However the guidelines do say that the 3 month test is to be post-exposure. This means it will only be 2 months post-PEP.

And on my rashes and such, some of them are continuing to improve, still with no itch. However the patches under my arms are not responding and look red and strange. I will probably call the HIV hospital dept I've been seeing and get them to assess it.

Thanks

[Ann]

superr,

Let me remind you that the new document is still in its draft form.

I think there is a very good chance it will be amended in its final form to reflect the current UK and European guidelines which clearly state that one should be tested at twelve weeks following the conclusion of PEP.

But six months, no. Not necessary.

Good luck.

Ann

[superr]

Hi ann,
You're right, it's still possible for that to happen. Although I think I need to change the subject for unfortunate reasons - I went back to the hospital clinic on Monday, both my nurse and doctor there said it was almost certainly just dermatitis, and the good news is it all seems to be clearing up, they decided to do another HIV blood test though. However, this morning I've awoken with a stuffed nose, a sore throat and mucky chest along with what is probably bacterial conjunctivitis (bright red watery eyes with lots of crust). I'm going back to the hospital for the test results tomorrow morning, but now I'm absolutely freaking out about these new symptoms. Are these symptoms ever HIV-related and if so, what are the odds of this 2 month post exposure/1 month post PEP result coming back positive (assuming that I got infected at all)?

[Jeff G]

Your symptoms not specific to the HIV virus by any means .

You have done all you can do and that's complete PEP . Ann went over the testing window periods already so you know testing at the appropriate time is the best you can do now .

I would expect a negative result . 

[superr]

Just saw a doctor at a separate medical centre about the eyes, nose and throat. Diagnosed with bacterial conjunctivitis and sinusitis. He said the two very often occur together, that the sinusitis could've spread to the eyes easily. I had acute sinusitis only 2 months ago or so and it took a long time to fade because I didn't seek treatment, it could possibly simply be a recurrence gone wrong. It's eased my mind a little but I will still obviously be speaking about it to the HIV clinic tomorrow morning when I get Mondays results back. I'll keep you posted. Thanks for the help 

[Andy Velez]

We continue to expect you to come out of this ok as far as HIV is concerned.

[superr]

Just got my 1 month post-PEP result, all clear, negative for both antibodies and antigen My consultant nurse also said that the conjunctivitis and sinusitis don't appear to be relevant to any potential infection. Next due blood test is on September 2. I'll keep you all up to date with any relevant happening between now and then.

Thanks for the continued support

[Andy Velez]

While waiting to re-test you need to make a real effort to focus on other matters in your life. Don't bother saying you are too worried to do that. That response won't fly here. Just do it. You will find that the waiting time will pass much more easily than you may imagine is possible.

We continue to expect that ultimately you will test conclusively negative.