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Sore throat, skin rashes after unprotected oral sex and protected vaginal sex. Have pharyngitis. Worrisome

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General & Family Physician
Practicing since : 2009
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I had unprotected oral sex and protected vaginal sex with a high risk individual seven weeks ago. I had a sore throat a couple days later which resolved quickly. two weeks later I developed a sore throat and went to a doctor when it did not resolve. He placed me on z-pack and towards the end I developed thrush which resolved with an oral nystatin mouthwash. I have had rechecks with the doctor every week for last several weeks and have been fine. Today, 7 weeks post exposure I have developed a non itchy skin rash on my breasts and back. It consists of red spots, some raised and others not. I am convinced I have HIV. All of my basic bloodwork is pending including STD panels which I wanted done. I still have a pharyngitis which has been four weeks. Please any advice I am scared to death. The rash got worse after a warm bath too. I thought I was just paranoid until I got the rash that seems like a maculopapular rash to me. I am surprised because from everything I have read seven weeks is later to experience this rash. Please help with any advice
Posted Mon, 13 May 2013 in Sexually Transmitted Diseases
Answered by Dr. Shoaib Khan 6 hours later
Hello and welcome to XXXXXXX

Thank you for writing to us.

I have gone through your query, and shall try my best to address all your concerns one-by-one. If there is anything I have overlooked, feel free to write back to me asking for more information. I would be more than happy to help you.

Now, first coming to your presentation of a non-itchy rash consisting of red spots, some raised and others not. It is a little difficult to comment on the specific cause as: first of all, we would have to physically examine the rash; and next, a laboratory analysis of the rash would be required. Without this, any doctor will only be able to put forward a few possibilities like:
-Seborrheic dermatitis
-Shingles (herpes zoster)
-Insect bites
-Viral exanthem
-Fungal infections
-Sexually transmitted diseases (eg. gonorrhea-will have fever, rash, sore throat, weakness; HIV- dry cough, difficulty breathing; syphilis - sores in mouth or throat; secondary fungal infections from HIV; etc.)
and a few others.

For a more concrete diagnosis, you will have to visit a doctor, without which it is difficult to comment on the disease or its cause.

Now coming to your fear of having HIV. At 7 weeks after exposure to a possibly HIV-infected individual, the best test to get conducted would be a HIV DUO test. This test combines an antibody test for both HIV-1 and HIV-2 strains with an antigen test for p24 antigen. This test is considered to be 99.9 % accurate from 30-90 days post-exposure. You could request for this particular test.

It is a good thing you have undergone an STD panel, this will greatly contribute. Do let me know the results once you receive them. You also need to know that there is no specific pattern of appearance of symptoms. Some individuals can experience their symptoms very early, and some very late. In my opinion, at this stage it is best to get tested at the earliest (if you haven;t already). Do not worry, and hope for the best.

I am always available to be of assistance, if anything. Do write back to me for any further clarifications. Wishing and hoping for the best.

Be safe,
God bless.
Above answer was peer-reviewed by
Follow-up: Sore throat, skin rashes after unprotected oral sex and protected vaginal sex. Have pharyngitis. Worrisome 12 hours later
Thank you for nice response. So it was actually six weeks possible post exposure. My antibody test was negative. I developed the rash two days after my blood draw for the test. I was wondering if two days later when I developed the rash would it have been positive? I know the test is the only way to know for sure but just wondering what you thought. Also, Can a rash be the only sign of acute retroviral syndrome? I have been told and have seen online that six week post exposure negative antibody test is likely to be pretty accurate. I also saw that most people show antibodys by 3 weeks post exposure. Is this accurate? Also the whole std panel was negative. Thanks
Answered by Dr. Shoaib Khan 10 hours later
Hello once again.

Thank you for writing in to me. I am glad you liked my previous response.

Normally, majority of patients are still asymptomatic (do not present with any physical symptoms) when the tests can detect or rule out HIV. Which is why the scientific world could not rely on the physical presentation and had to develop tests which would detect the virus much earlier. So, whether or not you had the rash, a test conducted at 6 weeks post-exposure will surely be accurate.

No, a rash is not the only sign of the condition. Let me explain the sequence of symptoms.
-Up until 2 weeks after exposure, majority of patients do not have any symptoms, and can just complain of not feeling their best
-From 2-4 weeks after exposure, patients experience a flu, which they can refer to as the worst flu they have ever experienced. This can also last up to 3 months. Symptoms are: fever, sore throat, ulcers in the mouth, muscle cramps, chills, rash, night sweats, weakness, etc.
-After this comes the latent phase, during which individuals will not experience any symptoms up to almost 10 years

Now coming to the last part of your query. Yes, all tests that are conducted after 3-4 weeks of exposure can give accurate results. Which is why I consider your test to be 99.9 % accurate.

I hope this information was what you were looking for. Do write back to me for any further clarifications, I would be happy to help you.

Best wishes.
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