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Dr. Abby
Dr. Abby, US Board Certified MD
Category: Medical
Satisfied Customers: 10330
Experience:  Family Physician practicing medicine for over 10 years, United States
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I have a rash, swollen lymph nodes, sore throat, canker sore,

Resolved Question:

I have a rash, swollen lymph nodes, sore throat, canker sore, abdominal pain upper right below rib cage, had sinus congestion for 10 days, burning sensation on skin. These symptoms started to appear 2-6 weeks following a same sex encounter with another male. There was no sexual intercourse, just oral copulation (receiving), and mutual masturbation. Are these symptoms of ARS or Hepatitis
Submitted: 5 years ago.
Category: Medical
Expert:  Dr. Abby replied 5 years ago.

Have you had any fever?
Jaundice (yellowing of the skin/eyes?)

Dr Abby
Customer: replied 5 years ago.
No fever, vomiting or jaundice
Customer: replied 5 years ago.
Some very minor nausea, but very brief, momentary only
Expert:  Dr. Abby replied 5 years ago.
Ok, thank you.

Do you know the HIV status of your partner?
Customer: replied 5 years ago.
I had two encounters, the first on July 22 who indicated HIV-, the second on August 16 I do not know.
First encounter was oral copulation (receiving) and mutual masturbation, with some heavy, rubbing on the genitals, and opening of the anus, no insertion of finger or if so was very slight, but it was aggressive and fast rubbing in the region a little time. There was no ejaculation there, but concerned his hand may have had his pre-cum

Also, the second encounter was mutual masturbation only, no rubbing anus or genital area
SymptIns started on August 22 with a rash in the morning, a got a sinus cold on aug 30 with minor sore throat
Since aug 30 the other symptoms developed, abdominal pain, small red bumps, burning sensation, lymph nodes.

I feel like I practiced safer sex, and worried and confused by these symptoms
Expert:  Dr. Abby replied 5 years ago.
The risk of HIV is extremely low from these encounters, regardless of the HIV status of your partners.
The symptoms that you are describing are consistent with a viral syndrome..including ARS. Fever is typically present in ARS, though.

Hepatitis C is difficult to transmit sexually, Hepatitis B can be transmitted sexually, including through oral sex.
However, hepatitis B would not cause many of the symptoms you are can cause pain in the right upper abdomen, jaundice, nausea/vomiting or no symptoms at all.

As you know, the only way to know if you have seroconverted is to be tested. Your chance of HIV is about 0.04% from one oral sex encounter--therefore it is highly unlikely that you have HIV.

I know that this can cause extreme stress and worry given the multiple symptoms. I believe it is more likely that you developed cold (sinus congestion/sore throat) that led to swollen glands as well. Canker sores are common and do not indicate HIV. The rash could be viral/non-HIV as well..or acne as you originally thought.

Feel free to ask any follow up questions you may have,

Dr Abby

If you are satisfied with my help, please remember to click accept. Thank you!!
Customer: replied 5 years ago.
When I did a rapid HIV test NAAT, aug 26, four days following the first encounter, it was negative
They said I would need to come back and test again, as results are more conclusive at least 7 days after possible exposure. I just tested again last Friday and need to wait two weeks for the outcome. It's not an anti-body test, but a test done by a research university working sob the firms that screen blood bank supplies to look for the virus in the blood to do early detection.

I am so confused about why I would be having these symptoms, showing up in the same period following safe sex guidelines. My fear is that pre-cum may have enter my penis or anus during mutual masturbation or rubbing. There was no ejaculation used as lubrication, but I am very concerned about these symptoms.

I have not had a fever, but realize ARS symptoms don't always show up all the time, and I am really confused and afraid. Are you familiar with the NAAT test for early HIV infection? And the accuracy of the test?

Expert:  Dr. Abby replied 5 years ago.
Yes, the NAAT test is reliable at about 10 days and is very accurate after this time period because, as you know, it detects the virus, not the antibody response to it. The Red cross uses this test to screen its donors.

You are correct, not all the symptoms of ARS occurs in all people (fever occurs in about 80% of people).
I cannot explain all of your symptoms in a neat little package. I wish I could. Much of it does sound like a cold.
The canker sore could have been triggered by your cold.
The abdominal pain is likely a separate issue although many viruses also cause abdominal pain.

It is so unlikely that you have HIV or hepatitis from these encounters but I cannot take away the fear for you until you have received your results.

Dr Abby

Dr. Abby and 6 other Medical Specialists are ready to help you
Customer: replied 5 years ago.
Thank you for your feedback.
The 2 different rash types, and burning sensation in arms persist
When using topical anti-biotics the small red bumps that might be confused for acne at first glance didn't go away
Perhap they are causing some of the subsequent rash issues because I have been using a lot of it twice daily

Because my doctor said I had liver enzymes twice what they should be on August 29, I started taking milk thistle as I heard it was a liver cleanse. My mom suffered from auto-immune hepatitis, but I understand that is rare and happens more frequently in women.

Should I stop taking milk thistle until I consult a physician?
What other issues could cause liver enzymes to be produced twice the amount, if it were an STD one week following an encounter?

The group that took the NAAT test said if I didn't get a call this week, then I should be okay, so they look at a 7 day window. negative results are posted online two weeks after the test.

Expert:  Dr. Abby replied 5 years ago.
Do you take any medications regularly? (prior to the liver enzymes test?) including over the counters?
Drink alcohol?
Are you overweight?
Customer: replied 5 years ago.
I do an albuterol inhaler once a day when exercising
Claritan for allergies, mild hay fever
Erythromycin bezoyl-peroxide gel
Milk thistle
Ginko-biloba in vitamin supplements
Extra Vitamin D, B
Fish oil

I was 35 pounds overweight in Jan 2011, but working out, and eating low carb, high protein, and fat diet lost the excess weight by July 29. I had minor constipation around the same timeframe, 7/29-8/10, never had abdominal pain on the right side before that persisted for about 10 abdominal pain right now, and no vomiting or diarrhea.
Expert:  Dr. Abby replied 5 years ago.
Ok, thanks.

Elevated liver enzymes can be due to many things-medications being one of them.
Cleocin, if you were on it prior to the test, could be the cause.

Being overweight can as well--since you have lost the weight, this is less likely to be the cause (congratulations!).

Alcohol and tylenol are two other causes.
I would stop the cleocin prior to the next test if possible.

As for the milk thistle, it may improve liver function tests; however, we really want to know what is going on (ie whether they are elevated or not on your next test). I would stop it for now.

The evaluation for elevated liver enzymes is this: repeat them a second time. If still elevated, then test for hep b and c, check iron levels (excess iron can cause high liver enzymes--this condition is called hemochromatosis) and order an ultrasound of the liver.

Further tests (autoimmune tests, etc) would be done if the above blood work is normal.

dr Abby
Customer: replied 5 years ago.
Thank you for the info.
Was being overweight the casue of higher liver enzymes or losing the weight over 9 months?
I was overweight 2 years ago (still 35 pounds overweight) and I can't remember if liver enzymes were higher then
The Cleocin I use is a topical solution however, does that make a difference??

Expert:  Dr. Abby replied 5 years ago.
If the cleocin was topical, it is not the cause...

Weight loss usually causes the liver enzymes to improve. So it was not likely the cause of your elevation.

If they were higher prior to the weight loss, then it may be due to your weight and you simply need more time for them to normalize.

See what the repeat shows. If they are coming down, then it may be weight--or it could be viral (non-hep b or c) given the fact that you had other viral symptoms.
For example, mono can cause an elevation of the liver enzymes.

Dr Abby
Customer: replied 5 years ago.
Thanks for the info. I haven't suffered any fatigue, loss of appetite, or sweats, definitely anxiety and feeling not right, but wondered if mono can be in all lymph nodes, have a rash, and not experience fatigue or lethargy? And how long does mono take to incubate?

Thanks again
Expert:  Dr. Abby replied 5 years ago.
Yes, mono can cause a rash, swollen glands and a sore throat. Not everyone has the significant fatigue...
It has many variations.

The incubation period is 4 to 8 weeks.

Dr Abby
Customer: replied 5 years ago.
Ok thanks. Well maybe it will turn out okay
My liver test was July 29, so either mono didn't cause it or I got it before the encounter.
But the 4-6 weeks starting showing symptoms if I got some from this encounter
The Aug 16 encounter was mutual masturbation, kissing, only
That's too soon to see Mono from this encounter it sounds like.
Also had a rash on aug 23, one month after the first encounter. Last for a few hours only
Then had start of a sore throat on the 23rd, aug 30 sinus congestion, stomach cramp on right side Sep 2-8, lymph nodes same period, Sep 8 canker sore, Sep 11 lymph nodes same, Sep 13 sinus gone, Sep 14 sore throat 5% pain,
Sep 14 bumps still there, some new one on shoulders, rash that lasted only 1/2 hour on shoulder (mottled look), does this sound like a progression of mono and a cold?

I really appreciate your feedback while I wait forbid test results to come back in the next week

Thanks again
Expert:  Dr. Abby replied 5 years ago.
It is so difficult to say.
It sounds like your liver tests are likely unrelated to the encounters to begin with given the close proximity to the first encounter.

A typical cold virus does not cause a rash. Other viruses (CMV, mono) can cause a rash. The timing of everything does not all fit with mono; so I cannot say exactly what the cause of all of your symptoms are.
It may be that you have multiple separate issues, too, that cannot be related to one thing.

dr Abby
Customer: replied 5 years ago.
Thanks for the feedback. Are there are other STDs that could causethese symptoms?

Expert:  Dr. Abby replied 5 years ago.
No, not this set of symptoms.

Dr Abby
Customer: replied 5 years ago.
If Mono produced a rash, it would be at what point, at onset after incubation or later as it progresses?
Thanks again
Expert:  Dr. Abby replied 5 years ago.
The rash usually appears 1 to 2 days after the onset of symptoms but this is variable.

Dr abby
Customer: replied 5 years ago.
Thanks for your help
Customer: replied 5 years ago.
What are the first symptoms of mono
Expert:  Dr. Abby replied 5 years ago.
Like I stated above, it is variable.
Fever, fatigue, sore throat, swollen glands are some of the more common ones.

dr abby
Customer: replied 5 years ago.
Ok thanks
Expert:  Dr. Abby replied 5 years ago.
You are welcome.

I have a feeling mono is probably not the cause. A remote possibility.
Like I said, I wish I could tie everything together for you and give you a diagnosis but I just can't.
I do not think you have HIV, though.

Dr Abby
Customer: replied 5 years ago.
You are making feel better,
I just keep thinking back to those encounters and examine the details,
I wonder if the aggressive friction on the opening of the anus may have been higher risk if there was precum on his hands
Or what if the openings of our two penises were rubbed together, or touched briefly??
Just not sure and very worried

Expert:  Dr. Abby replied 5 years ago.
I do think that you may be over-analyzing a bit.
I can understand why you may be doing it given the fact that you have some unexplained symptoms.

Anal sex is more risky due to the fact that there is more risk of trauma/tears which allows more easy access to the bloodstream. If there was no trauma (you would feel injury/tearing) and no anal entry (you would feel this as well) I think the risk is negligible.

As for the urethral openings rubbed together or touching briefly, the amount of viral exposure would be very low (assuming that the partner was HIV positive to begin with) and therefore a lower risk exposure.

I cannot say that you have no risk if these happened. But you are not sure that this did happen....
You will know within 48 hours if you had a positive test. Try to get out and do things to distract your mind if you can.

dr abby