Can Diarrhea, Folliculitis And Muscle Twitches After Unprotected Heterosexual Exposure Be Indications Of HIV?

Posted on Mon, 13 Jan 2014

Question: Hi following an unprotected heterosexual exposure to a female of unknown status, I've noticed various symptoms that may or may not be connected to the event. Weeks 1-5 Diarrhoea after drinking alcohol one evening. Week 7 Small lump popped up directly behind ear lobe on one side only. Unable to confirm if it was. Benign cyst or lymph node. Had mixed opinions, became more anxious and unsettled. Can feel them in groin and both sides of jaw, unable to confirmed enlarged as I've heard checking them can cause monitor swelling. Week 9 Diarrhoea without any alcohol consumption, just once. Week 10 Diarrhoea once and woke up a couple of times in a sweat. Week 11 Tongue appeared to have a white coating, constant salivation. Not painful and seemed to clear within two weeks. Not confirmed as Thrush but a noticable change that send me into panic. Week 12 A few pimples on but cheeks Week 14 White coating appeared again, doctor said it didn't look like oral thrush to him. pimples confirmed as a mild case of folliculitis by doctor. No medication given, he wasn't overly concerned. Week 15-16 occasional cramps in muscles behind thighs and buttocks Week 15 various muscle twitches in arms and legs, especially when resting. Not as many now but still from time to time. Week 22 Folliculitis appears to be clearing with use of anti bac soap and head and shoulders. Not quite gone but better. Week 22 slight cold, chesty cough and coughing up mucus for 5 days. Through this whole time, I don't recall fever and didn't have any flu like illness between 2-4 weeks. However the ongoing symptoms seem to happen link in to HIV from what I've read online. I have been under chronic stress about this, so my immune system will be weakened anyway, I just don't know if it's anxiety or there is genuine cause for concern. I'm told that my exposure, even if the person was confirmed would be quite a low risk 1/1000 and quite often symptoms mean nothing. This is hard to understand, when a few things out of the usual have happened. What is your opinion? Thanks in advance.

Answered by Dr. Roopa Hiremath (1 hour later)

Brief Answer: HIV exposure and HIV symptoms Detailed Answer: Hi, Welcome to health care magic. I have gone through your query and I understand your concern. You have elaborated on your symptoms for the past 22 weeks but you have not made any mention about HIV tests you have undergone to confirm your HIV status. Please get back with details regarding any HIV testing done and their results. I also want to mention that HIV and AIDS is the most discussed topic on the net and there is lots of information about HIV which can be misleading and can cause anxiety to the reader. I suggest you trust your treating doctor here who can decide on examination of your symptoms, if significant or not. WHO (World Health Organization) has defined AIDS in adults as follows: AIDS in adults is defined by the existence of 2 major signs associated with atleast 1 minor sign in the absence of known causes of immunosupression such as cancer or severe malnutrition or other recognized aetiologies. Major signs include: Weight loss more than 10% of the body weight Chronic diarrhea for more than 1 month Prolonged fever for more than 1 month (intermittent or continuous) Minor signs include: Persistent cough for more than 1 month Generalized pruritic dermatitis Recurrent herpes zoster Oropharyngeal candidiasis (thrush) Chronic progressive and disseminated herpes simplex infections Generalized lymphadenopathy Let your doctor decide if you are having any of the above mentioned signs. I hope I have answered your query satisfactorily. Please get back if any more clarifications. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Roopa Hiremath (6 hours later)

No test as yet, which is why I enquired about the possible symptoms. I would like a more personal reply based on your experience of people with similar issues. Although helpful most of the information provided can be found online. If I'd tested I'd have no reason to ask the questions. I'd like to know if my symptoms fit with Ars? How often do you see straight male with one exposure test positive? If not HIV what could cause such symptoms? The mild folliculitis and possible lymph node scare me the most. Of course I will most likely test, I'm just trying to work out if the things I've had could be completely unrelated to exposure, as I've researched online and still left very confused. Apparently after ARS 2-4 wks symptoms go away for quite a while most the time. I never had fever of any sort, no sore throat until week 13 and nothing I would call a rash. I was never really ill, just extremely anxious to the point it became chronic anxiety / stress.

Answered by Dr. Roopa Hiremath (13 hours later)

Brief Answer: Acute Retroviral Syndrome Detailed Answer: Hi, Welcome back. I understand that you are trying to corelate your symptoms with the information available on the net. But this information is so vast and confusing that it can cause stress and anxiety rather than helping the reader in any way. I suggested you share your symptoms and signs with a GP nearby you and let him decide if they are significant or not. In my practice, I have seen patients with no symptoms but have turned HIV positive on testing after potential exposure. So as such symptoms cannot be a very reliable indication unless it is full blown AIDS. Potential exposure meaning unprotected sexual intercourse (oral, vaginal or anal) with a HIV positive individual or occupational exposure to infectious fluid of HIV positive patient. Acute retroviral syndrome as you correctly mentioned occurs within 2-4 weeks of exposure and symptoms include fever, lethargy, arthralgia, skin rash, lymphadenopathy (mild). Rarely mucocutaneous ulcers and depression. Your symptoms do not fit with ARS. Lymph node swelling is seen when there is any kind of infection in the site that they drain. For eg, if you have a lymph node swelling in the neck, most probably you have an infection of the ear, nose or throat. Similarly, infection in the genital, perianal area may cause swelling of groin lymph nodes. Your symptoms seem to be unrelated to the episode of exposure and I suggest you get a HIV test done to confirm your HIV status. ELISA for HIV 1 and 2 Ag/Ab would suffice to confirm your status. I hope I have cleared your doubts. Please let me know if I can assist you further. Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Roopa Hiremath (30 minutes later)

I would just like to ask a few more questions. When it comes to HIV the web is the most confusing place to go I realise. I've seen many cases of numerous symptoms like ARS and other things but the person test negative, quite often this happens. After ARS is it fair to say generally people don't experience symptoms in the first year? Could worry and fear of infection cause the immune system to be lowered? Is Mild Folliculitis a massive concern? Have you ever treated a heterosexual male that only had one vaginal exposure? To begin with it was just a case of test quickly and it will be ok, but the mind has switched to worst case scenario, so I'd just like a bit more info to know where I am. Thanks in advance

Answered by Dr. Roopa Hiremath (1 hour later)

Brief Answer: HIV symptoms Detailed Answer: Hi, The answers to your queries are as follows: I have seen patients who present with symptoms similar to acute retroviral syndrome but are actually HIV negative. This could be because that patient would have read about the symptoms on net or other sources and his anxiety about exposure makes him believe he really is suffering from them. Here a doctor plays an important role and he can help the patient decide if the symptom or sign is really significant or not. There is a period of latency which occurs in HIV which can vary from 1 year to 15 years. This period varies in different individuals depending on the level of immunity. Here the person is asymptomatic but will definitely test positive for antibodies against HIV. There are studies which show that high stress levels and anxiety can lower your immunity levels. High stress levels release hormones like cortisol which suppresses the immune system making the person more prone for infections. Folliculitis is a localized skin infection caused by a bacteria called Staphylococcus aureus. Mild folliculitis can be easily treated with antibacterial application and antibiotics. The seriousness of exposure depends on the volume of exposure to infectious fluid rather than the number of exposures. Exposure to semen, vaginal fluid and blood of HIV positive individual is considered high risk exposure as these fluids are very rich in HIV particles. I hope I have cleared your doubts. Please get the HIV test done as soon as possible to relieve your stress regarding this episode. Thanks.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar