Expert: John Thai, M.D. - 4/4/2007

Question
Hi Dr.
Thanks for the service! Last September, I had two unprotected insertive vaginal encounters with two different females over a crazy, stupid weekend. I got concerned about HIV. I went to a testing centre and got tested for all STDs and they told me to come back in three months. I was negative for everything again. They said come back for a six month test. I went back at 191 days - nearly seven months - and was negative. I thought that would be the end of it. But I still have mouth ulcers, and more worryingly, I've been diagnosed with molluscum on my inner thighs.
Is there any way my tests were inaccurate? I had a CBC done along with the three month test and the results were in the normal ranges.

Thank you for listening. I really just want to get on with my life, but the ulcers and molluscum have scared me.

Kind Regards,
James

Answer
Hi James,

HIV takes approximately 2-3 months to grow in the body to show up in your blood. Thus, it is highly recommended that you get checked for HIV once every 3 months. HIV, itself, does not cause oral or genital ulcers. Ulcers are caused by various diseases from herpes to stress ulcers. Molluscum contagiosum virus (MCV) is a sexually transmitted infection. It is highly prevalent amongst sexually active individuals and is only transmitted via contact with an infected individual. Additionally, it is present in as high as 20% of HIV patients in US. There is direct correlation between having contracted MCV and HIV. However, you can still contract MCV and HIV independently. Since your HIV tests were negative for the past 6 months, there is no reason to be concern regarding contracting HIV from the females you've had unprotected sex with. However, you are still not immune to HIV if you have had unprotected sex with other individuals thereafer.

MCV is usually seen in odd places - genitalia, scotum, skin folds between the thighs and the genitals, behind the knees, and armpits. In sexually active individuals, you can see it in the mouth as well. It presents itself as oral ulcers. Since MCV is self-limited, it will eventually resolve in 8-16 weeks without treatment. However, the discomfort and physical implications of MCV makes people scatch and pick on it. Please don't do that as this habit may lead to permanent scarring and leaves nasty marks around the genital area.

I do understand the impatience of individuals to have it for 2-5 months. There are elective treatments that are expensive but are highly effective. These treatments may be offered by your health department for free. Two very effective treatments are pulsed dye laser treatment which is well tolerated and resolves the MCV lesions within 2 weeks without scarring. The treatment is very expensive - about $500-2000 depending on the amount of the lesions present. If you are going to pay this much $$$, I would recommend going to a urologist specializing in laser therapy.

Tretinoin is a cream that is applied twice a day to the MCV lesions. It is expensive (about $100) but it resolves the lesions within 12-14 days. Please consult your dermatologist or primary physician for more information.

Since these are elective treatments, not all insurance companies will cover the costs for treatment.

CBC will not determine any problems relating to MCV, herpes, or HIV.

Regards,

John T, MD