Sexually Transmitted Diseases/HIV

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QUESTION: Had unprotected anal sex on November 14 first time an worst decision of my life. Four days later got a groin rash which was diagnosed as jock itch by my internist an 4 more ER doctors. Kind of afraid since I am having trouble getting rid of the rash for good. Is there anyway the rash might be connected to HIV ? Even went to a dermatologist who diagnosed it the same way yet I can't get rid of it. I have not had any of the so called symptoms such as fever etc. reay just concerned about the rash especially since I am 55 an never had anything like this before the incident that was 4 days earlier.. Doesn't help that I also have a very severe anxiety disorder an stress those conditions are so bad everything on my body hurts. Can someone please help

ANSWER: Hello Jeff,
Mistakes and bad decisions are foundations to get better, not to feel bad or guilty, or depressed.  Jock itch is  caused by a fungus.  Proper treatment requires a cream that effectively treats those fungi.

ER docs sometimes rely upon older, less expensive, or less effective antifungals, so I would consider changing to something stronger or more effective.  The ER is a place to go for acute potentially life threatening problems, such as gun shot wound, heart attack/chest pain, etc.  Post exposure prophylaxis of HIV infection with effective antiviral medications (expensive, but effective) should also be available in the emergency department, in a situation such as yours, if you were there within a day or two of the incident.  Much beyond that time, and the prevention is not effective.

My choices for jock itch are for over-the-counter products which sometimes work better than the prescribed ones, such as terbinefine (Lamisil), miconazole (Micatin), tolnaftate (Tinactin).  Such creams must be applied once or twice daily to the affected areas for at least 1-2 weeks, even in the apparent absence of symptoms. If this is ineffective, then I would reconsider the diagnosis, since anal sex is not necessarily associated with "jock itch."  

Acute HIV infection syndrome (symptoms similar to having influenza: fever, night sweats, fatigue, malaise, body or joint aches, headaches, etc.) usually occurs 1-4 weeks after infection with HIV.  

Good luck!
--mark


---------- FOLLOW-UP ----------

QUESTION: Thank you Mark just a few questions if you don't mind. I have a bad anxiety disorder an as you could imagine my stress is off the chart. Some of the symptoms such as muscle an joint pain is really all I have had an I think this is due to my sever anxiety. I have had none of the other symptoms an the exposure goes back to November 14 would that have been the time of infection? Also since I have had none of the other symptoms would you consider me lucky of not contracting anything an out of the woods with this ? My anxiety is so bad I cannot function at all just want to be asleep all of the time. When I'm awake it's all I think about an I am mentally devastated for making this decision. I know testing is the only definitive way to know but I am scared to death to take the test. The other person had a negative test on October 8 an November 18 four days after the incident. Based on what I have shared is it your feeling I can just move on with my life an know that I was lucky to not get something after such a poor choice. I really am at the end of my rope just want to sleep so I don't have to think about it. The other person swears up an down he is negative an has never had a problem. Thank you very much for your help an knowledge. Jeff

Answer
Hello Again, Jeff,
Your symptoms and history definitely point to you're NOT having HIV. However, there are other STDs such as gonorrhea & chlamydia which also may be easily tested for by a knowledgeable health care provider. However the underlying problem is anxiety and guilt, and until you deal with these through therapy, you may always be stressed and unable to function.

Get tested, and get therapy!
Good luck!
--mark  

Sexually Transmitted Diseases

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Mark P. Behar

Expertise

Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!

Experience

Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Organizations
Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Publications
Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Education/Credentials
Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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