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WHY CAN NOBODY GIVE ME AN ACCURATE ANSWER DOC.
Dec 27, 2004

Hi Doctor Bob, hope all is well for you and you are enjoying christmas. My problem: 16 days after posible (not sure if I used a condom) unprotected vaginal sex with sex worker in a club (drink which I have now erradicated from my life) I got this rash on upper trunk, it was pinkish reddish in colour but clearly differentiated from rest of my white skin. Sizewise it covered a big but not huge area and was located between the two nipples and reached base of my neck at collar bone level. I am really worried doc, seriously. Worried to the point I rang the lab were these girls get tested (I found out were it was...long story) and they told me they conduct p24 testing on them every 2 months. However, I also had lymph node pain under my right armpit at same time I had rash. All I had to do was touch that area mildly and it was painful. I dont recall having any fever or flu like smptoms. I just keep thinking its too much of a coincidence to get a rash on upper chest just like all web pages say as being the most likely area to get it and that my lymph node was paining me at the same time. I am convinced I got infected. About the rash I went to a dermatologist and he told me I had to get tested. I showed him a photo I took with a camara and he told me it looked like Seborrhoid dermatitis and that I was more than likely going to be ok and that this rash lasted an average 10 days normally. I have read this kind of dermatitis is a manifestation of infection. Is this true?. I have one main question Dr. How long does the acute HIV rash last on average if you get it because mine disseapeared after 1 day. 2 days later there were still some minute pinkish areas and 3 days later it was 99.9% gone. Please tell me about the rash and let me know what your thoughts are here. I feel v. much on my own. Note: also had unprotected oral (her on me) for further info. I am a male. Thanks Doc. By the way, wine I promised is on the way. Take care and have a good Christmas.

Response from Dr. Frascino

Hello,

First off, you feel "it's too much of a coincidence to get a rash on upper chest . . . and lymph node was paining me at same time" and so you are "convinced" you have contracted HIV. I, on the other hand, would say neither your coincidence nor your symptoms are at all convincing.

If the dermatologist thought you had seborrheic dermatitis, then that is most likely indeed what you had. Seborrhea is a very common disorder and certainly not highly suggestive of HIV disease. Can it occur in HIV-positive folks? Yes, it can.

As for your one main question about the duration of the ARS rash, perhaps the reason no one has been able to give you an "accurate answer" is that the rash is variable in presentation and duration from person to person. Rash occurs in about 70% of people with primary HIV infection. It is usually a reddish, non-itchy, slightly raised papular eruption. It is usually symmetrical with distinct 5 to 10 millimeter spots affecting the face or trunk. Sometimes it can affect the arms, legs, palms, soles or even be generalized. The duration of the rash, as I mentioned, is variable.

So, my friend, I would agree with the dermatologist:

1. Get tested at the three-month mark.

2. You are indeed "more than likely going to be OK." In fact, I'd say the odds are overwhelmingly in your favor!

Good luck! We'll all send you our best cosmic karma that your test will be negative.

Thanks for the wine! I'll toast to your good health and a new year of peace and happiness.

Happy Holidays.

Dr. Bob



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