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Scabies: Infection and re-infection.
Jan 20, 2007

I have just been treated for a possible scabies infection but I am afraid that casual contact with someone I might have exposed may re-expose me to reinfection:

I am HIV positive, on Kaletra and Truvada, my viral load is undectable and my CD4 are 818.

I have been experiencing generalized itchiness and red bumps, that are worse at night, generally located around my limbs and lower torso for several months and in that time I have seen a number of medical professionals who have given me differing advice.

I was afraid it was scabies so I first saw a nurse practitioner who thought it might be folliculitis or a fungal infection, but he doubted it was scabies because at the time he didn't see any escoriations he knew to be typical of mites. He suggested I use antifungal creams as for jock itch, but this did not help. About two months later the itchiness was still bothering me so I discussed it with my HIV specialist who said it might be eczema, folliculitis or scabies and in case it was scabies he prescribed Lindane -which I used- and I also tried very hard to wash all my sheets and bedding and clothes. But the itch persisted and two or three months later, because the itch was still bothering me, I consulted a dermatologist who said I definitely had some folliculitis but also thought I might have scabies AS WELL particularly because I was experiencing itchy scaby patches around my scrotum and buttocks and because my symptoms were always worse at night and so she took a biopsy and prescribed a two treatment course of Elimite. The biopsy results are not back yet but I have followed the treatment and washed all of my clothes and bedding (twice, once after each dose of Elimite) and I even bought new pillows.

If it is scabies, I hope the biopsy will prove it and I hope that this latest course of treatment will finally have killed it, yet if it is scabies I am worried that I may have spread it to one other person with whom I am intimite. He is HIV negative and though we do not have sex we do sometimes sleep together. He recently started experiencing itchiness while he was away on winter vacation (it was while he was away that I consulted the dermatologist and used the Elimite). He came back to town today and I invited him over to my place in order to tell him that I might have had scabies and that his itchiness might be scabies that he received from me.

Here is the problem. Before I could tell him that I might have had scabies and that he might still have it, in what would normally be a welcome act of affection he hugged me and kissed me pulled me down onto my bed attempting to cuddle with me. Only after he did this was I able to tell him about the scabies. I am terribly worried that in the simple acts of hugging and kissing and briefly cuddling that he might have re-exposed me to scabies. Most information I can find states that casual skin-to-skin contact and sometimes contact with clothing can spread the mites. I have tried so hard to eliminate this itchiness that it honestly scares me that I have to start over again. Is this likely? Is it really that easy to spread scabies? Should I wait to see if my itchiness subsides in the next few weeks or should I consider myself 'exposed' again? If my friend gets treated do I have to wait to be tested/treated again before I can sleep with him or even hug him?

Response from Dr. Frascino

Hello,

I think you are probably overreacting, particularly because we don't even know if you have or ever had scabies. I suggest you follow up with your dermatologist to get the results of your biopsy. If positive for scabies, you can describe your most recent potential exposure and get his advice on how best to proceed to eliminate the problem, OK?

Good luck.

Dr. Bob



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