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Cotton wool spot
Aug 23, 2008

Hello

Hope you are good. I went to see an opthalmologist for reduced vision. He examined my eyes and informed that I have myopia and right sided lattice degeneration causing retinal holes. He discussed it with the most senior consultant in the department and then after few days, the most senior consultant performed prophylactic laser on right retina to seal off the retinal holes. Both of them examined the retina and did not mention any cotton wool spot. When I came for the follow-up 2 weeks after the laser , I was seen by another ophthalmologist and I was informed that there was a cotton wool spot. I had laser on 27 June 08, few days after the diagnosis of lattice degenration and retinal holes and the follow-up was on 11 July 08. She told me in follow-up about various causes of cotton wool spot. I read on internet and one cause is HIV. I had Full blood count, Urea, Creatinine, electrolytes, CRP (all normal). Fasting glucose was not in the diabetic range. I checked blood pressure several times at home and readings were mainly not in favour of hypertenion. ESR was 10 (normal range of the lab result was upto 11). Any way, the very next day of my follow-up in eye clinic, I had an HIV1 and HIV2 antibodies test performed by a GP using a rapid test (recognised in the European Union and Canada)and it was negative.

I was so relaxed, then I had eye check up by an optician the same day for glasses and the optician said he has seen such cotton wool spots so many times & was not concerned. Then within next 2 weeks, I had another check up at eye clinic for foolow-up of cotton wool spot finding and the doctor who saw me the very first time (the one who diagnosed the lattice degeneation & retinal holes) told me that no cotton wool spot was seen and he said that he specifically focused on the area documented by the other doctor (retinal pics from previous examination were also in medical notes). He said that the spot has disappeared completely & not to worry. He advised me to have another check up fter 6 months for making sure that the laser treatment effects are well maintained as I mainly use right eye (left had traumatic maculopathy since childhood).

Then after all this above, few days ago, I read on internet about a case where patient had cotton wool spots in HIV seroconversion illness, however that paient had also other features of seroconversion such as rash and diarrhoea. That patient's disease progressed rapidly and patient died wthin few years.

My main concern is that do I need further HIV test? I had HIV test on 12 July 08 and the risk factors of HIV included protected vaginal intercourse with escorts in June 08 (last one was on 20 June 08). No condom breaks. I did receive unprotected from all the three escorts and gave unprotected oral but I was careful and avoided my tongue touching vaginal secretions by focusing on clitoris, except with one of the escorts, where I most probably oral did involve vaginal secretions(she regularly gets checked for STDs including HIV). I had these seperate escorts encounters in June 08.

Will you advise another HIV test?

What is the likely hood of cotton wool spot being a mainfestation of HIV illness.

Thanks for your help.

Worried man from UK.

Response from Dr. Frascino

Hi,

Your HIV-acquisition risk is very low. Protected sex is indeed "protected," assuming the latex condom was used properly and did not break. Oral sex carries only a very minimal risk for HIV transmission. Your negative HIV test in July was encouraging, but not definitive, as HIV-antibody tests taken prior to the three-month mark are not considered to be conclusive. Repeat your HIV-antibody test at the three-month mark for a definitive result.

I would not be concerned about the questionable cotton wool spot. Most likely the second ophthalmologist was mistaken.

Good luck. Be well.

Dr. Bob



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