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Do I Have HIV Rash? Or Are They From Other STD Related Rashes

Skin rashes and lesions are some of the most common signs and symptoms experienced in HIV infection. There is no single definitive HIV rash – individuals may have different types of rashes of varying severity, distribution, and appearance.
As there are many other conditions that can also cause skin rashes, including allergies, autoimmune conditions, and other infections, it is important to remember that there is no way to diagnose someone with HIV based solely on the presence of a rash. Conversely, there is also no way we can rule out HIV just because someone does not have a skin rash. The only way to know for sure is by doing an HIV test at the appropriate time.

Acute HIV Seroconversion HIV Rash

In the primary stage of HIV infection, viral replication progresses quickly and the viral load (VL) will be very high. Your body’s immune system will detect the virus and start producing HIV antibodies to try and fight off the virus – this process is called seroconversion. It is this activity of the immune system which can manifest in the typical symptoms of acute HIV infection, also known as Acute Retroviral Syndrome (ARS) – with fever, swollen lymph nodes, and rashes being the most common symptoms.
The seroconversion HIV rash usually develops around 2-6 weeks from exposure. It will appear as reddish macules (flat lesions) and papules (small swollen bumps) spread over a generalized region, typically over the chest, back, and abdomen, sometimes extending to the arms and legs as well. It can be very itchy for some people, but not always. Symptoms of itch can be reduced by antihistamines and topical creams.
These rashes may last a few weeks or months, but will eventually resolve by themselves, even if the HIV infection has not been diagnosed and treated. This happens as the HIV antibodies bring down the viral load and infected individuals enter the clinically latent stage (chronic HIV infection). Many people may have missed the diagnosis of HIV if they were told by a doctor their rash was due to some allergy or viral flu but did not get tested properly.

Other Infections

When a person contracts HIV, they are also at increased risk of other infections. Some of these are sexually transmitted and can be contacted at the same time as HIV (e.g. syphilis, herpes simplex virus, etc.), while some can occur later in the disease due to a weakened immune system (e.g. candida/thrush). These infections can also cause skin rashes or lesions to develop, so it is important to look out for any abnormal skin changes if you are concerned about any potential exposure risk, and also to inform your doctor of your concerns.

Syphilis

Syphilis is a sexually transmitted infection caused by the bacteria Treponema Pallidum and is commonly diagnosed together with new HIV infection as they share common risk factors. The primary stage of syphilis infection is a painless chancre or ulcer at the primary site of infection (usually genital, rectal, or oral), but it may go unnoticed by many people. The secondary stage of syphilis is a skin rash which can look very similar to acute HIV rash, with reddish papules around the trunk, arms and legs, and usually over the palms and soles as well – most of the time, this rash is not itchy or painful. Most people who present with a skin rash after potential exposure risk should be tested for both HIV and syphilis together.

Herpes Simplex Virus

Another sexually transmitted infection, herpes simplex virus (HSV) can cause small crops of fluid-filled blisters that can start off looking like a reddish rash. They are usually slightly itchy or painful, and may then burst to form small ulcers which will then dry and crust over. Sometimes, the initial herpes outbreak may be preceded by some viral, flu-like symptoms including fever and swollen lymph nodes. There is no ‘cure’ for herpes, but usually, your immune system will help to control the infection and keep it dormant, although reactivation and clinical outbreaks can still occur (around 2-3x per year on average). Herpes can be contracted both together with acute HIV or can recur frequently in late-stage HIV – persistent or chronic HSV lesions in the setting of untreated or late-stage HIV is considered an AIDS-defining illness, as the immune system has been weakened by the HIV virus and can no longer keep the HSV infection suppressed.

Kaposi Sarcoma

Not quite a rash, but rather an abnormal growth of capillary blood vessel tissues, Kaposi Sarcoma (KS) is actually a type of cancer that can be found in late-stage HIV.
It is caused by an infection with human herpesvirus 8 (HHV-8) which is an opportunistic infection and is also considered an AIDS-defining illness as the transformation of the skin cells only occurs in the presence of a weakened immune system. KS appears as either a single or multiple reddish purplish bumps over the skin or mucous membranes.
They are usually painless and not itchy but can cause other symptoms if they grow on internal organs such as the gastrointestinal tract or the lungs (e.g. GI bleeding, shortness of breath, etc.).
Also, read the 10 Common HIV-Related Opportunistic Infections (IOs)

Candidiasis

Also known as thrush, candida is a very common fungal organism that is found in the environment and can be isolated from around 30-50% of healthy people. Most of the time, it does not cause any symptoms of infection; however, in people with a weakened immune system, there may be an invasive overgrowth of the organism which leads to symptoms. Common areas of candida infection are the nails, skin, mouth/tongue, and genital region. Depending on the region affected, symptoms may include an itchy rash, with scaly or flaking skin, sometimes with a soft whitish layer which can be scraped off.
These are just some of the different types of skin rashes and lesions that may be present in an HIV infection. There is no single type of HIV rash that we can consider to be diagnostic by itself. It is important to assess clinical features of the rash, timing, and potential exposure risk. At the end of the day, the only way to diagnose an HIV infection will be through appropriate HIV testing at any of our clinics.
Join the HIV discussion in our Forum with our Doctors. For HIV Testing, you can walk-in to any of our clinics, for an appointment you can email us at hello@dtapclinic.com, or call any of our clinics.
Take Care. Be Safe!


Other Interesting Reads:

  1. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  2. World AIDS Day (2018) #KnowYourStatus – By Dr Tan Kok Kuan
  3. 4 Things You Need to Know About Penile Health
  4. Sexual Health Advice For Travellers 
  5. What are the Symptoms of HIV Infection and AIDS?
  6. Things You Need to Know about Travelling & HIV PrEP
  7. 11 Causes of Dyspareunia (Pain During Intercourse)
  8. What is HPV Vaccination (Gardasil 9)
  9. 10 Causes of abnormal Vaginal Lumps and Bumps
  10. An Overview of Gonorrhoea
  11. What is the Treatment for Cold Sores? What causes Cold Sores?
  12. Herpes: Everything You Need to Know!
  13. The HIV Pro-Viral DNA Test can be done 10 days post exposure.

10 Common HIV-related Opportunistic Infections

In late-stage HIV infection, the virus would have spread through the body and attacked the immune system for many years without treatment. On blood tests, the number of viral copies, or viral load (VL), will be very high, while the CD4 cells of the immune system would be very low.
When the immune system is in this weakened state, it is much easier for certain pathogens (bacterial, viral, fungal etc.) to invade and cause an infection – these types of infections are called Opportunistic Infections (OI’s). Sometimes, these infections can cause certain types of cells to become cancerous, and these are also classified as Opportunistic Infections.

What is an Opportunistic Infection?

In a healthy and normal functioning immune system, these pathogens do not usually cause infection, or they may cause very mild disease. Apart from advanced HIV infection, Opportunistic Infections may affect people who are on chemotherapy for cancer, immunosuppression for autoimmune diseases or post-organ transplant, among other conditions.
In HIV, many of these Opportunistic Infections are what we also term as “AIDS-defining illnesses” – that is, if these infections are found in someone who has HIV, we would classify them as having AIDS (Acquired Immunodeficiency Syndrome). Many of the symptoms and signs of late-stage HIV infection are due to these Opportunistic Infections rather than directly from the virus itself.

What is HIV Treatment?

HIV treatment and management consists of taking a set of correct HIV medicines to delay the control HIV, monitoring for and treating any opportunistic infections, and taking care of the patient’s general health and well being.

What are the most common Opportunistic Infections?

This is a list of some of the most common HIV-related opportunistic infections:

1) Candidiasis (Esophageal, Tracheal, Bronchial)

Also known as thrush, candida is a very common fungal organism that is found almost everywhere in the environment and can be isolated from around 30-50% of healthy people. Most of the time, it does not cause any symptoms of infection; however, in people with HIV, there can be invasive candida overgrowth in the esophagus and airways. It is often the first sign of a weakened immune system in previously undiagnosed individuals.

2) Cryptococcosis

Caused by the fungus cryptococcus neoformans, this can infect any part of the body, but most commonly will invade the lungs (pneumonia) or the brain (abscesses).

3) Cytomegalovirus (CMV)

Caused by an intracellular virus, this infection can cause inflammation of the brain, lungs, intestines, and eyes. CMV retinitis of the eye is sight-threatening and should be treated as a medical emergency.

4) Herpes Simplex Virus (HSV)

Another common virus, Herpes Simplex Virus (HSV) can cause symptoms in people with a normal immune system as well – usually cold sores or blisters around the mouth, genital region or anus.
However, in people with a weak immune system, outbreaks tend to be more frequent, severe, and prolonged in duration, and can also invade the lungs and esophagus.

5) Mycobacterium Tuberculosis (TB) & other Mycobacterial infection

Tuberculosis (TB) would most commonly affect the lungs, but may also spread to lymph nodes, brain, kidneys, or bones. Symptoms of TB include recurrent fever, night sweats, chronic cough, and weight loss. Other mycobacteria are very commonly found in soil and around the environment, and very rarely would cause problems in healthy individuals; as Opportunistic Infections, they will usually affect the lungs but can spread throughout the body.

6) Pneumocystis Carinii Pneumonia (PCP)

Caused by a fungus pneumocystis carinii, now renamed as pneumocystis jirovecii, this infection is commonly one of the first signs of a late-stage HIV infection. Symptoms would include shortness of breath on exertion, dry cough, and high fever, and if left untreated can be deadly.

7) Salmonella septicemia

Salmonella is a common bacteria that is usually found in contaminated food or water. In healthy individuals, this may cause an acute ‘food poisoning’ with vomiting, diarrhoea, and sometimes fever. However, salmonella as an Opportunistic Infection can spread throughout the body and cause septicemia, or blood poisoning, leading to multi-organ failure and death.

8) Toxoplasmosis

This is caused by a parasite called toxoplasma gondii, which is found in the faeces of certain animals (normally cats, rodents, and birds), and can be found in undercooked red meat such as pork. It can cause infection of the lungs, eyes, liver, and brain.

9) Kaposi’s Sarcoma (KS)

This is a type of abnormal growth/tumor of connective tissue – more specifically, of the capillaries (small blood vessels). It can occur anywhere in the body, but if it arises on the skin or mucous membranes, KS will usually appear as firm reddish or purplish lumps. The cancerous changes in the cells are a result of infection by human herpesvirus 8 (HHV8),

10) Invasive cervical cancer

This is a cancer of the cervix, which is the neck of the womb, or uterus. Malignant changes can occur after infection with certain types of human papillomavirus (HPV), and all women (HIV or not) should be screened regularly with pap smears and HPV testing. It is also recommended to get the HPV vaccine (Gardasil 9), to prevent HPV infection, cervical cancer, and genital warts.

How can Opportunistic Infections be prevented?

As these infections only occur in people with a weakened immune system, the most important way to prevent them would be to treat the underlying HIV infection. Highly Active Antiretroviral Treatment (HAART) is very effective at treating HIV and ensuring the virus is adequately suppressed. With a low or undetectable viral load, the body’s immune system has time to recover – and when the CD4 cells have returned to sufficient numbers, the risk of Opportunistic Infections is lowered drastically. The earlier an HIV infection is diagnosed, the earlier treatment can be started and the better the chances of avoiding Opportunistic Infections.
For patients who are diagnosed with HIV later and have low CD4 counts at diagnosis (<500), it is important to consider Opportunistic Infections prophylaxis while we are waiting for HAART to work. This means starting patients on certain medications (e.g. antibiotics, antifungals, and/or antivirals) to prevent some of these specific infections. It may take 6-12 months for the CD4 counts to recover once HAART has been initiated; once the CD4 counts are improved, these prophylactic medications may be stopped.
Other general advice for people living with HIV would include:

  • Reducing or preventing exposure to other sexually transmitted infections
  • Getting vaccinated (e.g. HPV vaccine, annual flu vaccine, pneumococcal vaccine, etc.)
  • Avoiding undercooked or raw foods (including eggs, meat, unpasteurized milks and cheeses, etc.)
  • Avoid drinking untreated water
  • Speak to your doctor about any other changes that may need to be made at home, work, or when on vacation to reduce exposure to OI’s

Take Care!

Other Interesting Reads:

  1. An Overview of STD – From an STD Doctor
  2. The HIV Provirus DNA Test can be done 10 days post exposure.
  3. What are the Symptoms of HIV Infection and AIDS?
  4. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  5. What are the Causes of Abnormal Penile Discharge?
  6. Low HIV Risk Doesn’t Mean No HIV Risk
  7. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  8. 11 Causes of Dyspareunia (Pain During Intercourse)
  9. What is HPV Vaccination (Gardasil 9)
  10. 10 Causes of abnormal Vaginal Lumps and Bumps
  11. An Overview of Gonorrhoea
  12. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  13. Syphilis Symptoms (Painless STD Sores & STD Rashes) 

What is the Treatment for Cold Sores? What Causes Cold Sores?

What exactly is a cold sore?
You have probably heard of cold sores or even have had one at some point in your life. But perhaps you’re not entirely sure of what it is caused by and what else you may need to be concerned about.
A cold sore is a small, painful, fluid-filled blister that most commonly occurs near the mouth or on the face, although it may infrequently appear elsewhere on the body. Cold sores tend to occur in clusters.  The appearance of a cold sore is sometimes preceded by an unusual tingling or itching sensation over the same area.
The blisters then form and eventually burst, leaving shallow ulcers/open sores which scab over, forming a crusty lesion. They may come and go, with each flare lasting up to a few weeks.

What Causes Cold Sores?


Cold sores are caused by the Herpes Simplex Virus

There are two types of Herpes Simplex Viruses (HSV) – Type 1 and Type 2.
Cold sores are caused by the Herpes Simplex Virus (Type 1), and genital sores are caused by the Herpes Simplex Virus (Type 2).

Herpes Simplex Viruses (Type 1)

HSV-1 usually causes cold sores, while HSV-2 tends to be responsible for genital sores. HSV-1 is extremely common in the general population, with the World Health Organisation (WHO) estimating 3.7 billion people under the age of 50 have HSV-1 globally.
Herpes Simplex Viruses (HSV) is transmitted through body secretions.
HSV-1 can be transmitted through saliva via kissing, or sharing of utensils (oral-to-oral transmission), but oral-to-genital secretion can also occur through oral intercourse. This means that someone with cold sores can transmit HSV-1 to their partner’s genitals, resulting in genital sores. An STD Screening can screen for both herpes simplex viruses.
Individuals with HSV are most contagious when they have cold sores, but can still be infectious even when they have no sores or blisters.
Here’s a video about Herpes

Unfortunately, HSV infections are lifelong – meaning there is no cure for HSV and once infected a person carries the virus for life.
This is the reason why cold sores can flare up from time to time. There are certain triggers that can set off an outbreak of cold sores- for instance, environmental factors such as sunlight and cold temperatures, or anything which weakens your immune system, such as an illness, or medications which suppress your immunity.

What is the Treatment for Cold Sores?

Antivirals can help clear up and keep cold sores away.
While there is no cure for HSV, the good news is that anti-viral medications (treatment for cold sores) are extremely effective in suppressing the virus and can be used to treat an outbreak of cold sores, and even prevent or minimise future outbreaks.
Some people may not be significantly bothered by their cold sores, which flare up only occasionally and go away by themselves. However, if you are troubled by your symptoms and worried about transmission of the virus to people around you during a flare, anti-virals such as acyclovir or valacyclovir are available as both oral tablets and topical creams.
Sometimes, just the topical cream (treatment for cold sores) may be enough to address your cold sores but if they fail to respond or if your flare is particularly bad, your doctor may prescribe a short course of tablets on top of the cream.
If you are someone who experiences frequent and painful outbreaks of cold sores, or if you are concerned about transmitting the virus to your loved ones, then suppressive anti-viral therapy may be a good option for you. This is when you take the anti-viral medication on a daily basis in order to achieve continued suppression of the virus just like HIV treatment. This not only stops flares from occurring but also reduces your infectivity and the risk of transmitting HSV to others.
Now that you know a little more about, the cause of and, the treatment for cold sores, hopefully, this has helped you realise that you do not need to live with intermittent painful outbreaks. There are treatment options available in our clinics, so if this is an issue which has been troubling you, then it’s time to make that a thing of the past.
Take Care!

Other Interesting Reads:

  1. An Overview of STD – From an STD Doctor
  2. What are the Symptoms of HIV Infection and AIDS?
  3. Weak Erection? Erectile Dysfunction? How to Improve Erection with Pills
  4. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  5. What are the Causes of Abnormal Penile Discharge?
  6. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
  7. 11 Causes of Dyspareunia (Pain During Intercourse)
  8. 10 Common HIV-related Opportunistic Infections
  9. What is HPV Vaccination (Gardasil 9)
  10. 10 Causes of abnormal Vaginal Lumps and Bumps
  11. An Overview of Gonorrhoea
  12. Genital Warts: The Cauliflower-Like Lumps on the Genitals
  13. How Do I Get an Anonymous HIV Testing?
  14. Syphilis Symptoms (Painless STD Sores & STD Rashes)