Wired/Unexplained rash - HIV? / IGM also positive

[goodhealth1]

Dear Doctor
My last sexual exposure was 8/06/09 (about 7 weeks ago)
First of all my test results were
After 4 weeks
HIV Elisa 1&2 (antigen+antibody) – Neg
TPHA – Neg
Herpes1&2 IGG – Neg
Herpes 1&2 IGM – Eqvo (neither positive or negative)

But after 6 weeks
All others same but
Herpes 1&2 IGM – POISITIVE

I have this unexplained rash on my body.
Rash looks like small (2mm-5mm) red mosquito bite like bumps, Itches a lot when they swell. Normally comes in 2-4 bumps in one area(3 squre inch area). But there are also individual ones. Stay swelled like 1-2 days. Itches time to time. No liquid/crush or anything. Stays redish for the swollen period. Some bumps completely go away after 2-3 days. some bumps swell back again in the same place when i scratch like they were being there under the skin unnoticed. But some stay like a small pimple without puss. Some rashes leave a blac mark on skin. (specially on chest,thighs and buttocks)
The rash is there for about 2.5 weeks now.

Areas in my body that I had the rash are

loads of them in my upper thighs and buttocks (still there are active 6 bumps),
3-4 Behind Ears and behind neck (near the hairline) (was first to come and still there like small pimples, itches a lot)
Around ankle (quite a few lately) and foot
Upper arms
Lower arms near wrist (1 in one wrist and 2 in other wrist yesteray)
Chest
Upper back
stomach
2-3 in my groin area,

Other Symptoms
Very itchy skin (Forehead, face, back neck, behind years, arms and legs)
Itchy Scalp
Feels like someone is sticking a pin on my skin time to time, No specific area, get the feeling one at a time every where.
Joint pains only in fingers

1) Is this sounds like HIV acute rash or something else?
2) Is there a HIV Elisa ANTIGEN test? (not antibody, not p24) If there is how accurate is it?
3) In a later outbreak of herpes can IGG be Neg and IGM be positive?
4) Can HIV be detected as herpes IGM in the window period like in my results?

[H. Hunter Handsfield, M.D.]

I don't understand the terminology from your lab.  The only test I know of that measures both "antigen + antibody" is the duo, including p24.  You'll have to clarify it with them.  But in the overall context of your question, a negative antibody-only HIV test proves you don't have HIV, for all practical purposes -- i.e. from the combination of the low risk nature of your exposure and the description of your rash, plus the test result, it is virtually impossible you caught HIV.  Please let it go and seek proper medical care.  I will have no further comments until and unless you report the results of professional medical evaluation.

[goodhealth1]

Ok i will.
Thanks Doctor..

[goodhealth1]

Thanks a lot for your early reply.
Understood all you've mentioned.
One more clarification about the antigen test.
Its not the duo (antibody+p24) test that my hospital has.

They said the test is called HIV 1&2 Elisa (antigen + antibody)

They do have a separate p24 antigen test (which is very expensive) but p24 is not related to the above test.

They said they test for antigen using elisa method. (not p24 method) is there a truth in that? If so how accurate would that be?
Thanks again for your reply.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  You have already been reassured about both HIV and herpes on the STD, HIV, and dermatology community forums.  I agree with that reassurance.  You are obviously focusing on the coincidence of a new sexual encounter and your subsequent rash, assuming that the one caused the other.  In fact, your rash has nothing at all to do with your protected sexual encounter in early August, just a coincidence.  In any case, your description of the rash does not hint at HIV (or herpes) and the test results to date prove that neither one is the cause of the problem.

Let's dismiss the herpes business first. As you were told on one of the community forums, the IgM antibody test results are meaningless.  For more detail, see http://www.medhelp.org/posts/STDs/hsv-2--recent-vs-not-recent-infection/show/541451

To the specific questions:

1) Something else.  Not any STD and unlreated to your sexual exposure in August.

2) p24 is an antigen test.  In addition, there are PCR tests to detect HIV RNA in the blood.  That test is not necessary in your case.  A negative duo (antibody, p24) test at 4 weeks is definitive proof someone did not catch HIV, especially in such a low risk situation (based on your description in the community forums, condom-protected sex in Thailand, where HIV no longer is especially common).

3) No.

4) HIV and HSV IgM testing do not affect one another in any way.

Since you don't mention a doctor's opinion, I assume you have not sought professional advice for your rash.  You need to do that and stop assuming a nonexistant connection with your sexual encounter in Thailand (or anywhere else).  You probably arranged for your own STD/HIV testing through an online service or other direct laboratory method, without professional advice.  You have wasted a lot of money on those tests.  You need to stop trying to diagnose yourself or through online advice.  See a primary care physician/clinic or a dermatologist.

I will be happy to comment again after you report the outcome of in-person professional evaluation of your rash, but not until then.

HHH, MD