AIDS lesions or something else?

Dear Alice,

I am a long time reader and practicing bisexual. Because of my orientation, I am more concerned than most (I think) about contracting HIV. My question is related, but not about the virus. My question is this, "What is the difference between blisters, sores, and lesions?" It seems like I get a tick bite, and I spend the next week thinking of every dirty thing I've ever done because I'm worried about AIDS lesions. How can you tell if something is to be concerned about or not?

Thank you very much,

Dear Guy,

First off, great that you are seeking to be informed and keeping your health as a present thought. Now, to answer your questions…A blister is a bubble of skin, usually filled with fluid, which is caused by irritation, injury, or a burn. A sore is an open wound or ulcer. A lesion is an injury or pathologic change in an organ or other body tissue, or an abnormal patch of skin.

It's difficult to tell whether or not someone has HIV just by looking at a skin condition — regardless of whether you think it's a blister, sore, or lesion. The skin conditions commonly associated with HIV and/or their symptoms can occur in people who have HIV, as well as those who do not. Since HIV attacks and weakens the immune system, bacteria, fungi, and viruses that cause skin disease are able to infect and grow more easily. Also, in a person with HIV, the body can become more prone to uncommon forms of skin cancer.

Some of the skin problems associated with HIV (though these can happen to HIV- people also), as well as some of their identifying symptoms include:

  • Molluscum contagiosum: A viral infection that causes small, waxy, smooth, skin-colored bumps on the forehead, cheeks, chin, and/or groin area. HIV can cause these bumps to be especially widespread, large, and numerous.
  • Herpes simplex virus type II (HSV-2): A virus that can cause reoccurring cycles of painful, fluid-filled sores. People with HSV-2 who also have HIV often have herpes outbreaks that are more frequent and take longer to heal.
  • Herpes zoster (shingles): Another herpes virus that causes blistering and a crusty rash, usually on only one side of the body. Since shingles is caused by the reactivation of the chickenpox virus (which stays dormant in the body from childhood), it's often seen as a warning sign for HIV or an otherwise weakened immune system.
  • Scabies: Intense itchiness and rash caused by a highly contagious parasite, the symptoms of scabies are caused by female mites that burrow into the skin and lay eggs around hair follicles.
  • Ringworm: An itchy, red, scaly rash caused by fungus. You may know this as athlete's foot and jock itch. Ringworm can affect the scalp, feet, groin, and finger- and toenails.
  • Kaposi's sarcoma (KS): A rare form of skin cancer that causes painless, reddish-brown or bluish-purple swellings that can occur anywhere on the body.

You said that whenever you have a skin symptom, you think about all of the "dirty" things that you have done. What is it about your behavior that you see as "dirty?" Are you referring to risky sexual behaviors (e.g., unprotected sex) you chose to share with one or more partners? And if you really see your behavior as "dirty," then perhaps it makes sense to rethink your actions, so that you are only doing what gives you and your partner(s) pleasure, and do only what you feel good about doing.

If you find that you're having more severe, frequent, and/or persistent skin problems than normal, or other symptoms that seem out of the ordinary, it makes sense to see a health care provider about your concerns and/or to get tested for HIV. Getting tested for HIV regularly — maybe before becoming sexually active with a new partner, after any sexual activity that might have been risky, or once a year, just to be safe — is a big step towards keeping you and your partner(s) happy and healthy. It may help you worry less if you are protected with condoms and lube (to mitigate skin friction) whenever and with whomever you have sex.

Again, kudos to you for staying on top of your health status. Being an informed health care consumer and taking steps to protect yourself (and your partners) goes a long way in promoting peace of mind.

Last updated Mar 09, 2015
Originally published Mar 05, 2004

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