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ideas.....
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ideas.....

I am going to outline: 25 yr old hetero male, only been with 4 woman, 2 years ago had on time encounter of uprotected vaginal and oral sex. ~ 2-3 weeks later red rash around the opening on meatus on my glans (glands) penis.  thought it was herpes but negitive herpes swab. lasted about 2 months went to dermo and thought it was contace dermatitis. has not recurred since. Within this time also became ill. pea sized lymph nodes bilateral in cervical anterior chain. dry cough, conjuctivitis both eyes, tonsil stones lasting about a year. low grade fever (99.5-100.) .
pain upon ejaculation. Having a medical bg, I thought for sure oral chlamydia and genitial, I thought epididmytis for sure. negitive urine analysis though.but still took doxy and cipro. started to think HIV all symtoms (symptoms) there I tested over 15 times in the first 10 months after symptoms shown.

All HIV tests negitive including a negitive Viral load after 10weeks ( majority were Unigold rapid HIV and ora sure, but veinpuncture was done also. Last HIV test was ~10 months after unprotected sex. Negitive.  I finally stopped thinking it was HIV. 10 months is well outside the window? I am very athletic and even played college football .

had negitive Hep, gon, trich, syphilis, Hep b surface antigen. CBC with normal levels( ~ 12 weeks after occurance)

Its been over 2 years since this . Ive gotten engaged and put this behind me long ago. until...... petchiea on mucousal membranes inside cheeks. show up for about a day and the goes away ...... have happened every week for the last 2 years. pea sized lymphnodes have been present since flare up. under arm, groin, cervical and on behind my right ear all pea sized.

If you could please give me any ideas on what to test for would be great, as I do not want this to come back into my engagement and take over our lives.

thank you for your time
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1119654_tn?1263235422
Without a complete history, physical exam, lab result review and medication list, I can’t give you an exact diagnosis or treatment plan.

It sounds to me like your major concern is possible HIV infection from an unprotected sexual encounter 24 months ago.  You can be reassured that most people will develop detectable antibodies to HIV within 2 to 8 weeks (the average is 25 days). Ninety seven percent will develop antibodies in the first 3 months following the time of their infection. Some individuals will take longer to develop detectable antibodies. So, if the first test was performed within 3 months of exposure, a second HIV test should be considered after 3 months of exposure, as you have done. In very rare cases, it can take up to 6 months to develop antibodies to HIV.  So you are probably ok.

The body has approximately 600 lymph nodes, but only those under the jaw, armpit and groin areas may normally be felt in healthy people. You mentioned you have “pea-sized” lymph nodes in several areas. In general, lymph nodes greater than 1 cm in diameter are considered to be abnormal.  Generalized lymphadenopathy is defined as two or more sites with abnormal lymph nodes.  Generalized adenopathy should always prompt further clinical investigation.

Only a few patients with swollen lymph nodes have serious illness and most have self-limited disease.  Serious illnesses such as lymphoma, acquired immunodeficiency syndrome or metastatic cancer can manifest themselves as swollen lymph nodes. In primary care settings, one study showed that patients 40 years of age and older with unexplained lymphadenopathy have about a 4 percent risk of cancer versus a 0.4 percent risk in patients younger than age 40.  Enlargement of non-inguinal lymph nodes that persists for at least three months in at least two sites is defined as persistent generalized lymphadenopathy and is common in patients in the early stages of HIV infection.

You should consult with your doctor about further work-up.  Readily diagnosable causes of  lymphadenopathy  include upper respiratory tract infection, pharyngitis, periodontal disease, conjunctivitis, lymphadenitis, tinea, insect bites, recent immunization, cat-scratch disease (do you have cats?) or dermatitis.  

Other things your doctor may ask you or review:
• Are there localizing symptoms or signs?
• Are there constitutional symptoms such as fever, weight loss, fatigue or night sweats?
• Are there epidemiologic clues such as work exposures or recent travel?
• Are you taking a medication that may cause lymphadenopathy such as phenytoin, cephalosporins, penicillins or sulfonamides?

Your doctor may examine the region drained by the nodes for evidence of infection, skin lesions or tumors.  S/he may note the characteristics of the nodes including size, pain, consistency, matting and location.  Her/his physical examination should focus on searching for signs of systemic illness. The most helpful findings are rash, mucous membrane lesions, a big liver, a big spleen or joint inflammation.  


It sounds like a lot of the testing for STD’s has been completed and found negative.  If your doctor thinks it necessary, it may be worthwhile to do ANA, RF (rheumatoid factor), PPD (TB skin test), and a chest x-ray to rule out Hodgkin’s lymphoma, TB and sarcoidosis.  If a diagnosis cannot be made, the clinician should obtain a biopsy of the most abnormal node.
3 Comments
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so you think hiv is not the issue with all my negitive tests then? Is that what your saying
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1119654_tn?1263235422
One can never say never because there are always outliers that fall outside the usual spectrum and because I don't have the complete picture.  Since HIV patients usually seroconvert within the first 3 months and rarely outside 6 months, you are probably ok.
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