Mono

[worriedsick7]

Hi back in the begining of Jan i had swollen nodes in my neck, a mild sore throat that lasted for one or two days, and a low grade temp maybe of 99.3 (thermom not too accurate). Anyways i went to the doc bc i was worried it was ARS for hiv (stuck with a dirty needle at work and pt hiv status unknown). my doc did a cbc an all was normal, no eleveated WBC and lymphocyte was normal. at the end of the month of jan we did a monospot test and it was neg. Well last week i went to the doc bc my ears hurt and i have two swollen nodes in my neck that havent settled down since jan. he did a cbc and a monospot test. this time the mono test was positive but i have no symptoms of mono. NO fatigue, no fever, no sore throat, and most of all my cbc came back normal for bothe WBC and lymphocyte. So 2 days later i did a rapid mono test and it came back negative but the blood test done two days before was pos but never had classic mono symtoms. i have several questions.

1. what is the chance that the positive result was a false positive
2. can you have mono with no symptoms but at the end of jan it was negative
3. i havent kissed anyone just shared food with my parents and siblings but i am an RN
4. what causes a false positive test
5.also i have read that an hiv infection can cause a false pos monospot test but two days before my monospot test i had my 12 week hiv test done and it was negative (i was stuck by a needle at work) so could my 12 week hiv antibody test be wrong
6. also isint my 12 week test conclusive
7.  3 weeks and 5 weeks post needle stick exposure i had two decadron shots and i have eczema so i have been on long term topical steroid creams- can that cause a false negative hiv antibody test at 12 weeks bc it supresses my immune system. could the steroid shots delay both hiv antibody production
8.  could it have supressed my immune response to mono so thats why my symptoms didnt show for mono\

i am sorry for the long letter but im worried and cant sleep.

[J.M. Keyes, MD]

Hi there,
I think it is unlikely that your symptoms are due to acute mono.  If the positive test was real, you may have been exposed to mono in the past, and are still positive for antibodies which can last up to a year.  False negative results are fairly common in the first couple of weeks, but a false positive for your second test is also posible.  There are various medical diagnoses that can give a false positive, but it is most commonly due to lab error.  Because your symptoms don't sound like mono, and you did not have the other lab indicators (eg increased lymphocytes), I think that infectious mono is unlikely the cause.

The risk of HIV transmission after needle stick injury is only 0.3%, and that is if the patient was HIV positive, so the liklihood that you acquired HIV from a patient with an unknown status, and have had a negative test at 3 months is next to nil.  In some people it can take as long as 6 months for antibodies to show (very rarely), so if you are concerned, have a repeat test at the 6 month mark.  Studies quote a false negative rate of 0.003% in the general population.  

I think that your symptoms are likely due to a viral respiratory illness, but if you are not improving, or your lymph nodes are remaining enlarged, make sure to follow up with your doctor.  The liklihood that you have transmitted HIV is extremely low, so try not to lose sleep over it.  If you want further reassurance, repeat testing 6 months post exposure.

I hope you are feeling better soon,
JMK MD

[worriedsick7]

I am sorry but when i went to the dr i found out things that i didnt know when i wrote you. First my monospot was negative back at the end of jan 3 weeks after my symptoms started and currently but my early antibgen ab, IgG was positive. they told me that i was probably recently exposed to it agian and was recovering so my questions is:

1. why did my monospot test three weeks after symptoms come negative. could my two 4mg total of 8mg decadrom IM shot a week apart from eachother suppress my immune system so much that i wouldnt produce the mono anitbodies.

2. would that combination of decadron shots one 3 weeks after exposure and another 4 weeks after exposure delay hiv antibody production- would that dose cause immunosupression and delayed hiv antibody production.

3. how bad is taking two IM decadron shots and how much will it suppress my immune system

4. also what rare cases would cause people not to produce detectable antibodies until 6 months after potential exposure.

sorry about the wrong questions posted the first time

[J.M. Keyes, MD]

Hi,
I do not think that 2 decadron shots would make the difference in your developing antibodies for mono or hiv, but I suppose it is possible.

The following is what the CDC has to say about the window perios, as well as accuacy of testing:

"Antibodies generally appear within three months after infection with HIV, but may take up to six months in some persons.

This CDC definition of a three to six month window period has been commonly used for a number of years.  The three month window period is normal for most of the population. Many people will have detectable antibodies in three or four weeks. Very, very rarely (i.e., only a few cases ever), a person could take six months to produce antibodies.
You may be anxious to be tested soon after an encounter which you perceive to be risky (for a discussion of what behaviors put you at risk for HIV and which ones do not, see the section on How HIV Is Spread). You want to know: can I be antibody tested without waiting three months? How accurate is the test after, say, six weeks?

Unfortunately, we simply don't know.

Think about this: if you got a negative test at six weeks, would you believe it? Would it make you less anxious? If so, then go for it. But to be certain, you will need to be tested again at three months. Some test centers may recommend testing again at six months, just to be extra sure.

Although HIV may not be detected by a test during the window period, HIV can be transmitted during that time. In fact, individuals are often most infectious during this time (shortly after they have been exposed to HIV). "


I would suggest repeat testing at 6 months for HIV if you are overly concerned.  I cannot imagine it would be positive if you have no further exposure.

JMK MD



       Antibody tests are extremely accurate, whether receiving a rapid test or a more traditional ELISA. Rapid test, for example, have an accuracy rate exceeding 99%. However, positive results from a rapid or ELISA test must be confirmed by another test to ensure that a person is HIV-positive.

The accuracy of a medical test is a combination of two factors: sensitivity and specificity. The ELISA is extremely sensitive (about 99.5%), which means it will detect very small quantities of HIV antibody. This high sensitivity reduces the odds of reporting a "false negative" when HIV antibodies are present. Assuming you are being tested beyond the "window period" and have not engaged in activities that put you at risk for HIV, if the ELISA is "negative," there is virtually no chance you have HIV.