HIV - Prevention Expert Forum
HIV risk and testing
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HIV risk and testing

Hello. Thank you for the fantastic job you do here. I'm writing to you because recently I had an unfortunate experience. I went to a strip club and ended up having sex with a condom with a stripper on April 5. Now, this was fairly easy so it made me think that surely I'm not the only one that had easy sex with her. So I consider that she is actually a CSW.

She gave me unprotected oral sex and we French kissed for a while. I also kissed her vulva and licked her briefly. I had gingivitis at the time and had bled with brushing.

After a while, she put a strawberry flavored condom on me (LifeStyles) and we had sex to climax. As far as I am concerned the condom did not break.

After I withdrew myself, I noticed that when my penis touched my thigh (with the condom still on) it painted my skin lightly red and I removed it with a finger fairly easy. Now, I don't know if this was blood or just the "strawberry" lubricant on the condom.

Shortly thereafter (2-3 days) I developed a sore throat and seven full days later I had an exudative tonsillitis. I have noticed two enlarged lymph nodes in the neck ever since. At first they were slightly painful but now they are not tender.They have become smaller somehow but they are still about one cm. large. The tonsils are mostly clear now after my doctor prescribed an antibiotic.

Two weeks after the event, I have developed a very mild runny nose and a slightly dry cough. The throat is not tender anymore. I have had no  fever, no muscle aches, no diarrhea, no rashes, no urinary discharge or discomfort.. I haven't had sex after the event.

I am thinking about getting tested tomorrow (about 21 days after the event) with a HIV RNA PCR + HIV 1/2 Antibodies (I don't have access to the p24 antigen test).

Questions

1) Do you think this symptoms are worrisome for ARS?
2) Would a combined PCR/ELISA test be reassuring enough at 21 days?
3) Is tonsillitis/lymphadenopathy and common cold symptoms suggestive of ARS?  
239123_tn?1267651214
Welcome to the forum.  Thanks for your question.

I agree with your assessment of the stripper -- whether or not she is technically a CSW, her willingness to have sex in this situation implies high risk for STD.  On the other hand, presumably she has her partners/clients use condoms for vaginal sex -- which of course would lower her risk.  But regardless of STD risk, in the US and other industrialized countries, very few women with such sexual histories have HIV.  And even if she had it, the fact is you had protected vaginal sex.  The possible presence of blood makes no significant difference in risk.  The presence of an intact condom while your penis was in her vagina is what matters.  Oral sex and kissing carry virtually no risk for HIV, so those exposures don't matter.

And your symptoms are not consistent with ARS, which doesn't cause cought or nasal congestion and runny nose; and all by itself, absence of fever is strong evidence against ARS.  It sounds like you caught a cold, nothing more -- which could have been from the stripper (via kissing), but of course also from other people in your environment.

To your specific questions:

1,3) As just discussed, your symptoms are not worrisome for ARS.

2) From a medical or risk standpoint you really don't need HIV testing at all.  Of course I understand you may wish to do it anyway; a negative test result probably will be more reassuring than anything I can say, no matter how scientific and rational my analysis and advice may be.  Nnegative results on both PCR and antibody testing (ELISA) at 3 weeks will be highly reassuring but not quite conclusive.  My advice is to skip the very expensive PCR test altogether and have a duo test (for both HIV antibody and p24 antigen) at 4 weeks, which will give a conclucive result.  (f you insist on the PCR test, you'll still need an antibody test at 4 weeks, not 3.)  Whatever testing you do, I'm confident the result will be negative.

I hope these comments are helpful.  Best wishes--  HHH, MD
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Thank you for your answer, Dr. Hansfield. I am just a little worried because after 3 weeks and after completing a course of antibiotics for my tonsillitis (and clearing it up) I still have these swollen lymph nodes (one on each side of my neck). They are rubbery and painless.

Would it be normal for this to persist this long?

If this is indeed a result of ARS, would you expect the test to be positive at 3 weeks?

Thank you for your time!
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239123_tn?1267651214
When ARS causes lymph node inflammation, it isn't just in one or two localized areas -- it would be expected in the neck, over the collarbones, in the armpits, groin, etc.  And once nodes enlarge following a localized infection like viral pharyngitis, it can take a few weeks for them to return to normal.

Yes, I would expect an HIV testing to be positive at 3 weeks if your symptoms were ARS.  But not certain.  It's still smarter for you to wait until 4 weeks.
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Avatar_n_tn
Thank you so much for your time and answers, Dr. Handsfield. I really appreciate it. I went ahead and got tested today before I read your advice to duke it out for another week. I tested for HIV RNA PCR and HIV 1/2 at LabCorp.

I came across some information that is confusing. It was published in a medical journal (link below) and it states that you can detect HIV RNA in 10-15 days if the sensitivity cutoff for the test is 50 copies/ml.

According to LabCorp, their test detects 20-10,000 copies/ml (link below). Is there some conflicting information regarding this or am I getting it wrong?

Thank you so much for your help, Dr. Handsfield. I hope this question will help others as well. Take care!

Attachments:

1) Detection of Acute HIV infection paper: http://jid.oxfordjournals.org/content/205/4/521.full.pdf+html

2) LabCorp test description: https://www.labcorp.com/wps/portal/!ut/p/c0/04_SB8K8xLLM9MSSzPy8xBz9CP3I1JT8YquyzNTykNTiEqdKEOlXmpuUWqQfDlJeguBHmpoamBgZ6Bfk5joCAIws-zo!/
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239123_tn?1267651214
You didn't say you had already been tested for HIV -- you gave the impression you were considering it and asked my advice about it.  But if you indeed have had a negative PCR test at around 2-3 weeks after your potential exposure, it is strong evidence (probably ~90%) that you weren't infected.

Thanks for the link to the editorial by Drs. Branson and Stekler; they are colleagues and personal friends of mine.  However, there is nothing in it that modifies my opinion and advice for you .  I would suggest your anxieties are not being helped by your online research.  Like many anxious persons, you are being drawn to information that fuels your anxieties and misses the reassuring bits.

If you want to return with a comment with the results of final testing, as suggested above, feel free to do so.  Until then, however, I won't have any further comments or advice.
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Avatar_n_tn
I'm sorry for the confusion. I was asking for your advice but got anxious and got tested earlier today before I had the chance to read your answer.

I hope to have the results within a week. I will let you know. Thank you!
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Avatar_n_tn
Hello! I just got my results and I wanted to share them with you.

HIV-1 Antibody - Negative
HIV 1/0/2 Qualitative - Non reactive
HIV DNA - Non reactive

The tests were done at 21 days. What do you think, Dr. Handsfield? Should I put this behind me or test again?

I want to thank you so much for your support through all of this. Really! Thank you!
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P.S.: At least I know my lymphadenopathy is not a result of ARS, right? Phew! :D
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239123_tn?1267651214
You were tested a week early for definitive results.  Have another antibody test at 4-6 weeks.

"At least I know my lymphadenopathy is not a result of ARS, right?"  Right.
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Avatar_n_tn
Given my exposure and some of the data that we discussed earlier (Branson and Stekler) suggesting that these tests would pick up more than 90% of the cases at 3 weeks and considering my exposure (protected sex with a high risk person of unknown status), do you think I can have unprotected sex with my partner until I reach the 6 week mark?

Thank you. I will report my next test as well for closure for anybody that reads through this in the future.
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PS: Just a fun exercise: Considering the odds that this person was actually infected plus the odds of contracting it with my exposure plus the odds of testing negative at three weeks I think I can at least have some piece of mind until my next test!
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239123_tn?1267651214
Yes.  As I said in my initial reply, "From a medical or risk standpoint you...[didn't] need HIV testing at all."

I have nothing more to say.  There is no need to post any further negative test results.
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Avatar_n_tn
Hi, Dr. Handsfield! I have new worries :(

Unfortunately, I have developed lymph nodes that are waxing and waning throughout the day (they get larger in the day, smaller at night). I also feel slightly hot during the day. Took my temp and it was 37.3 C.

I also have diarrhea! Still no rashes. I think I noted an extra lymph nodes: One in the right above collar bone slightly posterior. Another in the left same position. I may have one swollen lymph node in the left groin.

My tonsils are enlarged again but without exudate. It's been almost 5 weeks now and I still have these symptoms :(

Does this change your level of awareness at all? Should I be more worried? Should I test this week again? Can I use an OraQuick or do I need to go to the lab?

I'm worried again with these symptoms and I'm not anxious at all. Logic tells me this is a long shot but symptoms keep piling up and I'm not making that up. I'm able to function at work and everything. Maybe this is mono, I don't know. No muscle aches, or bad sore throat. Sometimes I have a dry cough, which I've had since the very beginning. Sometimes my eyes hurt. Kind of feels like common cold + diarrhea + lymph node enlargement.

By the way, my lymph nodes are very hard now. Still painless and as I said they change sizes through the day. I'm so worried now especially since I resumed having sex :(
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239123_tn?1267651214
No lymph nodes can fluctuate in size over the course of a day or a few hours.  This information doesn't change my opinion or advice.

That's definitely tne end of this thread.  Any furhter questions or comments will be deleted without reply.  See a doctor if you continue to have symptoms that concern you.
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