HIV risk assessment

[sabrisari]

Hello Doctor,

I'm a 20 year old male living in Canada. Exactly 44 days ago, I had unprotected vaginal intercourse with a female escort for about 10-15 seconds and I let her ejaculate in my mouth. At 2 and 4 weeks after this event, I had Duo HIV tests (I think this would be a 4th generation Elisa?) which came back negative. However, I've been having flu-like symptoms for the past two-three weeks. I've swollen lymph nodes on my neck and groin (my groin area feels rather hot), I feel more tired than usual. I'm going to have my 6 week test tomorrow but I'm a bit worried, especially about the swollen nodes on my groin. What would be your risk-assessment of my situation? I've been reading that the Duo/Combo test is at least 95% accurate at 4 weeks but I'm not convinced due to the swollen lymph nodes (the last and only time I had swollen lymph nodes on my groin was when I contracted gonorrhea about 4 months ago). I also know that it's not conclusive (btw. would you be so kind to explain why there's a 5% inaccuracy? Is it really just counting people with ongoing cancer treatment etc. or does that 5% apply to healthy people as well?). I'd greatly appreciate if you could tell my your assessment.

Kindest Regards

[sabrisari]

This is a great relief, thank you so much for your answers and also patience.

Best,
Sabri

[H. Hunter Handsfield, M.D.]

Herpes doesn't cause enlarged or inflamed lymph nodes in the neck without also causing overt, painful sores and severe sore throat.  The combination of fatigue plus lymph node inflammation suggest infections mononucleosis, as well several other (mostly non-STD) possibilities.  My advice is that you see a physician to confirm your lymph nodes indeed are abnormal; and, if so, follow his or her advice about evaluating the cause.

In my view, it would be a mistake to be tested for HSV in this circumstance and I strongly urge you not to do so, at least not on your own. (If you had a positive blood test for HSV, the conclusion would not be that you have a new HSV infection -- but instead that you have asymptomatic HSV plus some other cause of the lymph node problem.)  But follow your doctor's advice after you have been professionally evaluated.

That will end this thread.  Take care.

[sabrisari]

I've yet another question if you don't mind me keeping you busy for too long. I've had swollen lymph nodes on my neck and groin for over 2 weeks now; if this was caused by herpes, would the disease have to present symptoms such as cold sores and rashes or can herpes cause swollen lymph nodes, fatigue and fever without the painful symptoms? I've been drifting into a dark place with the fear of herpes and HIV lately, all of my std blood tests came negative (not including tests for herpes, since the doctor in the walk-in clinic said that there were none for herpes). Could you please tell me what could cause my lymph nodes to swell in both areas for so long, with persisting fatigue? Finally, if there are tests for herpes, how long after my last intercourse should I wait to take them.

I'd greatly appreciate you answering this one last post...

Kindest Regards,
Sabri

[H. Hunter Handsfield, M.D.]

Thanks for the thanks. I'm glad to have helped.

[sabrisari]

Thank you very much for the clarification, I appreciate and admire your services. I'll take the 6 week test since I've an appointment anyway, but I'm greatly relieved thanks to you. Let's see if I can persuade my doctor not to wait 3 months until looking at other options to explain my symptoms...:)

Best wishes and respect,
Sabri

[H. Hunter Handsfield, M.D.]

Welcome to the forum. Thanks for your question.

With a negative duo test 4 weeks after the last possible exposure, you can be 100% sure you didn't catch HIV.  Your symptoms don't matter; the test result proves HIV isn't the cause.  I disagree with your discription of only 95% accuracy of the duo test at 4 weeks; it's 100%. Below I've provided the link to a thread that discusses this in more detail.

http://www.medhelp.org/posts/show/1704700

I will add that most female escorts (expensive sex workers by appointment) are very cognizant of safe sex and rarely have HIV.  And oral sex is never a risk factor anyway, whether or not she "ejaculated" in your mouth.  (Female "ejaculation" in fact is just a squirt of urine, and urine doesn't carry HIV.)

So no worries.  You really don't need another test at 6 weeks.  But feel free to do it if another negative result will give you greater confidence.  But I am confident you didn't catch HIV; any additional testing will also be negative.

I hope this has helped.  Best wishes---  HHH, MD