Hiv scare

[Michael1389]

Dear Doctors

I am back again. I am having trouble getting over this. I posted on your forum before (http://www.medhelp.org/posts/HIV---Prevention/HIV-Scare/show/2070382#post_9805716) and Dr Hook was kind enough to respond. And even thou assured me that my risk was minimal, and he even suggested that no test were required. This assessment is in line with the assessment I got from my GP. And despite all that, here I am again…….

I will be brief, as you are undoubtedly very busy. Last night I, whilst having a shower, I found two lymph nodes on my partner. One was posterior cervical, on the right side, and the other is superficial inguinal, on the left side. She had an episode of tonsillitis recently, which could explain the cervical node, but nothing I can see could be responsible for the inguinal one, both nodes are about the green pea size.

And it has been just over 3 months since I had unprotected sex with her. Other than tonsillitis, no other symptoms at all.

I understand that I am overreacting, and I have started seeing a psychologist recently, as this has started taking over my life. But I just wanted to ask you, is there any medical relevance to this?

Thank you very much

Michael  

[Edward W Hook, MD]

I think you are getting carried away here.  My follow-up comments will be brief:
1) In regards to lymphadenopathy, from what I can figure out, in order for it to be considered to be generalized, lymphadenopathy needs to include lymph nodes from at least two different body sites, but not counting  inguinal area. Would you agree with this?
Yes.

And is it really that common to have palpable inguinal lymph nodes?
I answered this above. Do you think I made it up?

2) And a comment that you made: "There does not need to be any sort of active, ongoing infection for swollen lymph nodes to be present" would simply mean that a mere presence of lymph node does not guarantee the presence of a pathogen?
Obviously

3) If your immune system reacts to the mere presence of a rhinovirus or a strep, (eg, swollen cervical node during the episode of sore throat/tonsillitis)   would it be safe to assume that there would simply have to be some sort of reaction to the presence of hiv?
Many but not all patients with HIV have diffusely swollen lymph nodes.

4) And last, in regards to the size, I came across several sources stating that anything under 1 cm is just not clinically relevant. Would you agree? and as I said, the ones I felt, are about 5 mm, not really hard, just there, so unless they get bigger, I can just let it go?
Yes, you should have let this go long ago.  Now would be a good time.

Take care.  EWH

[Michael1389]

Dear Dr Hook

Thank you for the prompt reply. I was hopping you could clarify few things for me further...

1) In regards to lymphadenopathy, from what I can figure out, in order for it to be considered to be generalized, lymphadenopathy needs to include lymph nodes from at least two different body sites, but not counting  inguinal area. Would you agree with this? And is it really that common to have palpable inguinal lymph nodes?

2) And a comment that you made: "There does not need to be any sort of active, ongoing infection for swollen lymph nodes to be present" would simply mean that a mere presence of lymph node does not guarantee the presence of a pathogen?

3) If your immune system reacts to the mere presence of a rhinovirus or a strep, (eg, swollen cervical node during the episode of sore throat/tonsillitis)   would it be safe to assume that there would simply have to be some sort of reaction to the presence of hiv?

4) And last, in regards to the size, I came across several sources stating that anything under 1 cm is just not clinically relevant. Would you agree? and as I said, the ones I felt, are about 5 mm, not really hard, just there, so unless they get bigger, I can just let it go?

Thank you very much!

ps. I bet that you and Dr Handsfield can't wait for a day anti hypochondria pill is invented ;-)

Michael

[Edward W Hook, MD]

I'm sorry that these fears continue to concern you.  I'll try to help.  I would not be worried that you could feel lymph nodes on your partner- this is quite normal.  There are many other illnesses which can cause lymph node swelling.  Swollen lymph nodes are a non-specific response to any number of stimuli including infections due to bacteria and viruses, allergic reactions and autoimmune disease.  There does not need to be any sort of active, ongoing infection for swollen lymph nodes to be present.   Of all persons with swollen lymph nodes only a tiny proportion of them have HIV and when lymph node swelling is HIV related it is widespread (in fact this is called generalized lymphadenopathy).   The majority of people have swollen inguinal lymph nodes and for your partner to have swollen nodes in her neck following tonsillitis is to be expected.  This is nothing to worry about.

I am glad to hear that you are working on these fears with a mental health professional- that is the right thing to be doing.  EWH