How concerned should I be?

[blank65]

I am writing because I am wondering how concerned I should be about having another HIV test.  On Dec 15, I had a one-time unprotected encounter with a female who I was later told is a bit promiscuous. This is the only questionable unprotected encounter of my life, though.  A couple weeks later, though, I got a very swollen gland on one side of my neck, severely swollen tonsil on the same side, a fever, headache and night sweats.  An ENT could not provide a diagnosis but prescribed antibiotics that did not work, and the mystery illness eventually went away on its own in a couple weeks. After doing some research I began to worry that I was suffering from ARS. I waited some time and got a negative finger prick test at the four-week mark, which I understand is 90% accurate.  The test was also 18 days after what I thought might be ARS symptoms first appeared, which I've read would be enough time to trigger a positive test if I were HIV postive.  My concerns were greatly eased and I haven't thought about it since then.

Now, I've had a slight cough for the last few weeks (maybe two months) that never seems to go away entirely.  And in the last month, I've had 5 or 6 canker sores pop up.  Some research online suggests that HIV positive people are more prone to canker sores like that because of a weakened immune system, which also made me  wonder if maybe that's why the cough isn't going away.  It just all fit together a little too well.

What are the chances I am HIV postive and my four week test was not accurate?  From what I understand, theres only a 1 in 1000 chance the girl was HIV postive to begin with, a 1 in 500 chance for transmission, and a 1 in 10 chance of an inaccurate test at four weeks.  So if my math is right, we're looking at 1 in 2.5 million odds that this chain of events is actually happening.  As reassuring as that is, I still wonder.  How much should I be concerned?

I know getting tested is the only way to know, but do you see any signs for concerns?

[Edward W Hook, MD]

Glad to help. Don't underestimate the effect of anxiety and guilt on your general state of health.  Take care.  EWH

[blank65]

I tested negative today.  What a relief.  

I apologize for being a pest throughout this, but I was dealing with it privately and had no other way of venting at times.  

Your responses were very professional and helpful.

I'm still a bit concerned about why my immune system is allowing all this to happen, but I'm still very relieved it is not HIV and I'm very grateful for your guidance.  

[Edward W Hook, MD]

Please get a grip on yourself and seek a profesional evaluation.  Oral Hairy leuloplakia is seen in persons with HIV who have been infected for years, not weeks or months.  You need to have another HIV test (which I predict will be negative), get a professional opinion about your oral lesions, and stop searching the internet which is only misleading you in your anxiety driven state.  I will have nothing more to say until you ahve an HIV test.  At that time, I will tell you that you need to believe the test results which will, once again, be negative.  EWH

[blank65]

Taking a closer look, it appears the spots on my tongue are actually oral hairy leukoplakia, not thrush.  They are right on the side of my tongue and they don't scrap off.  Everything I've read online says they are a huge indicator of HIV.  

This can't be happening.

I actually went to the ER to get a HIV test because I felt like I was going to have a panic attack over this, but they said they don't do them.  

I don't even know what question to ask at this point...

[Edward W Hook, MD]

I agree with the docotor you saw.  These symptoms are coincidnece, not HIV.  I urge you not to worry and not to go doctor shopping.  EWH

[blank65]

Well I went to a walk-in place today.  The doctor believes I just have an upper respiratory infection, which is causing the canker sores and oral thrush.  He gave me a z-pack and an antifungal that dissolves in my mouth.

I'm not sure if he actually believed the spots on my tongue were oral thrush or not.  I said that I read online that they could be a sign of your immune system weakening, and he said "No that's not what this is."

What should I do?  Go to another doctor?  If the cough and thrush go away with the prescriptions, would that mean I'm okay?

All of a sudden, I'm terrified all over again.   :(

[blank65]

Sorry to open this discussion again.

But I noticed yesterday that, in addition to the canker sores and chronic cough, I also have some cottony spots on the side of my tongue I believe are oral thrush.  

Clearly, something's not quite right and I'm going to the doctor tomorrow.

I'm wondering, though, in the meantime, how confident are you based on my testing and everything I've told you that this is not HIV related?

[Edward W Hook, MD]

Typically the HIV antibody test is postive about a week (or less) after the onset of ARS.  EWH

[blank65]

Just one quick clarification question....

Exactly how long after ARS symptoms appear, would you expect a test to be positive?

When I say I got tested 18 days after the onset of my symptoms, this means it was 18 days after I first noticed the swollen lymph node.  And over the next 2-3 days, the fever and other symptoms gradually appeared.  So the symptoms weren't in full force until about 15 days before my negative test.  

Does this change anything about how accurate the test would be in relation to the onset of possible ARS symptoms?  

I know I'm getting technical - just want to be sure I am presenting my information correctly.

Thanks again in advance!

[Edward W Hook, MD]

Glad to help.  EWH

[blank65]

Great answer.  Thank you!  The mind can play tricks sometimes, and this dose of reality is exactly what I was looking for.  

[Edward W Hook, MD]

Welcome to our Forum. this is clearly on your mind as I see that you asked a similar question on the HIV Prevention Community site a few weeks ago.  I agree with the advice that Teak gave you at that time.  You can be confident that your symptoms were not due to HIV as an HIV test more than two weeks following the onset of the ARS would certainly be positive.  

Furthermore, I think your risk calculations, are too conservative.  Your risk of infection from a single encounter is less than 1 in 1000, not less than 1 in 500, thus your calculated risk is less than 1 in 5 million, not that a million one way or another really makes much difference statistically.  No matter how you "slice it", the chance that you have HIV is incredibly low and not something to worry about.  

Finally, your questions address issues that we deal with on this Forum quite often.  The questions often start with statements that "in searching the internet, I note that ______ (canker sores in your case) has been associated with HIV infection.... ".  The sorts of well intended statements made at some internet sites fail to place situations in the context of the fact that there are many common infections which people who do not have HIV or other predisposing conditions get with great regularity and, for that reason, are not a major reason for concern that they might be signs of HIV infection.  The fundamental thing that HIV does to persons who acquire the infection is that, over the course of many years (i.e. typically 10 or more) it progressively weakens an infected person's ability to fight infections of all sorts.  As a result, in its advanced stages, after years of infection, persons with HIV can no longer fight off infection by micro organisms that people with normal immune systems co-exist with on a daily basis.  In addition certain more common infections that people with HIV get are also regularly acquired by people who do not have HIV.  These latter sorts of infections include canker sores, fungal infections, sore throats, pneumonia and  tonsillitis.  That you have tonsillitis however is by no means a sign that you have acquired HIV or that prior tests have somehow failed to diagnose an infection which is present.  Sore throats are most often caused by viral illnesses (and sometimes bacteria such as strep) cause by the hundreds to thousands of viruses that regularly circulate in communities and happen to normal people on a regular basis (once or twice a year). As a result, getting a sore throat is certainly not a sign that you have HIV or something to worry about.  The same is true for lots of other common, every day illnesses.  Given your history of a negative test, you really have nothing to worry about.  That is not to say that it is not worthwhile to occasionally (typically annually) have yourself screened for HIV and other STDs as long as your choices include non-monogamous relationships and sex with new partners, just as we would recommend you get your blood pressure checked once a year as well.  I hope this places your question in a context which is useful for you.  EWH