I am losing my mind.

[auskie912]

Hello Doctor. Three months ago I had protected sex with a CSW in Macau. I had a scrotal lesion that I discovered two days later, and it didn’t really have a raised surface. A doctor told me it was probably some skin trauma, gave me betadine ointment. Two weeks later I had loose stools in the morning upon waking up (sometimes diarrhea) and a sinus post nasal drip sort of symptom that was sticky. Symptoms eventually resolved after 1.5 weeks or so. The scrotal lesion remained and I got it checked up again by another doctor last week. It now has a more raised surface and darkened in color slight pain when irritated. The doctor told me it’s a subcutaneous gland that got blocked or something, and that it’s a common thing, and that these types of lesions develop closed, which is why it’s blocked, so it was never open and is of no risk for HIV transmission. Another doctor said it’s an ingrown hair type of thing. However, I do remember there was some scabbing a month ago or something which seems strange. Two weeks ago (like 10 weeks after sex) the sinus problem started again and has persisted until now, which worries me greatly. It is a post nasal drip and I keep having to spit out the mucus or phlegm, but it is also sticky. I don’t ever remember having something like this for this long. 1) Can I trust my doctor’s assessment? 2) Could HIV cause a sinus problem of the likes of what I described, 10 weeks after exposure and last over 2 weeks? It seems too late for ARS right? 3) I also suspected I had a swollen lymph node at the back of my neck, but both doctors say I don’t. I read in the archives that you state ARS lymph nodes cannot last for more than a month correct? However on the community forum two people claim that they have witnessed lymph nodes that lasted like a year. Could you clear up this conflicting information of expert opinion and first-hand information? Thank you.

[Edward W Hook, MD]

Glad to hear it.  Thanks fo rthe follow-up. EWH

[auskie912]

I followed your advice and got tested at 13.5 weeks. HIV 1 and 2 antibody test, negative! Thank you for your reassurance it helped ease my mind during these few weeks and while I was waiting for the results. Thank you!

[Edward W Hook, MD]

this will be your last answer.  After than you need to decide who you wish to believe.  Your anxiety is getting the best of you and I will contribute to it no further.

1.  Lymph nodes represent a reaction to infection.  This can occur with virtually any sort of infection.  Sinusitis is an infection that would explain the lymph node you are fixated on.
2.  Lymph nodes ressolve after ARS.  Later in the course of HIV which is a chronic disease, swollen lymph odes may become part of the syndrome which precedes advanced infection (AIDS).

No change in my recommendations.  If you chose to not believe me or my advice, fine.  As I said before, rather that perseverate on ill founded concerns, why not just get an HIV test.  It will be negative.  Then get on with your life.  Right now you are spending entirely too much time worrying about something that is not a problem. EWH

[auskie912]

I just visited the doctor regarding the sinus problem and he says I have a cold. However, this time he did find a swollen lymph node, he missed it last time probably because it was small but this time I showed him where it is. It is at the back of my neck, and he said not to worry about it.

However, from what I was saying in my original post. Here are two posts from the community forum: "my son's are still enlarged after a year." and  "If it's of any use to anyone: my partner, who was diagnosed HIV+ in february 11th was adviced to take an HIV antibodies test precisely because he had a swollen lymph node in his neck. it came out a couple of weeks after having unprotected sex with another person in October... the "ball" was present and didn't show any sign of change across the months of November, december, January and february. It stayed the same."

As you can see both posts are in regards to ARS lymph nodes and based on personal accounts, yet professional opinion is that ARS lymph nodes resolve when ARS ends. Could you please clarify this conflicting information? Conflicting information certainly adds to confusion and frustration for people in anxiety. I discovered the swollen lymph node about one week after intercourse, could have been there earlier and it is still there now. Reading posts like those two causes more anxiety. Thank you for your patience in regards to the concerns I posted.

[Edward W Hook, MD]

NO, there would be no symptoms are resolution of the ARS.  Your sinusitis is not HIV EWH

[auskie912]

Thanks for your prompt response. I do realize that symptoms are useless for ascertaining the risk, but please bear with me. As I am anxiety ridden, I would like to have my question answered so that I know based on medical fact that it's illogical. My question is simply: after the window period of ARS (after 2 months) would someone with HIV show no symptoms until years later or could they start getting more infections like sinus infections and other diseases immediately? If they were rapid progressors would they show signs of more serious infections and not just a mild sinus infection?

Thanks I truly appreciate all the help in easing my anxiety, Dr. Hook and have felt much better. I am trying my best to move on.

[Edward W Hook, MD]

Read other posts on this site.  Symptoms are useless for ascertaining HIV risk.  Your sinusitis, past or present tense, is in no way related to your HIV risk, which is virtually non-existent.  No change in my recommendations.  EWH

[auskie912]

Thank you for your response. I am still unsure of getting tested. I do want to clarify regarding the sinus problem since you said the sinus infection I 'had', past tense.

I did have a sinus problem around 2 weeks after intercourse and it resolved after about 1.5 weeks. However, just over two weeks ago (10 weeks after the incident) it came back and has remained until now. I have not experienced this type of sinus problem before, especially not for this duration of time (more than two weeks) which makes me anxious and causes immense worry that it may be HIV related. I do know that it is past the ARS window period, so if it isn't ARS related then can HIV cause one to be more susceptible to infection within 10 weeks already? I keep producing more mucus/phlegm that I have to spit out, but sometimes it is sticky, but it is clear, and not yellow or green or even that thick. When I do spit it out, I feel good for awhile then it starts bothering me again. Why has it not resolved yet after two weeks? This is driving me on edge, thanks for any help or comments.

[Edward W Hook, MD]

Both of your doctors used somewhat different words to describe the same thing.  They had the chance to examine you and from what you describe, i agree with their assessment.  As for your questions:

1.  Yes, They both said the same thing, different words.
2.  No.  Sinus infections do occur in persons with HIV just like everyone else but to think that the sinus infection you had indicated HIV is incorrect.
3.  Believe the doctors. If they say you don't have nodes, you do not.  As for the lymph nodes of the ARS, yes they do go away as the ARS resolves (but, this is irrelevant to you).
4.  Chronic HIV infection can have persistent lymph nodes swelling.  In the ARS, nodes are swollen and ten go away.

Overall, it sounds as though you have little to worry about.  If the reassurances by me and your doctors are insufficient, get an HIV test.  It will be negative.  (There is no reason for you to get an HIV test other than to alleviate your anxiety).  EWH