Needle stick, transmission, symptoms, testing

[Concernedpartner145]

Dr,

I will be brief, but wish to start with a thank you for your efforts and time, and acknowledge those in the HIV prevention forum that have offered so much comfort and advice to date (Teak, nursegirl to name a few).

I was exposed to a needle which penetrated the skin of my foot/sole and went in approx 1". The angle of the injury causes me to suspect that there would be some pressure placed on the 'plunger', and I have reason to beleive that it had been very recently used for drug injection (the needle was located within a seated group of suspect individuals, in a known drug area).

I have been provided with very good advice by health care professionals as to the potential transmission risks of both HIV & Hep C, and take comfort from the relatively low 'one exposure' risks associated with all HIV/Hep C transmission methods/routes, not just needle sharing/needle stick injuries. My questions to you are about my health and testing since, and your recommendation as to future testing.

I was screened for most drug types 3 days post - negative. I had a HIV test (Oraquick HIV1/2 Gum swab) & Hep C blood test at 33 days post exposure - negative.

While I appreciate symptoms are not a reliable indicator of transmission/infection, I am usually never sick, and I am fit and healthy, but I have suffered from the following:
Day 3 - 6 - Fever, loss of appetite, nausea
Day 18 - 24 - Dry rash across kidneys
Day 23 - Day 64 (present) - Swollen glands under arms (not individual nodes, a general swelling/pain and 'hot' feeling, occasional 'pin pricks' of pain at point sources in under arm, on both sides)
Day 58 - Day 64 (present) - Swollen glands along groin line (as per armpits feeling, on both sides)

Questions:
1) Are the negative tests at 33 days a good start?
2) Given I had the swollen glands pain/sensation 10 days prior to the 33 day testing, does that rule this out as a symptom?
3) Are there any other blood borne nasties that you would have me tested for?

[Concernedpartner145]

Dr,

An update -
- HIV testing at 70 days has been negative
- Armpit and groin swelling is still apparent and a concern (for what we don't know, given the results above)

Thanking you for your advice above in this thread, your highly reassuring infomation has made this period of time far more bearable. Good vibes your way.

[H. Hunter Handsfield, M.D.]

Testing always outweighs symptoms in judging whether someone has HIV.  Always.  Therefore it is impossible that your apparent armpit swelling is due to HIV.  Also, you don't say whether a health professional has diagnosed enlarged lymph nodes.  That is critical, because self assessment of lymph node enlargement by medically untrained persons is very unreliable.  

No more comments please.  This thread is over.

[Concernedpartner145]

Sorry Dr, what I meant was, given I now have more general swelling (armpits day 23 to present, groin day 58 to present), not just one area, is it still unlikely to be from HIV infection given the swelling didn't all start at the same time, and with other associated HIV symptoms at the same time?

Could swelling at 58 days still be from an acute HIV infection?

[H. Hunter Handsfield, M.D.]

I don't follow your meaning for hte first question.  You're just asking me to repeat what I already said.  I haven't changed my mind.  And yes, 9 weeks is plenty.  With modern HIV tests, almost every newly infected patient has positive results by 6-8 weeks.

[Concernedpartner145]

Dr,

Thanks, it really does help a lot.

Just to clarify (last questions promise):

1) an individual experiencing HIV symptoms/seroconversion illness is far more likely to have 'an all out assault' on the virus - that is you would expect him/her to experience the symptoms generally (all over the body in this glands case) and in conjuction with any other symptoms experienced - ie not swollen armpit glands for 35 days, then groin, then neck etc etc - more likely a week or two of flu symptoms + glands etc?

2) is 9+ weeks since exposure long enough to not consider any 'symptoms' acute HIV symptoms?

Thanks for all your help and the time you invest here. I am (was?) :) a rational, educated individual who has learnt a great deal through this experience, and is looking forward to a negative result on all fronts in 3 weeks.

[H. Hunter Handsfield, M.D.]

I scanned your questions and responses in the community forum.  You had accurate advice and there and from your own providers, and you had a very low risk exposure event, as Teak told you.  I will go directly to the questions.

1,2) Yes, the negative result at 1 months is highly reassuring.  HIV doesn't cause swollen glands only in one region of hte body, such as armpit; it causes enlargements all over (groin, neck, underarms, etc).  Doesn't sound like HIV.

3) No, none.  If you wan't total reassurance about HIV, have a final test 3 months after the needlestick.

I hope this helps. Best wishes--  HHH, MD