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Night Sweats and Risk Assess

Dear Doc. I am worried sick.  Here goes:

I am a 30 year old, heterosexual, non-drug (IV or otherwise) user:

I have had protected oral and vaginal sex (with exception of brief unprotected oral sex) with approximately 20 professional sex workers over the past 7 years.  I have had unprotected sex with only three women, all over the past one and half years (none of them sex workers):  (1) Ex-girlfriend who showed me a negative HIV Test (unprotected sex included Anal twice); (2) Very brief vaginal sex (approx. 30 seconds) during a threesome on Jan. 26, 2007 along with another male friend of mine who had just had unprotected vaginal sex with the same girl, neither known to be a drug user (I pulled out once I realized I was acting inappropriately and no sexual contact with the Male); and (3) Very brief (less than 30 secs.) with another girl on about three separate occassions between Dec. 06 and March 07 (we would rub naked genitals before protected vaginal sex and some slippage inside vagina and/or she would place my penis in her vagina and would keep it inside briefly before i insisted on condon use. I stopped the very casual, brief relationship with this last girl because I feared her willingness to have unprotected sex so freely.  

The last time I had intercourse was on March 10, 2007 (as described above with girl No. 3). I am currently in a relationhip with no intercourse, but with oral sex.

On approximately April 29, 2007 (approx. 6-7 following last intercourse), I began a cold. I had been having allergies with severe nasal congestion for about one year and have begun snoring for about 6 months (possibly due to the allergies and continued weight gain).  The cold was accompanied by a little cough (I believe related to post-nasal drip) and fatigue. No known swollen lymph, no known fever. The cold subsided within about a week, although the congestion and nasal drip (perhaps associated with the allergies) have remained.  

During this same time, I began having night sweats. The sweats were rather localized to the head and neck.  The sweats have continued almost regularly (with exception of approx. 2 or 3 days) for the past two weeks, with varying degrees of dampness to the pillow and my head.  Some of the sweats dampen my pillow quite a bit.  

I have begun taking my temperature for the last few days. I normally have had a low body temporate (below 98 degrees) during the last 3 or so years that I have checked and my temperature has ranged from 97 to 99 degrees over the past few days, despite the continued night sweats.

However, last Friday, I began to feel very ill while at work during the afternoon:  Severe headache, Fever (between 100 and 101), body aches. I went home to sleep for a couple of hours (no sweat ironically) and woke up to stomach cramps.  The next morning, the fever, headache and body aches had subsided although i did sweat while awake during that night.  However, the craps remained and I had diarehha the next afternoon and felt an upset stomach the entire weekend.

Over the last few days, I have also been coughing (albeit not very often).  The coughs are result of itchy throat, but do appear to have mucus in them...in other words, don't appear to be a dry cough, although I really don't know the difference.  

Note #1:  I have had folliculitis of the scalp since teenage years that has gotten worse  in the past 2 years or so. Also, over the past two years, I have developed red and brown flat spots all over my body (arms, legs, inner thighs, chest and abdomen).  I was told by doctor friend that most likely sun related, but definitely are not moles.

Note#2:  During this entire time frame, I have had mouth ulcers that have come and gone.  I believe that I have had similar type of ulcers for some years that come and go, sometimes attributable to mistakenly biting lip. However, some of these bumps are located on fleshy part of bottom lip, not visible necessarily in mirror and can be popped with teeth.  

Note #3:  I received a PPD test last Wednesday from same Docotor friend and came back negative for TB; no further blood work has been done to date.

Subject to the foregoing summary:

1) How would you characterize the risk level of my sexual history as it relates to HIV or STD infection;

2) Do the symptoms appear to be ARC/HIV related;

3) If not, how would you describe these symptoms, particularly the night sweats;

4) Do you believe these symptoms (including the night sweats) can be attributable to anxiety over fact that my current girlfriend has recently asked me to get an HIV test before having sex and I have always avoided taking one out of fear over the results.

5) What should I do?!?
3 Responses
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239123 tn?1267647614
MEDICAL PROFESSIONAL
True night sweats are themselves evidence of fever; they happen when a fever breaks, accompanied by sweating. This is true regardless of the cause--HIV, tuberculosis, influenza, pneumonia, malaria, or anything else. In the absence of fever, getting a little moist during the night isn't the same thing and doesn't count as an HIV symptom, and is not a symptom of any other inflammatory illness or infectious disease.

Thanks for the thanks. Take care.
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Avatar universal
Doc. Thanks for your detailed response.  However, to clarify, the night sweats I have been experiencing for the past two or three weeks (ongoing by the way) are not really accompanied by a fever (either before or after).  Rather, as I expressed, I have not been experiencing a fever at all, with the exception of one day where I felt a headache, fever of approx. 100.5, body aches and stomach cramps (followed by diarehha).  

1.  Is it true that night sweats not associated with fever are generally not indicative of HIV infection, or am I mistaken in prior literature I have read on the internet?

2.  Likewise, are Night Sweats which are indeed related to HIV generally brought on as the virus progresses, or can such night sweats be present at the early/acute phase of infection?

I apologize for not being more specific about these questions in my original posting, but I would truly appreciate the follow-up responses to these lingering questions.

Bless you for all your good work!
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Relax; you are badly overreacting.  Sure, some of your symptoms COULD be due to HIV.  That's because if you list the 50 most common symptoms of every illness that exists, 30 of them occur with HIV.  (Those numbers are just educated guesses, but you get the idea.)  In someone at low risk of HIV--and your risks are very low--the chance that symptoms are caused by HIV is almost zero.  Equally important, most of your symptoms don't suggest HIV at all.

But most important of all, the answer to your fears does not lie in getting online advice; it lies in getting evaluated by a personal health care provider and, if s/he agrees, having an HIV test since you are so worried about that possibility.  More than 8 weeks has gone by since your last possible exposure to the virus, so a negative result will be 100% reliable.

Accordingly, my direct responses to your questions are:

1)  Your HIV risk is very low.  If you followed your current sexual lifestyle for 60 years, probably you would never acquire HIV.

2)  Your symptoms don't particularly suggest HIV.

3) Any of a hundred other conditions could cause the same symptoms. Night sweats are just a sign of a fever that breaks during the night; in other words, they occur commonly with any illness that causes fever.

4) A fever to 101 degrees and night sweats are not symptoms of anxiety.  Many of your other symptoms could be due to anxiety (and as I have said many times, when a person suspects his or her symptoms have a psychological origin, s/he probably is almost always right).

5) What should you do?  Isn't it obvious?  Make an appointment with a health care provider.  (Don't just discuss things informally with your doctor friend.  You may or may not choose him as your provider, but if you do, make a formal appointment and go to his office.)  Tell him/her everything you have stated here, including your concerns about HIV.  Follow his or her advice.

Good luck--  HHH, MD
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