Swollen painful glands sore throat - six weeks

[phoenix199]

I'm a 40 yr old woman.  I've had unprotected sex with two men.  The first, twice approx four yrs ago; the second on approx 4 occasions, 2 yrs ago and again a yr ago (brief unprotected contact, no orgasm inside me,I had poss mouth sore during oral sex).  I believe the latter had unprotected sex in far east (poss with sex workers).

6 wks ago my glands swelled rapidly (extremely tender), one on each side of throat, under jawline.  Gp was so shocked by how large and inflamed they were, he shouted his colleague to come and examine me also.
- Inflammation decreased wi antibiotics. Gp said "incidental" as pattern of inflammation inconsitent with bacterial infection.
- Wk 2 initial glands went down and dry sore throat emerged, from swollen glands that had come up down centre of my throat, bilateral (4 right, 1 left) - radiating ache from glands.  
- Wk 4 - brief respite from pain for 4 days, returned when drank alcohol.
- Now had aching painful glands and intermittant sore throat for 6 wks.
- CRP 40, Esr 29, electrolytes ok, wbc count and diff ok.  EBV -
- Had NO other symptoms

Gp suspects acute virus. Poor communicator.

Is this a familiar presentation with HIV?  Too long has elapsed for acute phase, but do you get such patterns of glandular swelling as non symptomatic stage becomes symptomatic?  Or would I have more signs/symptoms wi opportunistic infection?  Could thishapen at 2-4 yr mark?

Is this pattern of acute inflammation/pain consistent with largely assymptomatic HIV?

Are painful rapid swellings solely in neck area consistent with HIV presentation?

If HIV had progressed to a level that I were showing symptoms, would there likley be changes identifiable in my wbc count, or higher crp, esr?

Could extreme chronic stress for a year explain lowered immunity?  

I realise to be 100% certain I'd need a test.  I am considering this, fear is a barrier.  Would just like to know if this is a common HIV pattern?

[Edward W Hook, MD]

Welcome to our Forum.  I would not worry about HIV as the cause of your difficulties.  Your encounters were relatively low risk and as you point out, this is too far out to be a manifestation of the so-called Acute Retroviral Syndrome which occurs 2-4 weeks following infection and a bit too early to be a manifestation of HIV which had progressed to the point where you would begin to get other sorts of infections. If you wish to rule out HIV however (remember, I said your risk is low and it is), the right way to do this is with a blood test for HIV, not indirect tests such as the CRP, ESR or WBC- these can be normal for years in persons with progressive HIV.  

When persons get HIV, the lymph node swelling is generalized, not just localized to a region like the neck.  this is more consistent with localized infection such as a viral sore throat or mononucleosis syndrome.

Finally, regarding your fear of testing.  Testing does not give a person HIV but it does give them the power to know what is going on and whether or not they have the infection.  Most tests are negative and if you were so unfortunate as to have HIV, the test would allow you to seek treatment sooner.  There is no reason to delay or avoid HIV testing.  I anticipate that your test would be negative, perhaps relieving some of the stress that you mention.

Hope this information helps. EWH

[Edward W Hook, MD]

Glad I could help.  I hope you'll be feeling better soon.  EWH

[phoenix199]

Thankyou for your prompt and thorough response.  I am strongly considering a test for the reasons you outline.  I recognise that I have a low level paranoia re HIV and this odd lingering illness that I have is emphasising that fear.  Thankyou for putting my concerns re this illness to rest, though I appreciate knowing my status either way may in the longer term be helpful.  Being avoidant probably keeps me in low level fear!

I appreciate your help.  Best wishes