what are the chances?

[vitaminwater84]

Hi Doctor,

Less than a month ago I performed oral sex several times on a man without him ejaculating in my mouth and we also performed condom protected anal sex twice, both times in which he ejaculated outside, where I was the receiving partner.  He claims to not have HIV.  What is the risk of infection from these activities?

Now for the past 3 days I have been experiencing a slight fever, an excruciating migraine today, night sweats, achyness, fatigue, and I've had swollen lymph nodes for a couple of weeks (even without the other symptoms), which I feel is strange given that these aren't exactly common symptoms of a common flu (i.e. no runny nose, cough, sneezing, sinus, etc....not yet at least)

I went to see a doctor yesterday and she discovered that the inside of my left ear was very red so she believes I have an ear infection although I don't feel any pain or discomfort in my ear.  I also described the above concern to her and she believes I am at no risk for HIV infection.  In any case, my research on swollen lymph nodes that last for more than a week or two is that they can be indicative of something more serious (such as HIV infection or lymphoma).  I'm a young 24 y/o otherwise healthy male with no previous medical history, including from my family's side.

Any thoughts or opinions on this? I plan to get tested at the 4 week mark but in the meantime I'm very stressed.

Thank you.

[H. Hunter Handsfield, M.D.]

I agree exactly with your clinician; if your symptoms were due to HIV, your blood test probably would have been positive. That's good evidence you don't have HIV.  But follow your clinician's advice as to whether she recommends any additional HIV testing, and to learn the results of the other tests to evaluate your symtoms.  

[vitaminwater84]

Hello again Doctor,

At this point it's been about a month since the sexual activity and I've gotten an Oraquick Elisa rapid test and the results were negative. I explained the above symptoms I was having to the clinician and she explained to me that if I were infected by HIV and am experiencing those symptoms, then the seroconversion would have produced enough antibodies to be picked up by the test at this point.  But the test came back negative.  Any thoughts or comments on this?

I still have swollen lymph nodes and night sweats here and there (not every night). I've already gone to a doctor to get blood tests done for other possible purposes.

Thanks.

[H. Hunter Handsfield, M.D.]

You won't like hearing this, but I agree those symptoms are of concern.  I'm not sure about the night sweats -- you say you had "slight" fever, but night sweats are basically a sign of fairly high fever.  If you truly have lymph node enlargement in several body areas, that also is a concern -- but almost everybody has lymph nodes in the groin that can be felt on careful examination, so that might not count.  As for other possibilities, infectious mononucleosis (mono) comes to mind, but no other STDs.  

As I said above, it seems like you have a pretty knowledgeable doctor, and her reassurance is a good sign, especially if she is experienced in management of persons with early HIV infection.  But if she isn't, ask her about seeing an infectious diseases specialist or other provider with partricular HIV experience.  Rather than a rapid antibody test, direct testing for the virus (PCR test) or other testing might be wise.

[vitaminwater84]

Thank you for your response doctor.  I am still, however, concerned about these two symptoms:

1).  Pretty sever night sweats throughout the night.  They occurred for a couple of nights a few days after the activity of concern, subsided for sometime, then returned for the past 3 nights.  I would wake up quite soaked several times a night.

2). Swollen lymph nodes (in the neck and groin and perhaps other places that I am not aware of) for more than two weeks which all research I have done indicates that that long of a period for lymph nodes to be swollen is cause for concern.

Although the doctor's response as well as yours have made me feel better about the situation, I am still concerned because I have not experienced symptoms like these before.  They do not seem like the flu or a cold since they don't include any nasal or throat symptoms (runny/stuffy nose, cough/sore throat, etc).  The strong migraines in the morning (for the past 2 days) are also quite concerning.

Would a rapid HIV test at 3 weeks be reliable?

Also, could these symptoms be indicative of another STD?

Thanks again.

[H. Hunter Handsfield, M.D.]

I see no serious risk here.  Few people lie when asked outright about their HIV status, so it is very unlikely your partner was infected.  And oral sex is low risk anyway; even with ejactulation in the mouth by an HIV infected partner, the average risk is somewhere around one transmission for every 10,000 exposures.

Your symptoms sound like an upper respiratory infection and your doctor obviously agrees, and I see no reason to question her judgment about the low risk of HIV.  And the generalized lymphadenopathy associated with acute HIV infection is exactly that  -- generalized; several areas of your body would be involved, not just the head and neck. This doesn't sound at all like lymphoma.  I'm sure your doctor said the same.  (If you didn't ask her these questions, please do so.)

You can expect negative HIV test results.  You obviously have a knowledgeable physician.  Continue to follow her advice.

Best wishes--  HHH, MD