Active Lymph Nodes-Early HIV Testing

[SS17]

Dear Doc:

Had sex with a prostitute February 10th. During vaginal intercourse, condom broke & I ejaculated inside her. Tested for HIV, Chlamydia, & Gonorrhea Feb. 13. Began to experience frequent urination, slight burning during urination, & finally whitish discharge from penis Feb. 14. Dr. wrote script for both Chlamydia/Gonorrhea Feb. 15. Medication referred to as T-pack I think. Results for all tests received Feb. 15-all negative due to window period i assume. above symptoms have sense disappeared. Over the weekend began to notice area around neck/lymph nodes felt “active” & mildly sore. Didn't notice any swelling here-worried about HIV early symptoms involving swelling of lymph nodes b/w 2-4 weeks after infection.  Sensations/mild soreness in neck area much decreaed as of yesterday. Understand HIV is more easily transmitted from a person with another existing STD at time of contact & given that sex was with a high risk person I am extremely stressed, unable to sleep much, loss of appetite, etc. Considering taking the HIV PCR with HIV EIA test thru Request a Test Monday which will be over 2 weeks, retest at 28 days w/antibody test at 6 weeks. Not clear whether PCR test covers all HIV-1 subtypes & the mention of increased likelihood of false positives a little scary but waiting 6 weeks, or worse 3 months, will be hell at this rate. Is 2 weeks to soon for the PCR test? What about 28 days? Or just wait it out for the antibody test, & if so, how soon can it be considered, if not conclusive, darn reliable? Thanks.

[H. Hunter Handsfield, M.D.]

Even if your partner had HIV, the odds you caught it were in the range of 1 chance in 2,000.  That risk is higher if you acquired nongonococcal urethritis (NGU), which seems likely, but still tghe odds are strongly in your favor.  Statistically, it is not likely your commercial partner had HIV.  Symptoms are never meaningful in judging new HIV infection, and you cannot judge yourself whether your lymph nodes are 'active'; without obvious swelling, probably not.  If a health care provider experienced in new HIV infections recommends PCR testing, fine; but you should not request it on your own without an experienced provider's recommendation.  If you just cannot handle a 6 week wait, have an antibody test at 3-4 weeks; although not definitive, a negative result after 3 weeks will be reassuring.  Then have a second test a few weeks later.

Use the Search link and enter 'time to positive HIV test' and/or 'HIV diagnosis' (with the quotation marks) for over 150 threads with repeated discussions of test reliability at various intervals.  Also search for 'ARS symptoms' for more information about why your symptoms probably are meaningless.

Good luck--  HHH, MD

[sparkeler]

One time vaginal exposure carries a 1/2000 risk.  The risk probably increases SLIGHTLY if she had a bacterial std.  However,  even if she did have a bacterial std, it doesn't mean she has hiv.  Remember, Chlamydia & Gonorrhea are much more common & easier to transmit then HIV.  Your symptoms suggest more of anxiety than anything else.  Not consistant with HIV at all.  The doctor will NOTrecommend PCR testing.  Those tests are known to give false positive results.  Would you want to risk the chance of possibaly having a false positive?  Think about all the unwarranted stress it will cause.  Your better off having a regular test done at 6 weeks.  You can expect a negative result.  I guarantee you.

[SS17]

I appreciate the feedback. Re your comment that the risks are higher if I acquired NGU - if the ratio is 1 to 2000 normally what does this then become in above scenario involving concurrent NGU. Again, thanks.

[RB888]

     I doubt you can get a number or odds that would reflect accurately your risk invloving a certain STD and your risk of aquiring HIV.

     You don't mention when the condome broke but it would have protected you up until the time it broke. I have read that HIV transmission from a broken condom although it does happen is quite rare. There is an FDA approved PCR RNA test for the expressed purpose of diagnosing early infection. It is in part FDA approved because it has a low rate of false positives - the main reason most experts warn against this type of testing. Although you would still need to follow up with antibody testing to be conlclusive, a negative on this test at two weeks would go along way in relieving your anxiety. The PCR is called Aptima and was only recently approved for early detection of HIV before antibodies can be detected.

RB

[SS17]

Thanks for the info.