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Dr. Edward Hook, assessment of situation please
Hello Dr. Hook,
A friend of mine who works in the mdical community suggested I correspond with you here to get expert advice on my situation. In brief, I'm extremely worried about an encounter I had 8 weeks ago. I had what began as protected vaginal intercourse but my condom broke mid way and I don't know how long I was exposed. When I did pull out (I did not ejaculate) I was covered in her vaginal secretions, I immediately got up washed myself and rubbed my enitre genital area with a strong aftershave! I then replaced the condom and completed the act. I'm now learning the girl is in a potential high risk category. Within 1 week I began developing a mild sore throat which lasted a few days and experienced a few days of fatigue. Between week 2 and week 4 I developed other symptoms including nausia, loss of apetite, about 3 episodes of diarreah, 1 episode of a cold sweat. In week 3 I developed some sort of a rash on my back, it was a blotchy reddish area, not raised, about the size of 3 fingers together in length and width. It is still somewhat present although very faint, and becomes more pronounced after a hot shower. Also in week 3, I developed another rash on the insode of my elbow consisting of a cluster of little red raised dots which went away the next day.
In week 5 I began noticing red spots appearing randomly on my torso and armpit area. Sometimes they are clearly pimples, other times there is no white head and they go away after a few days. In week 5 I also began getting random hot flashes and many nights with night sweats, as well as a consistant headache, especially in the morning when I wake up. 2 days ago ( 7.5 weeks) I again experienced faint nausia, hot flashes and sweating (I think they occure while or after I eat), and last night more night sweat.
A friend of mine who works in the mdical community suggested I correspond with you here to get expert advice on my situation. In brief, I'm extremely worried about an encounter I had 8 weeks ago. I had what began as protected vaginal intercourse but my condom broke mid way and I don't know how long I was exposed. When I did pull out (I did not ejaculate) I was covered in her vaginal secretions, I immediately got up washed myself and rubbed my enitre genital area with a strong aftershave! I then replaced the condom and completed the act. I'm now learning the girl is in a potential high risk category. Within 1 week I began developing a mild sore throat which lasted a few days and experienced a few days of fatigue. Between week 2 and week 4 I developed other symptoms including nausia, loss of apetite, about 3 episodes of diarreah, 1 episode of a cold sweat. In week 3 I developed some sort of a rash on my back, it was a blotchy reddish area, not raised, about the size of 3 fingers together in length and width. It is still somewhat present although very faint, and becomes more pronounced after a hot shower. Also in week 3, I developed another rash on the insode of my elbow consisting of a cluster of little red raised dots which went away the next day.
In week 5 I began noticing red spots appearing randomly on my torso and armpit area. Sometimes they are clearly pimples, other times there is no white head and they go away after a few days. In week 5 I also began getting random hot flashes and many nights with night sweats, as well as a consistant headache, especially in the morning when I wake up. 2 days ago ( 7.5 weeks) I again experienced faint nausia, hot flashes and sweating (I think they occure while or after I eat), and last night more night sweat.
Thank you for everything Dr. Handsfield!
MEDICAL PROFESSIONAL
No medicines interfere with HIV testing.
By the way, if you have both oral and genital herpes, you can be quite certain the genital infection is due to HSV-2. People with HSV-1 can't catch a new infection with HSV-1 (same for HSV-2); and dual genital-oral HSV infections are uncommon.
That has to end this thread. Try to accept the reassurance you have had, stop overthinking it, and stop looking for more information on the web. There is no information you can possible provide that will change the fact that you don't have HIV.
By the way, if you have both oral and genital herpes, you can be quite certain the genital infection is due to HSV-2. People with HSV-1 can't catch a new infection with HSV-1 (same for HSV-2); and dual genital-oral HSV infections are uncommon.
That has to end this thread. Try to accept the reassurance you have had, stop overthinking it, and stop looking for more information on the web. There is no information you can possible provide that will change the fact that you don't have HIV.
Hello Doctor,
Thank you for your replies. Just one last quick question please, if I took acyclovir (for 1 day, 4 pills in the morning and 4 at night) for an oral cold sore outbrake I had at about 10 days after my exposure, would that delay/interfere in any way with the results of my HIV tests at 2, 3, or 6 weeks?
That's all, thank you Doctor!
Thank you for your replies. Just one last quick question please, if I took acyclovir (for 1 day, 4 pills in the morning and 4 at night) for an oral cold sore outbrake I had at about 10 days after my exposure, would that delay/interfere in any way with the results of my HIV tests at 2, 3, or 6 weeks?
That's all, thank you Doctor!
MEDICAL PROFESSIONAL
"I was informed the accuracy of a 6 week result depends on the individual's immune system and abaility to develop enough detectable antibodies at that stage."
You were misinformed. This theoretically might be true, and to that extent I agree it "seems logical". But it doesn't work that way. There is no signficant difference in how rapidly people develop antibody, regardless of how "strong" their immune systems are. The test results seem to be equally valid at the same intervals in everybody.
1) The value of P24 antigen and/or PCR testing is in detecting infection within 3-4 weeks. Beyond that, it's a waste of money to have anything other than an antibody test.
2) Your new understanding is correct. The numbers (HSV-1 versus 2) refer to the viruses, not the disease. HSV-1 usually causes oral infection, but is often the cause of genital herpes, usually acquired by oral sex. HSV-2 is usually genital, but once in a while is transmitted to a partner's mouth by oral sex.
If you have frequent recurrent herpes outbreaks, e.g. a few times a year, you can be pretty sure you have HSV-2. Genital HSV-1 recurs infrequently, in many people not at all. Beyond those clues, there are 2 ways you can know which type you have. If and when you have a future outbreak, see a provider immediately (within 1-2 days) so the lesion(s) can be tested for HSV, including virus type. Second, blood tests are available to tell whether someone is infected with HSV-1, HSV-2, both, or neither.
For excellent online information about genital herpes, see the websites of th American Social Health Association (www.ashastd.org) or the Westover Heights Clinic of Portland, OR (www.westoverheights.com); or just scan the many discussions in our STD forum or the MedHelp herpes forum. Full disclosure: Dr. Hook and I are on ASHA's Board of Directors and WHC is owned and run by Terri Warren, who moderates the herpes forum.
That should end this thread. Don't worry about HIV. If you have other questions about your herpes, either the STD forum or herpes forum would be appropriate.
You were misinformed. This theoretically might be true, and to that extent I agree it "seems logical". But it doesn't work that way. There is no signficant difference in how rapidly people develop antibody, regardless of how "strong" their immune systems are. The test results seem to be equally valid at the same intervals in everybody.
1) The value of P24 antigen and/or PCR testing is in detecting infection within 3-4 weeks. Beyond that, it's a waste of money to have anything other than an antibody test.
2) Your new understanding is correct. The numbers (HSV-1 versus 2) refer to the viruses, not the disease. HSV-1 usually causes oral infection, but is often the cause of genital herpes, usually acquired by oral sex. HSV-2 is usually genital, but once in a while is transmitted to a partner's mouth by oral sex.
If you have frequent recurrent herpes outbreaks, e.g. a few times a year, you can be pretty sure you have HSV-2. Genital HSV-1 recurs infrequently, in many people not at all. Beyond those clues, there are 2 ways you can know which type you have. If and when you have a future outbreak, see a provider immediately (within 1-2 days) so the lesion(s) can be tested for HSV, including virus type. Second, blood tests are available to tell whether someone is infected with HSV-1, HSV-2, both, or neither.
For excellent online information about genital herpes, see the websites of th American Social Health Association (www.ashastd.org) or the Westover Heights Clinic of Portland, OR (www.westoverheights.com); or just scan the many discussions in our STD forum or the MedHelp herpes forum. Full disclosure: Dr. Hook and I are on ASHA's Board of Directors and WHC is owned and run by Terri Warren, who moderates the herpes forum.
That should end this thread. Don't worry about HIV. If you have other questions about your herpes, either the STD forum or herpes forum would be appropriate.
Hello Dr. Doctor Handsfield,
Thank you very much for your detailed reply. It definitely helps put things into a clearer perspective.
For my own peace of mind I am going to do another test either this comming week or the following week which will be my 9 week mark. Given all the statistical information, I find it hard to believe a result at 8/9 weeks will change by 12 weeks. I was informed the accuracy of a 6 week result depends on the individual's immune system and abaility to develop enough detectable antibodies at that stage. Would a person with a stronger/healthier immune system develop antibodies much faster than someone with an already compromised/unhealthy immune system, meaning that a generally healthy person's 6 week result would be much more conclusive? That just seems logical to me, but what do I know.
1) Do you think that a regular ELISA will suffice, or should I try to get a P24/Anitgen or PCR RNA, are any of those other 2 relevant at this point, would they provide a closer to 100% accurate result before 12 weeks, and is there one specifically that you would recommend over the other to get? I only about those tests what I read on the net.
2) I was very confused about the HSV. I always thought that HSV 1 was oral herpes and that HSV 2 was genital herpes! So if I understand correctly now HSV 1 and 2 are two different type of HSV strains? So you can have oral herpes that's either HSV 1 or 2 and same for genital? How can I find out which one I have?
Thank you Doctor.
Thank you very much for your detailed reply. It definitely helps put things into a clearer perspective.
For my own peace of mind I am going to do another test either this comming week or the following week which will be my 9 week mark. Given all the statistical information, I find it hard to believe a result at 8/9 weeks will change by 12 weeks. I was informed the accuracy of a 6 week result depends on the individual's immune system and abaility to develop enough detectable antibodies at that stage. Would a person with a stronger/healthier immune system develop antibodies much faster than someone with an already compromised/unhealthy immune system, meaning that a generally healthy person's 6 week result would be much more conclusive? That just seems logical to me, but what do I know.
1) Do you think that a regular ELISA will suffice, or should I try to get a P24/Anitgen or PCR RNA, are any of those other 2 relevant at this point, would they provide a closer to 100% accurate result before 12 weeks, and is there one specifically that you would recommend over the other to get? I only about those tests what I read on the net.
2) I was very confused about the HSV. I always thought that HSV 1 was oral herpes and that HSV 2 was genital herpes! So if I understand correctly now HSV 1 and 2 are two different type of HSV strains? So you can have oral herpes that's either HSV 1 or 2 and same for genital? How can I find out which one I have?
Thank you Doctor.
MEDICAL PROFESSIONAL
The important information in all that long description is that your HIV antibody tests have been negative. At least 95%, perhaps 99%, of people with new HIV infections have positive results by 6 weeks. Therefore, your negative results show you were not infected with HIV and that something other than HIV explains any and all symptoms you have. In addition, you describe a low risk exposure, because -- assuming you are in the US other industrialized country -- the chance a random sexually active woman has HIV is under 1 in 1,000. And even if she were infected, the chance of transmission during a single episode of vaginal sex averages around 1 in 2,000. So even before you were tested, the odds you caught HIV were in the range of 1 in 2 million -- a lot lower than the chance of winning the lottery!
To your specific questions:
1,2) Acute HIV symptoms rarely start later than 2-3 weeks after exposure, if ever. Most symptoms probably come within a few days of each other. But I'm not going to address your symptoms in more detail than that, because the test results prove HIV isn't the cause.
3) Genital herpes due to HSV-2 (but not HSV-1) roughly double the risk of HIV if exposed. But again, the level of risk in your exposure became irrelevant once your blood test results were known.
4) All such estimates are rough, based on different kinds of research. Dr. Hook tends to round off the CDC data, which suggest 1 in 2,000 for male-to-female transmission by vaginal sex, to 1 in 1,000 -- but it makes little difference in risk assessment. (If we use 1 in 1,000 in my estimate above, your risk would calculate to 1 in a million instead of 1 in 2 million. Both are so low as to be highly reassuring.) I cannot vouch for a figure of 6 in 100, which is impossible if you're talking about single sexual exposures. I have to assume that estimate is in discordant couples over time, or perhaps it is for specific kinds of high risk exposures such as anal sex among HIV-discordant men having sex with men.
5) The reliability of a 6 week result is discussed above. Combined with the other factors that argue against HIV -- the nature of the exposure plus your symptoms which were not typical of HIV -- it is impossible you have HIV. Because so many experts recommend 3 months as the final, definitive testing interval, you might want to be retested at that time -- for further reassurance. It really isn't necessary, but it's up to you.
Best wishes-- HHH, MD
To your specific questions:
1,2) Acute HIV symptoms rarely start later than 2-3 weeks after exposure, if ever. Most symptoms probably come within a few days of each other. But I'm not going to address your symptoms in more detail than that, because the test results prove HIV isn't the cause.
3) Genital herpes due to HSV-2 (but not HSV-1) roughly double the risk of HIV if exposed. But again, the level of risk in your exposure became irrelevant once your blood test results were known.
4) All such estimates are rough, based on different kinds of research. Dr. Hook tends to round off the CDC data, which suggest 1 in 2,000 for male-to-female transmission by vaginal sex, to 1 in 1,000 -- but it makes little difference in risk assessment. (If we use 1 in 1,000 in my estimate above, your risk would calculate to 1 in a million instead of 1 in 2 million. Both are so low as to be highly reassuring.) I cannot vouch for a figure of 6 in 100, which is impossible if you're talking about single sexual exposures. I have to assume that estimate is in discordant couples over time, or perhaps it is for specific kinds of high risk exposures such as anal sex among HIV-discordant men having sex with men.
5) The reliability of a 6 week result is discussed above. Combined with the other factors that argue against HIV -- the nature of the exposure plus your symptoms which were not typical of HIV -- it is impossible you have HIV. Because so many experts recommend 3 months as the final, definitive testing interval, you might want to be retested at that time -- for further reassurance. It really isn't necessary, but it's up to you.
Best wishes-- HHH, MD
Hello Dr. Handsfield,
Thank you for your reply, I only specified for Dr Hook because a doctor friend of mine gave me his name. I appologize again for going over the limit, my post above has my questions.
Thank you Docotor!
Thank you for your reply, I only specified for Dr Hook because a doctor friend of mine gave me his name. I appologize again for going over the limit, my post above has my questions.
Thank you Docotor!
MEDICAL PROFESSIONAL
Dr. Hook and I take questions without regard to requests for one of us or the other. And the purpose of the word limit is to keep things brief, so that the entire question is in the first field. (Some MedHelp moderators set their browsers so they never even see any follow-up comments.) Yours doesn't go that far over the limit, though, so I'm letting it stand. Don't mean to lecture you about it -- I do want other users to understand that we normally don't respond if the initial question spills over into a comment field.
HHH, MD
HHH, MD
Sorry I did not know there was a space limit for typing the post. Continued below;
3 days ago, I had an itch on the inside of my right knee and a few moment later a cluster of what looked like mosquito bites appeared and went away after about an hour, and again yesterday, I had the exact same thing appear on the inside of my left thigh/groin area and disappear after about a half hour. So far I have not had any fever or swollen lymphnodes. I also did a total of 3 HIV tests, the first at 2 weeks, then at 3 weeks, and my last one at 6 weeks all of which came back negative.
1) Can symptoms of infection begin beyond 4 weeks?
2) Do the symptoms hit all at once and disappear all together, or is it possible for each one to appear several days or a week before the next one and disappear one at a time as well?
3) I am circumcised but I do have genital HSV. I read that increases the possibility of infection, is this true and if so by how much?
4) In terms of statistics, I read here you stating that the risk of infection is less than 1/1000, another doctor states 1/2000, and a doctor on the International forum states 6/100, which is the most accurate?
5) How conclusive is my 6 week test?
Thank you very much Doctor.
3 days ago, I had an itch on the inside of my right knee and a few moment later a cluster of what looked like mosquito bites appeared and went away after about an hour, and again yesterday, I had the exact same thing appear on the inside of my left thigh/groin area and disappear after about a half hour. So far I have not had any fever or swollen lymphnodes. I also did a total of 3 HIV tests, the first at 2 weeks, then at 3 weeks, and my last one at 6 weeks all of which came back negative.
1) Can symptoms of infection begin beyond 4 weeks?
2) Do the symptoms hit all at once and disappear all together, or is it possible for each one to appear several days or a week before the next one and disappear one at a time as well?
3) I am circumcised but I do have genital HSV. I read that increases the possibility of infection, is this true and if so by how much?
4) In terms of statistics, I read here you stating that the risk of infection is less than 1/1000, another doctor states 1/2000, and a doctor on the International forum states 6/100, which is the most accurate?
5) How conclusive is my 6 week test?
Thank you very much Doctor.
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