Worried sick

[Soscared22]

Hello doctors,

Thank you for all you do on this site. I'm a 27yr old white circumcised male. In the past 33 days I've been to 2 different massage parlors and have had an oraquick at home test and an hiv RNA test. Both girls were sex workers and their hiv/std status is unknown. If I need to pay to post for std advice too please let me know.
Sept 3rd: one minute of oral sex performed on me followed by handjob with her saliva used as lubricant. I have dry skin due to masturbation and baby powder, and the 10 minutes of motion left me chaffed and red with some open skin (no visible blood).
Sept 9th: protected oral sex performed on me and protected vaginal (same condom) -- the girl left the room to get it condom, there was no wrapper. Condom worked fine no breakage or anything out of the ordinary.
Sept 24th: at home oral hiv test resulted negative
Oct 4th: hiv RNA test, hepatitis b and c (result pending)

I started having symptoms about 2 weeks after the first encounter and they've persisted since. Everything from swollen lymph nodes in groin, neck, and armpit (googled how to check for them; all feel swollen and tender to the touch) white coating on my tongue and with a tongue depressor, looks like bumps on the back of my tongue. A few canker sore looking things in my mouth, night sweats for about 5 days, noticeable sweaty feet (not common for me), difficulty swallowing, fatigue, shortness or breath and pain in my chest at times. I can see my neck pulse on both sides, frequently feel hot or flushed but no confirmed fever. Dry cough developed a few days ago.

[Edward W Hook, MD]

This is a rather repetitive question.  As I said before, testing with BOTH an HIV antibody test and an HIV RNA test... at this time (any time more than 28 days after exposure) will provide definitive results.  This will prove that you do not have HIV.

I also repeat "none of the activities you describe place you at risk for HIV or, for that matter any other STI."

You should look for other reasons for your symptoms.  EWH

[Soscared22]

Hi doctor hook,

I just wanted to inform you I took a rapid hiv blood test and at this point it would have been 34 days since my first episode. It came back negative. I am still awaiting the hiv RNA test results. If both tests come back negative as you (and now I) fully expect them to, that would be 100% certainty of being hiv negative? I am still feeling symptoms mainly in my throat and lymph nodes. I just wanted to ask you if any other studs would have an effect on the lymph nodes and/or throat, causing redness or spots. If one wear to have ghonorea (sp) infection in the throat, that would have to come via oral sex? Or if you received it in the genital area could it still affect a different part of the body, like the throat. Just hypothetically asking. I will go to a doctor for these symptoms as you suggested, I just wanted to rule out anything else std related that would be a medical improbability or impossibility.

Thank you for your assistance. I am starting to feel less worried

[Edward W Hook, MD]

Welcome (sort of) to the post.  Let me start with two comments- you did not follow our instructions for questions and you know it.  You could have easily posted this question within our guidelines. Second and more important, it is often said that the person who has themselves as a patient has a fool for a doctor (and this may be even more true for those who rely on the internet for medical assessment).  This is salient in your case.  Your exposures, as I will indicate below are not associated with any known risk for HIV and your symptoms are non-specific.  If you are feeling poorly because of them, you need to see a doctor, not because you are likely to have HIV (you are not) but because there may be something else going on.  See your doctor.

Now for my assessment.  There is no known  risk for HIV from receipt of masturbation or condom protected sex (vaginal or oral) as long as the condom is used throughout and does not break.  Thus, none of the activities you describe place you at risk for HIV or, for that matter any other STI.  

Your tests make HIV most unlikely, had you been at risk although your OraQuick was done at only about two weeks after exposure and should have been done, in combination with the HIV RNA test at 4 weeks if you wanted to be sure you were not infected.  At two weeks HIV antibody tests detect only about half of recent infections and if anything, the oral fluid tests are less sensitive than other antibody tests (but only very slightly so).  

Your symptoms are quite non-specific and could have a great number of possible causes (mononucleosis or other, non-STI community acquired viral infections are common causes of lymph node swelling which are far, far more common than the ARS).  White tongues are meaningless, as are canker sores.  

There really is no medical reason for testing at all.  If you wish to prove that the internet has mis-informed you, testing with BOTH an HIV antibody test and an HIV RNA test, or a 4th generation combination HIV p24 antigen/HIV antibody test at this time will provide definitive results.

I do not mean to be harsh.   I hope my comments are helpful  There is no known risk for HIV from the activities you describe.  EWH

[Soscared22]

Sorry for the length of the post please don't delete I will gladly pay again just needed to get the complete thought out. Thank you again and anxiously awaiting your feedback

[Soscared22]

Everything I read suggests ars symptoms. I have read literally hundreds of posts -- I understand oral sex and saliva coming in contact with genitals is low risk as well as anything with a condom being safe, but the symptoms, timing, etc all suggest otherwise. I also see hundreds of posters worried about similar things, given the same prognosis, but rarely does the worried person come back to confirm everything is okay. It concerns me that someone with similar exposure to the kind I've had has gotten diagnosed and just never says anything on the forum. I'd like to know what chances you think there are that I contracted hiv -- if not hiv, what other stds could cause symptoms like these? Will my RNA test at the 31 day mark from the first incident be conclusive about my hiv status? What else would you suggest getting tested for? I read that ars symptoms are also caused by other common ailments, but I can't shake the timing of it all -- I mean it's either hiv/std related or some other kind of infection my body is fighting off, right? Stress couldn't cause all of these symptoms and it not actually result in being sick could it?