HSV vs ARS symptoms

HSV vs ARS symptomatology

Hello Dr.  Very impressive website.  Here

[H. Hunter Handsfield, M.D.]

I'll try to help.  First, herpes:  I'm not certain have it.  I gather there were no lesions to culture, so you should have serological tests.  Acute and convalescent would have been good, but if not yet done, it might be too late for the acute specimen.  But you still could have type-specific serology now and, if negative for HSV-1 and/or HSV-2, be retested for same in a few weeks. But the immediacy of the genital lesion is strong evidence against herpes, whose incubation period is at least 2-3 days, and any herpes-related symptoms should have responded promptly to acyclovir.

HIV:  Statistically, the odds are against it.  The odds any particular heterosexual, non-drug-using woman is HIV infected are low (even in women with HSV-2).  And you say all your vaginal sex was condom-protected, and acquisition by fellatio is extremely rare, if it occurs at all.  The symptoms indeed are compatible, but they are nonspecific.  However, your partner's refusal to be tested is disconcerting. In any case, the pending test will tell the story.  Even though 24 days is early, in people with your symptoms, if due to HIV, it probably would be positive, so a negative result will be substantially reassuring (but not perfectly so).  It will be especially reassuring if you had a modern "duo" test, i.e. if both antibody and P24 antigen are negative.  In that case, you still will need follow-up testing a few weeks down the road.  But I will be surprised if you turn out to have HIV.

As to the cause of your illness, assuming not HIV, that's hard to judge.  Your symptoms are consistent with mono, but given both your age (too old) and negative monospot, classic mono (EBV infection) has been ruled out.  Conceivably cytomegalovirus (CMV)--but no particular need to document, since diagnosing acute vs chronic latent infection (which most people have) can be difficult.  Since your symptoms now are resolving, you probably should just sit tight, with the likelihood you'll never know for sure.  Perhaps some unidentified EBV-like or CMV-like virus, whether acquired during your big weekend or somewhere else.  Or even a drug reaction; acyclovir is rarely an allergen, but in view of the low likelihood of herpes and lack of other explanations, I suggest stopping it.  But if symptoms persist or relapse, you might ask your doc to refer you for consultation by an infectious diseases specialist.

To the forum users who might be inclined to challenge an apparent inconsistency with my usual strong statements against symptoms as an indicator of early HIV infection:  Don't go there.  There is no inconsistency and I'm not going to discuss it.

Good luck--  HHH, MD

[Glappy]

Thank you Dr. H.  Your insight has helped tremendously..  Re an addendum to the primary lesion, 5 years ago I underwent a mid-life circumcision after a bout w/ balinitis.  The pre-circumsized foreskin had a ~ large genital wart of 20 years' duration there.  Interestingly, the 'lesion' 27 days ago came up in this exact position.  My MD and I at day 10 noticed a seperate, raised, fluid-filled single <1 X 1mm lesion 2 inches away on the shaft.  Sorry for the detail, but I thought you might find it interesting;  how many mid-life circumcision scenarios like this exist?!  Perhaps weaker connective tissue at this particular point or some such predisposition I suppose.  I've been sexually active since that surgery and this is a first..

I'm cutting out the acyclovir.  Let's just see if I run into any OB's.  We are running serology looking for HSV at present.  I'll be practicing abstinence of course, and I will keep the forum posted unless I'm told not to re the outcome.  

My partner has agreed to testing herself next week by the way.  This coupled w/ my western blot should give me a definitive answer one way or the other...  Thanks again!

[Man_Apart]

Dear Dr. H, I know u didnt want anyone to comment about what u said here, i just have a quick follow up on my questions. As far as ARS symptoms, is it possible to have 1 swollen lymph node behind ur ear 4 weeks after ur intial symptoms start? I had this node behind my ear swollen 4 weeks after my initial symptoms and it has been now swollen for 3 weeks, can this be ARS related from ur experience, or it could be sthg else, may be a gum infection(which i have a history of) or sthg like syphilis? Thanks for ur help Doctor.

[H. Hunter Handsfield, M.D.]

How many times and in how many ways can I repeat that symptoms never are reliable indicators of early HIV infection, especially after low risk exposures.  See a health care provider if you are concerned.  Do post any more questions about it on this forum.

HHH, MD

[Glappy]

Hello again.  I'm posting a quick update.  Turns out bloodwork day 24 wasn't quite as perfect as I'd first thought.  CD4 percentage was down to 16.  My MD isn't too alarmed, quoting that various other reasons could be responsible, lab error, variation, etc.  Turns out he didn't run Western Blot back on day 24, but another EIA which came back - .  He'd never heard of the duo and wasn't keen on referal to an infectious disease doc at this point.  I went to an STD clinic and had them run an oraquick advance using drawn blood on day 31.  Another - .  My 'partner' has finally agreed to hit that clinic today.  Whether she'll tell the truth or even actually go is another story, though I believe her.    Lethargy and tingling, etc has gone.  I've felt more or less normal since around day 32 and this is now day 34.  I actually enjoyed my first good nights sleep in a month day 32...  Does the percentage alarm you?  Basically down 20% below the lower normal.  They didn't run CD8 in that test...

I will post re her results.  Leaving tomorrow for a long-planed 2 week trip to Europe with my boys irregardless of her outcome..  Will restest upon returning end of August ~ week 7 to 8.  Any recommendations as to which test would be the most accurate at that time?           Thanks,
                                  glappy

[Glappy]

Dr H,
     Forgot to mention that MD was convinced that what he saw on day 10 was herpes lesion.  Any chance CD4's affected by bodies initial reaction to that virus?

[H. Hunter Handsfield, M.D.]

Only the HIV tests per se are reliable indicators of HIV infection:  not symptoms, not CD4 percentage, nothing else.  Absolute CD4 numbers are more important than percentage.  But in any case, CD4 levels vary to some extent naturally and can drop temporarily with infections and inflammatory conditions other than HIV.

Your own doc, and especially an infectious diseases specialist, in general are more reliable sources about specific causes of your problem, and the meaning of your lab tests, than I (or any online source) can be.

Good luck--  HHH, MD