Honest response

[eddy84]

Hi Doc,
I went to tijuana on 22 june had sex with professional it was protected but in between condom slipped of without cleaning my genital I put new one on, very next day felt very sick I wrote male to cdc they told me about pep I started pep after 60 hrs it was kelitra 2tabs twice a day 200mg and 1 tab twice a day of truveda 150 mg. today was my 28 day I felt very good in morning but as I reached school I was very tired I kind of felt my neck stiff and pain in throat then there was slight pain in my right groin area then I kept on looking for lymph node in neck found something like a pea in my submadular area near throat nothing felt (could it be tonsil??)  swollen  then in my groin are near my waist found some nerves and something like pea but very small but I felt headache too for whole day I even had a blister in my back with pus and gave me pain ( came 2 days ago) and some small pimples I never had any side effect of pep before except some dizziness. IS this a symptoms of ars I check my temp it was 97.1F  if its not ars then why do I feel so sick at the last day of my pep what should I do as I am a international student with not good insurance I cant afford to go to doc I am already in debt of 2400$ because of pep.  I am only 23 and life is seems to be getting over for me please help and please gave you’re honest response as I cant afford to go to a doc and yes I am feeling like having  sore throat (no cough)  I am still feel pain in my throat not much though and headache and some day back I was having pain in my submadular area too do swollen lymph nodes hurt?? I know chances of getting hiv is 1 in 1000 but sir I am one of the unluckiest people alive too :(    my whole body feel hot but i have no fever excuse my bad english its not my first language

[Edward W Hook, MD]

Your note is very difficult to follow. What I get from you is that you had an encounter in Mexico and the condom came off.  The very next day you felt ill and wound up taking PEP but the sick feeling you experienced has continued.

I have a few comments.
1.  I would not have recommended PEP for you.  You had only a single encounter and there is no reason to think that your partner had HIV.  Most commercial sex workers, even in Tijuana do not.  Your risk of side effects from the medications is higher than your risk of getting HIV.  I think you wasted your money.

2.  ARS does not start the day after exposure.  To me this is strong evidence that you did not have ARS but some other illness- probably a viral, non-HIV illness which you did not acquire sexually.  Furthermore, the sypmtoms you describe do not sound like ARS.  

3.  Your ability to find a few lymph nodes is irrelevant.  Everyone has lymph nodes and if you try long and hard enough you can feel them.

4.  Why do you feel so sick?  I suspect there are at least three contributors.  These are 1.) The viral illness you have acquired - it will take time to get better, 2.) possible medication side effects which should go away when you stop taking the medications and, 3) your anxiety is amplifying and all symptoms that you have, as well as possibly creating some of its own.

I did not see a specific question in your post.  These are my impressions.   AS to what should you do now?   As best I can tell you finished the PEP.  Now you need to just wait and get tested according to the follow-up plans of whoever provided you with the medication.  Hope this helps.  Try to calm down.  EWH

[eddy84]

Sir,
I felt sick very next day but could be just my anxity. I am done with my PEP yesterday and today i did not felt tired or no dierrohia but my sore throat is getting worst and my neck and throat is giveing me pain i can feel some cervical lymph node too. my question is do swallen lymph node give pain and how big a swallwen lymph node get because right now i can feel them as the size of pea although one one my left cervical i can see it in mirror as a little bump. and why do i suddenly having sore throat from only last two day even though i was on pep which should supress the infection?? and i also feelng dry mouth for whole day and when should i get tested for hiv
thanks for you reply

[Edward W Hook, MD]

The swollen lymph node in your neck are due to your sore throat.  Your sore throat is not HIV but due to something else.  As to what might be causing your sore throat, perhaps strep, perhaps some other virus.  The pea sized node you describe is irrelevant.  Pep will not supress anythng other than HIV and the chance that you have HIV is VERY, VERY low.

Following PEP you can get the most meaningful HIV test results 12 weeks after your last dose of medicine.  Results before that, starting at about 12 weeks will be helpful but not definitive.  EWH

[eddy84]

Thanks for response i tried my best in these days to stop looking for symptoms but sir my left tonsil is enlarged and give me pain, it been almost a week since i stop my pep so its no side effect and still have pain in throat so i still cant stop thinking about it so if its a normal viral ho much time it take to get better and if i keep touching my tonsil and throat does that make them swell to because my left tonsil is quite enlarged to my right and i still having some pinch kind of feeling in my throat plus little burning sensation on my tip of tongue

with regards
eddy  

[Edward W Hook, MD]

One last time, your symptoms are meaningless as an indicator of HIV.  What you are experiencing may be a viral sore throat which can vary a great deal in how long it will take to get better or it could be a manifestation of your uncontrolled and inappropriate anxiety, made worse by your continuuing manipulation of the area.  To get this sorted out, see a local doctor.  This is not a question I can answer.  

No further questions about "could this be" or "what if" will be answered - they will be deleted.  If you wish, ou may wish to take your concerns to the MedHelp HIV Prevention Community where I suspect you will get answers similar what I've already said.  EWH