PEP, armpit pain, 6 weeks test

[worried_sh]

Dear Doctors,

it's been 6.5 weeks since I had 1-2 minutes unprotected vaginal sex with a CSW in China. 55 Hours later I was put on PEP that I finished 28 days later without having missed a single dose. Side effects were nausea and being tired all day.

Since 10 days after the exposure I suffer from a stiff neck and shoulders.

21 days after exposure I had some very slight penile burning AFTER urination. Doctor didn't run a test, but suspected Chlamydia and gave me 4 pills and a injection of antibiotics. One day later the burning was gone.

Exactly one day after I finished PEP, 30 days after exposure, I experienced some random pains all over my body, lasting only for a few seconds. Until today (it's been 2.5 weeks now) I still experience this weird aches, but mainly in my armpits and knees, sometimes my shins, calves and underarms. Nothing severe, on and off, and even not on every day.

I never had any fever, sore throat or rash and nothing that reminds me of a typical flu. Doctors regularly checked my lymph nodes and said they are normal.

The day before yesterday, 2 weeks after I finished PEP, I decided to go for a test. It was negative. To my surprise the doctor said that I should be happy and forget about HIV. But isn't it too early to do so? He even got a bit angry, saying that my fears are totally irrational and refused to test me again. The doctor is very experienced and has an excellent reputation, but he is not an STD specialist.

So I'd love to forget about this whole thing, but testing guidelines on the internet say that I have to wait at least 3 months if not even 6 months to get a conclusive result.

My questions:

1. How do you judge my 6 weeks negative test? Any percentage?

2. If my on and off armpit/body aches were due to HIV should the test 2 weeks later have picked up antibodies?

3. Do symptoms of myalgia, athralgia or peripheral nerve disorders appear in ARS without any fever, sore throat etc.?

Thanks a lot for your help!!

[H. Hunter Handsfield, M.D.]

Welcome back to the forum.

I am in complete agreement with your doctor and do not find it a "surprise" that he reassured you, and although I might not characterize your fears as "irrational, they certainly are unfounded.  As Dr. Hook told you in the other thread, the chance you caught HIV from the exposure you describe is very low; according to most experts' criteria, your exposure was too low risk to require PEP.

Unfortunately, there are no good data on the effect of PEP in delaying HIV seroconversion, but most experts believe there is only a slight delay and I agree that your current test results are very reassuring.  To be maximally safe, however, have a final test 3 months after the exposure (not 3 months after finishing PEP).  When you read "testing guidelines on the internet", try to remember that official agencies tend to take very conservative positions and generally recommend longer testing intervals than our necessary.

The symptoms you describe are irrelevant.  They don't even hint at HIV, especially in the absence of fever and objective signs of lymph node enlargement.  Various aches and pains are meaningless with respect to HIV.  To the specific questions:

1) I judge your risk of having caught HIV as zero and your 6 week test highly reliable.  As I said above, have a final test at 3 weeks for the additional reassurance it will give you.

2) As a rule, HIV antibody tests always become positive within 7-10 days of onset of symptoms.  In other words, your test is proof your symptoms are due to something other than ARS.

3) No. See above.

Let's not get into another series of "yes but" or "what if" questions as in your previous thread.  Feel free to return one more time after your 3 month HIV test, but not until then.  In the meantime, mellow out.  You don't have it.

Regards--  HHH, MD

[Vander]

Hi,
   Im certainly no doctor but I am highly surprised you was given PEP after the exposure you describe!! If you read through the hundreds of other post on here and if you take your doctors advice you will soon come to terms with that you do not have HIV.

happy living dude, hope you find some answers but doubt HIV is one of them..

P.S the mind is a powerful thing

[worried_sh]

Dear Dr. HHH,

Thank you so much for your help. It gave me great comfort and for the first time in 6 weeks I really felt confident and good.

Unfortunately I now have developed some palpable lymph nodes in both my groins. About pea-size. They weren't there before...

It's really devastating and I feel sorry for all people who I drive nuts with my fears (including myself).

I just wanna forget about this thing. At least until the final test. But my body doesn't let me to do so. Please believe me if I say that I am not searching for symptoms. They just appear.

[H. Hunter Handsfield, M.D.]

Almost everybody has small, palpable lymph nodes in the groin.  It's not abnormal and doesnt' suggest HIV.  Stop examining yourself, and stop interpreting as every minor variation in your body as something significant.  Accept the reassurance you have been given.  And please stop returning here with every additional anxiety-driven add-on question that comes to mind.  I'll delete any further comments except for the one reporting your final negative test result at 3 months.

[worried_sh]

Dear Dr HHH,

I will try my best. I promise!

Thanks again and may life bless you and your colleague for the wonderful work you are doing. You have my greatest respect.

[worried_sh]

Just for the record: I had another test 8 weeks after exposure, 4 weeks (27 days) after my last dose of PEP.

Doctor checked my groin nodes and said they are not pathological (?). Well, I still have discomfort (almost like a sore or pulled muscle) down there, spreading to my thighs and sometimes to my knees. Strange thing is that I mainly feel that while sitting, not while standing or walking.

Yesterday I had something like a rash on my neck, shoulders and upper breast. Totally 20 little red spots, quite wide-spread, not in groups. Might have been to the really hot and humid weather. Almost disappeared over night.

I plan to go for another test in 2 weeks. This would make 6 weeks after PEP which I hope is as conclusive as 6 weeks after exposure without PEP.

[H. Hunter Handsfield, M.D.]

A negative test at 8 weeks is sufficient proof you weren't infected.  That's the end of this thread; please don't post any more negative test results.

[worried_sh]

Dear Dr HHH,

please please don't delete this post!! I am really in the need of help. I know that I suffer from anxiety and I am also seeing a psychologist, but she is on vacation. I am suffering from panic attacks and hope that you can help me out one last time.

It's 11 weeks now, and I even had another negative test after 10 weeks which gave me great comfort. You said that already the 8 weeks one - though I was on PEP after my exposure - was "sufficient proof" that I wasn't infected.

But a few days ago I discovered a cluster of small nodes (pea size at most, rather smaller) under both my arms, reaching into my breast. Totally it must be 10-20. They are a bit painful when I touch them and the whole area feels tense.

Are you still convinced that I am in the clear? Can these nodes be really just coincidence.

I am in the middle of nowhere and can't see a doctor until end of this week. So your words would surely help me in my situation. I don't know how to survive the up-coming days...

[H. Hunter Handsfield, M.D.]

Re-read my other replies.  You're in the clear.  Any more comments of any kind whatsoever and this entire thread will be deleted.

[worried_sh]

Dear Dr.HHH,

I know that you might gonna delete this thread. But 2 weeks ago I got diagnosed with an enlarged spleen (ultrasound) which is causing me pain now. Maybe this changes the whole situation which I don't hope...

Actually I just wanted to do a final test, 3 months after exposure as you advised to be maximally safe which I guess means conclusive.

That's what I did 2 weeks ago. It was one of these DUO-tests (AB & AG) and it came back negative.

Unfortunately the doctor did also an ultrasound of the abdominal organs which revealed the enlarged spleen (13.5cm). Moreover the blood count revealed an iron deficiency and a slightly elevated CRP.

Btw, the last time I did an ultrasound (maybe 5-6 months ago) the spleen was still normal-sized.

Based on these news, do you think that I have to continue testing? Or can the 3 months negative (after exposure) be regarded as conclusive?

Believe me, I really wanna close this darkest chapter of my life and finally forget about this. Can I?

[H. Hunter Handsfield, M.D.]

A big spleen is something to worry about.  I don't want to alarm you, but lymphoma (lymphatic cancer), various serious infections, and other potentially dangerous problems come to mind, especially when splenic enlargement is combined with low iron and elevated CRP.  Drop your laser-beam focus on HIV, which has been definitively excluded.  However, syphilis is one possibility, so be sure you get (or have been) tested for it; that is the only way this could be related to your sexual encounter in China.  Continue to work with your doctor about the important problem here, which isn't HIV.

In the off chance you turn out to have syphilis, please let me know.  Otherwise, this is truly the end of this thread.  Since your problem has been proved to not be HIV, any further commments of any kind are not appropriate for this forum.  Goodbye and good luck.