Risky exposure, andnow stressed out!

Doctors HHH and EWH,

I am a 25 year old heterosexual male, and I had a risky sexual exposure on August 1st with a CSW in NYC, where I live.  It was NOT an unprotected exposure but the condom was removed and then put back on.  

I did not ejaculate in the condom before it was removed the first time, and it did not break before I was finished using it the second time.  However, because the condom was removed and then reapplied it was not as airtight as it should, or could have been.  

Since that time, I have noticed that I have multiple lymph nodes throughout my body that have swollen; one in my right armpit, one in the back of my neck at the base of my head, and one in my groin.  It is worth noting that banged my shin pretty badly, so I guess that could be the cause for the swelling in the groin.  But I am worried that the additional swollen lymph nodes could be a sign of early HIV infection.  Before going on, I know that the only way to be 100% sure is to get tested, and I plan to do so in the next few weeks, when results will be indisputable.

Given the circumstances, what is the typical timeframe that lymph nodes would begin to swell after initial infection?

I have also read elsewhere that if lymph nodes were to swell because of HIV it would be in multiple sites, as I have.  I am not, nor have I experienced other symptoms; are swollen lymph nodes by themselves could be a good indicator that I have been infected?

I have been stressing a great deal as this experience is completely out of character for me, and it will be the last time I ever do something like that!

Thanks for your time, and the service you guys are offering here, you are truly doing a great job!

[H. Hunter Handsfield, M.D.]

You really are not at signficant risk of catching HIV from that exposure.  It is the rare CSW in the United States, even in New York, who has HIV.  Even with unprotected sex, the average risk of female-to-male transmission by vaginal sex is once in every 2,000 exposures.  And although it isn't ideal that the same condom was removed and replaced, the sex was still condom-protected and you can assume virtually 100% protection.  So the chance you were infected is zero for practical purposes.

Your symptoms make no difference in analyzing your risk.  You are correct that HIV does not cause lymphadenopathy (lymph node enlargement/swelling) without also causing fever and other symptoms.  Further, self-assessment of lymph node enlargement by medically untrained persons is very unreliable; I don't accept you have enlarged nodes unless/until confirmed by a health professional.  (Don't take that personally; it's just a fact.)  And even if you have generalized lymphadenopathy, several other causes are much more common, and therefore more likely, than HIV.  There have been innumerable discussions on this forum about the fact that symptoms virtually never are relevant in assessing someone's chance of having a new HIV infection; scan just about any 10-15 threads at random for additional discussions.

Since you're concerned, have an HIV test to prove to yourself you weren't infected.  It's more than 6 weeks since the exposure, which is sufficient to be confident in the negative result, which is what you can expect.  And if you remain convinced your lymph nodes are enlarged or you otherewise remain concerned, have your provider evaluate that when you see him or her for HIV testing.

I hope this helps.  Thanks for the thanks about the forum.

HHH, MD

[wrm0605]

Thanks Doctor!  That does help to ease my mind a bit, and I will let you know how the results come back when I get tested.

Take care!

[wrm0605]

Hi Doctor,

I went and had blood work done on October 2nd, so about 60 days after my risky exposure with the CSW.  I got the results to the HIV test today, and they came back negative, as you predicted.  It is quite the relief, as I have been very worried!  

My final question is how definitive is that result given the timeframe at which I was tested?

Thanks again for your support and all your help; and believe me, I have learned, and will  in no way be putting myself in such a risky situation again!!  

[H. Hunter Handsfield, M.D.]

With modern HIV tests, a negative result at 2 months is definitive, especially in the low-risk situation you described.  You don't need any additional testing.

[wrm0605]

Hey Doc, I know you said that a negative result at 2 months is definitive; but over the past weekend (about 9 and a half weeks after my exposure), I came down with a fever, and a very sore throat.  The fever only lasted a day, and my throat is no longer sore, but I now have two canker sores on my tounge, and a rash on my fingers that is very tender to the touch.

I really do want to move past this, but couldn't help but think the worst when this popped up on the weekend...is it possible I tested too early?  Given these symptoms, do you now recommend that I re-test at 12 weeks; or am I just being way too paranoid and need to move on?

Thanks again, and I promise this will be the last post regarding this!!

[wrm0605]

Also forgot to mention that I did get my lymph nodes checked when I got tested, and the doctor said they were in fact swollen...and at this time remain swollen.  So that, coupled with the other symptoms I just mentioned in the post directly above this add to the paranoia.

OK, that's all....no more from me...I promise!!

Thanks Doc, you and Dr. EWH are saints for dealing with over anxious people like myself!!

[H. Hunter Handsfield, M.D.]

Thanks for the thanks.  But I have nothing more to add.  Your symptoms cannot possibly be due to HIV and you still don't need further testing.  But it's your money, so feel free.