Scared of Infection

[cantfunction21]

Hi Dr. Handsfeld, I am scared out of my mind about HIV.  Here's my story...about 8.5 weeks ago, I had very brief sex with a guy of unknown status (I'm gay).  I was the receptive partner, and it was my first time being penetrated.  We used a condom, but the damn thing broke.  As soon as my partner realized it was broken he pulled out right away.  He did not penetrate very far and he definitely did not ejaculate.  Still, I'm scared about infection through precum.  He told me he was negative, but his sexual history was rather scary, and I don't know if he really knew his status.  Well, I know symptoms are not used to diagnose disease, but I've had so many obvious ones, I can't help but feel that there's something wrong.  About 4-5 days after exposure, one of the lymph nodes under my jaw became swollen (like a  miniature egg)..it was round and hard.  It has remained that way to this day.  Also, some of the lymph nodes around the left side of my collar bone are hard (feels like a hard wooden plank is around my collar bone).  They've been this way for a while.  About 4.5 weeks past exposure, I had a really obvious bout of neurological symptoms.  It felt like my limbs, hand, and feet were burning and tingling pretty much continuously.  It was not extremely painful but it was very noticable and strange.  These nasty sensations lasted for a week and then disappeared.  I have lost a lot of weight for no discernible reason...my rib cage is showing which is strange...I feel like I've lost a lot of muscle and fat all around my body...I don't think my diet has changed much and I'm not exercising much more than usual.  Also, a maculopapular rash has been on my back for a while...my back is splotchy with dark spots of skin here and there and little red and white bumps here and there.  Lastly, I had a nasty fever/flu occur exactly 8 weeks past exposure.  My temperature was a little under 101 and my body felt like ****/achy all over.  This lasted for about a day (I took some tylenol PM that night and the next day the fever was gone and I felt a lot better).  If I had ARS associated fever, could the Tylenol really make it disappear that quickly?  Could an ARS fever last such a short period of time?  I actually went to my doctor and asked him about all of my symptoms minus the fever (which came on the day after the visit).  Anyway, he felt around for swollen lymph nodes and didnt seem overly concerned.  He said that the node under my jaw was in fact mildly swollen but nothing to be concerned about and the ones aournd my collar bone seemed shotty.  Well, if they're swollen, isn't that cause for concern?  He made it seem like only nodes that were grossly swollen were of importance.  He couldnt explain the neuro symptoms (thought it was quite strange) and sort of shrugged off the weight loss.  He didn't know what to make of the rash.  I'm scared.  Please help...I'm almost positive I'm positive.  Should I get tested now or just wait another few months?

[H. Hunter Handsfield, M.D.]

If your doctor is not concerned about your lymph nodes, and especially if he couldn't find any except a single "mildly swollen" plus a few shotty nodes, then you shouldn't be concerned either.  In any case, your description does not sound like the sort of generalized lymph node enlargement that occurs with ARS.  In any case, even if your partner had HIV--which, given his story, he almost certainly was not--the risk of infection from the exposure you describe was very low.

You may be "almost positive" you are HIV positive, but I am almost 100% convinced you are not.  But of course get tested.  Almost all infected people develop positive antibody tests within 2 months.  Get tested now, just to relieve your anxiety.  The result will be negative.

Good luck--  HHH, MD

[cantfunction21]

Hi Dr. Handsfeld. Thanks for your reply.  I'm a little concerned about my other symptoms.  Do they not sound strange and a little too in tune with HIV?  The rash, the weight loss, and the neurological symptoms.  Also, how is it that you can so confidently say I'm HIV negative...I feel like I had a pretty high risk exposure.  Although ejaculation did not occur, precum was present and he probably penetrated far enough to be infectious.  When I asked him if he had HIV he said "No, if I had HIV I would be skinny and not look like this."  Yeah, so he was ill-educated about how HIV works, which is really scary.  Did you just say I'm negative bc you're fed up with us asking you questions?  I would really appreciate an honest response.  Thanks much for your services.

[H. Hunter Handsfield, M.D.]

The additional information doesn't change my opinion or advice.  Almost every infection that human beings get, as well as lots of non-infectious medical conditions, have at least some symptoms consistent with HIV.  And as I said, your symptoms--taken together--don't much suggest HIV anyway.

How can I be so certain?  I'm not certain at all; the only thing I can do is cite probabilities.  It will be surprising if you have HIV.

But all this talk is a waste of time compared to being tested.  Do it.

HHH, MD

[ascaredkid]

Dr. H,

I'm actually curious as to what you think about this question he asked:

"Lastly, I had a nasty fever/flu occur exactly 8 weeks past exposure. My temperature was a little under 101 and my body felt like ****/achy all over. This lasted for about a day (I took some tylenol PM that night and the next day the fever was gone and I felt a lot better). If I had ARS associated fever, could the Tylenol really make it disappear that quickly? Could an ARS fever last such a short period of time?"

What are these bugs that people get that feel like the flu and cause a spike in body temperature but eventually resolve in just several hours?

[H. Hunter Handsfield, M.D.]

ARS always lasts at least several days.  Any number of respiratory viruses, however, can cause fever that lasts a day or less.

HHH, MD

[ascaredkid]

Thousands of minor infections, I presume?  Things like mono and the flu seem to cause fever that lasts several days as well.