Swollen lymh nodes and HIV

Hi Dr HHH,

I have been very impressed by the quality of your answers on this site and am grateful for you input on my situation.

I am a 25 year old healthy, Caucasian heterosexual.  I have engaged in unprotected sex with my boyfriend for about a month.  We are monogamous and I insisted we both get tested prior to engaging in sex.  I was negative for everything and he said he was, too.  We have had unprotected sex approximately 30 times in as many days.  I have had some anxiety about contracting something even though I do not have any reason to believe he is being dishonest about getting tested or his result.  I have talked to him about it multiple times and he insists he has been tested for HIV and is negative.  His last sexual relationship ended at least eight weeks before he was tested.  

With that said- I have started to feel what I think are swollen lymph nodes along my jaw line and under my jaw bone on my neck.  I have night sweats and random soreness in my thigh muscles.  I have not had a fever.  I had dismissed these symptoms as anxiety but the lymph nodes continue to feel the same after 2 weeks.  I became concerned that my boyfriend somehow didn’t get tested for HIV and asked that he show me his test. He refused saying it was a trust issue and he was not out to scam me- that he did not have HIV.  

My questions for you are:
1. Based on my sexual encounters with him, what are the chances I have contracted HIV (especially if he turns out to be positive)
2. I have made an appointment to get an HIV test again in two days (34 days from my first exposure).  Should I take another test farther out since my exposures were ongoing?
3. I have not noticed any other swollen lymph nodes besides ones in my neck.  Does ARS and HIV enlarge all lymph nodes?

I am planning on getting an exam when I go for my test but appreciate your input in the meantime.

Thanks!

[H. Hunter Handsfield, M.D.]

Welcome to the forum, and thank you for your kind comments about previous responses.  FYI, it's only by luck that I am answering your question and not Dr. Hook.  We take questions randomly, without regard to specific requests.  It doesn't really matter:  although our styles differ, there never are substantial differences between our opinions or advice.  We have worked closely together for a quarter century and think pretty much alike.

Self-assessment of enlarged or inflamed lymph nodes is highly unreliable, especially if you are not a health professional.  I don't accept that anything is wrong until and unless you are professionally evaluated.  Second, when HIV causes lymph node enlargement, it is body-wide:  neck, underarms, groin, everywhere -- not just a localized site like you describe.  If indeed you have inflamed lymph nodes under your jawbone, most likely it is due to a garden variety minor virus, not HIV.  And it is very rare to have primary HIV infection without fever.

To your specific questions:

1) Even if your partner has HIV -- which he probably does not -- your symptoms started too soon for HIV to be a likely cause.

2) I suggest you be honest and open with your partner.  If you're going to have an HIV test, suggest that he have one too.  If he cares about you, he'll do it -- and if his test it negative, of course it will prove you could not have caught HIV from him.

3) See my comment above.

Bottom line:  I see no reason to be concerned about HIV in this situation.  I doubt anything serious is wrong.

I hope this helps. Best wishes--  HHH, MD

[grnchilegirl]

Thank you so much for your input, it makes me feel better.  It will be a challenge to ask my partner to get retested for HIV a second but I think it would help me put my mind at ease.

[H. Hunter Handsfield, M.D.]

I missed that your partner already was tested and negative for HIV.  That proves you couldn't have been exposed. (In theory, he could have been infected in the month before he was tested.  But what are the odds of that, for a non-injection drug using, non-gay male in North America or other industrialized area?  Zero for practical purposes.)  You need to work to get beyond your somewhat irrational fear of HIV.  If your partner is willing to humor you by getting tested again, it's fine with me.  But truly I see no need for either of you to be tested.

[grnchilegirl]

Thanks for your follow up comments.  I know I am having irrational fears on this and am working on it.  In your experience, is there any reason to be concerned that he refuses to show me his test results?  I have no reason to doubt he had the test and he said it is a trust issue.

[H. Hunter Handsfield, M.D.]

All I can say is that most people don't lie when asked about their HIV status.  And you're in a better position than I am to judge your partner's honesty with you.  Presumably you're also in a good position to know something about his potential HIV risks, which you didn't describe above.  Is he from a country with higher rates of HIV than the US or other industrialized countries?  Is he likely to have had sex with other men, or to be an injection drug user?  Has he been incarcerated?  If in the US, is he African American?  If the answers all are no, then the chance he has HIV is miniscule.

Beyond this, I can't help.  This is a relationship issue, even if the question happens to concern HIV.

[grnchilegirl]

Thanks again.  My boyfriend can answer "no" to all of your questions above.  It is good to know that regardless of his testing status he has a miniscule chance of HIV.