low Risk (?) Exposure but many ARS symptoms and Marginal HSV-2 + result

[CS961]

Dr. Handsfield,

Possible exposure involved protected vag and oral sex with a Japanese prostitute in NYC.  She put on condom, performed oral sex, but no ejac. Then I took off condom to put on lubed one.  Had some difficulty getting it on, but she helped and put on more lube. Brief vaginal sex until I came and the condom appeared intact.  

2 weeks and 3 days after encounter, I got sore throat, moderate blocked/achey ears and nasal cong., and cough.  2 days later I was very tired, temp as high as 99.4 degrees, and 1/2 day of upset stomach and little appetite. I remember having a medium/small red patch under my left eye, but can't remember exactly when it came/went. I have Excema around my eyes and that can occasionally cause something sort of like this, but very concerning.

Symptoms seemed to get slightly better, then 3 wks and 1 day after encounter I went to a doctor to get Twinrix booster and more bloodwork (with an HIV test). The day after this visit I felt very tired again, upset stomach, reduced appetite, and noticed a temp around 99.2. Next two days I felt somewhat better. Results from this panel was HIV antibody test negative but HSV-2 = 1.8, low but abnormal (recommended re-test).  Didn’t know about this before.  

I had noticed swollen lymph nodes, so 4 wks and 1 day after the encounter, I went to a doctor again. She confirmed a couple "very small" swollen lymph nodes, in my groin and neck. She was concerend given my past history of symptoms and recom. rapid test. I became extremely anxious.

4 wks and 2 days after the encounter, yesterday, I had a negative oral OraQuick Advance test. My stomach was crampy (not really upset) last 2 days with little / no appetite. Couple days ago noticed some raised red bumps on the back of my tongue and occasionally feel something sore when I swallow for .5-1 day.  Faint tingling in groin.

How worried should I be about HIV given this sounds so much like ARS?  Thanks so much.

[H. Hunter Handsfield, M.D.]

Reacting only to the title you chose for this question, before I read anything else:  If you will read the form (pick any 5-10 threads at random) you would know that symptoms NEVER outweigh test results as an indicator of new HIV infection.  It does not matter what symptoms you describe:  if you have had a negative HIV test a few weeks after your last possible exposure, your symptoms are not due to HIV.  

Now I have read the question itself.  Guess what?  Something besides HIV--probably a garden-variety respiratory virus, or a non-infectious condition--explains your symptoms.  You may or may not have enlarged lymph nodes; many people who think their own nodes are enlarged in fact don't have lymph node inflammation by professional assessment. Even if enlarged, many conditions cause it, most of them much more common than HIV.  And of course sore throat is one of hte most common symptoms human beings experience.  The rest of what you describe doesn't sound like HIV at all.

On top of all that, you had condom-protected sex, with a partner who most likely doesn't have HIV anyway.  Finally, with modern HIV tests, most people with new HIV infections have positive test results (including Oraquick Advance) by 4 weeks.

The positive HSV-2 antibody test probably means you are infected with HSV-2.  However, if your test also was positive for HSV-1, it's a good bet the HSV-2 result is false positive.  If negative for HSV-1, almost certainly you have a genital HSV-2 infection.  Repeat testing may help sort this out.  Search the STD forum for lots of discussions about HSV antibody testing.  Either way, this makes no difference in assessing your HIV risk.

Bottom line:  You definitely don't have HIV.  If you want to nail it down with even more certainty, have one more test 6-8 weeks after the exposure, but you can be sure the result will remain negative.  As to the actual causes of your symptoms, continue to follow up with your health care provider if the symptoms persist or you remain concerned.

Best wishes-- HHH, MD

[CS961]

Sorry, but I should add for completeness that 1 week after encounter I had severe fatigue.  Went to urgent care and they did labs, but not for HIV.  Only result was borderline Hep-B protection - booster was recommended, which is why I got Twinrix.

[H. Hunter Handsfield, M.D.]

Makes no difference in my opinion or advice.

[CS961]

I am willing to pay for this follow up question if necessary, as I trust your advice and understand you are busy.  The lymph nodes were confirmed by a doctor in groin and neck to be preset but very small.  Given the material probability of a facial rash (looked a bit odd but hard to be sure with my Excema and pimple breakout), repeated loss of appetite, and the sort of bumps / sores in my mouth I described (from what I have read all classic ARS) and sustained low 99's temp with hot feeling, you still remain confident that this doesn't sound like ARS and I definitely don't have HIV?  What else could cause these unfamiliar symtoms?  I think urgent care tested me for mono (negative...).  Thank you, I feel a little better.

[H. Hunter Handsfield, M.D.]

You came here for reassurance you don't have HIV.  I gave it.  Stop trying to talk me (and yourself) into believing that you do.  It is not possible that your symptoms are due to HIV.  Even among persons with "classic" ARS symptoms--which you do not have, regardless of what you have read--probably fewer than 1% have ARS; for people with the low risk exposure you describe, I'll bet it's fewer than 1 in several thousand.  And all of those would have positive blood tests by now.

Follow up with your health care provider if you remain concerned.  This thread is over; I will have no further comments.  

[H. Hunter Handsfield, M.D.]

I told you this thread is over.  That means I have nothing more to offer you.  You cannot get around that by posting an entirely new question, and I deleted it.  Take any and all additional questions to your personal health care provider.  Any further comments or questions from you and I will delete this entire thread.