Doctor I'm stuck - don't know what to do.

[paranoiac]

A month ago I had mutual oral sex with someone I didn’t know but always heard nice things about, a well off mature guy in his late 20s. I didnt have any damged skin on my penis (I am uncircumcised-a risk?). My act on him hardly lasted over a minute. I'm not 100%sure I tasted any precum I stopped and then jerked him for alot before he ejaculated on his chest. Do u agree this doesn't make HIV?

2 days later I developed a mild sore throat which worsened and was diagnosed by my doc as tonsillitis and pharyngitis. It didn’t go away after 10 days spent bedridden with antibiotics and cortisone. Then Mild fever, headache, fatigue, aversion to light and bulls testicles sized lymph nodes under my neck. Shortness of breath and tachycardia 24/7.

It never got better so at day 27 I decided to get a blood test. It came back HIV neg -was diagnosed with mono. The unexplainable thing is no Ac anti-VCA IgM showd, only anti-EBNA IgG were presnt (>600 U/ml). my doc said its mono but according to the internet and to the results I should have had acute infection MONTHS ago! As of today (day 37) still weak and swollen lymphnodes.

1If he had had open woundsin his mouth could he have passed the virus while kissing or sucking me?
2If I had mono when the thing happened could I have been exposed to a higher risk? I have had cytomegalovirus 1 ½ years ago. Is it relevant?I’m not a sports maniac, I smoke a lot and always feel tired. Ive always had problems w/ my tonsils, they're huge and cavernous. A possible way for the virus to enter?
3I asked him about his status many times; he always said he’s perfectly healthy and that I could never have caught anything from him. Should I bug him more and ask him to get tested? What if he didn’t know?
I am extremely hypochondriac. I’m fearing for my life.
Do you think I shoud take more tests? If I got infected I would be the 1 case in a million you talk about, the one that gets struck by the lightning out of his house. It was my one and only MSM episode.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.

To the extent you have residual concerns about HIV, I'm not going to go there. This is the wrong forum for HIV related questions and in any case your test results make it almost impossible that HIV explains your symptoms, since your partner apparently doesn't have it, the exposure was virtually no risk, and over 90% of newly infected people have positive test results by 4 weeks.

There has been little research on sexual transmission of CMV and EBV, the cause of mononucleosis -- aside from epidemiologic studies showing both often are sexually transmitted.  But no work has been done on incubation period and that sort of thing, and we almost never undertake diagnostic studies for either of these viruses in STD clinics.  Also, almost everyone gets infected with both these viruses sometime in their lives. Finally, as you have learned, the diagnostic tests are not very precise.

Neither EBV nor CMV can cause sore throat or any other symptom within 2-3 days of exposure; 7-10 days is the minimum.  Your initial symptoms sound like those of a common cold -- or if due to either EBV or CMV, from some exposure other than the one you describe above.  The same probably is also true of "heterophile negative mono" -- i.e. the same sort of infection perhaps caused by other (unknown) viruses.

To the specific questions:

1) The sorts of exposures you describe seem low risk for CMV or EBV but there are no specific data on this.  Saliva is a probable source for either infection.  

2) Higher risk for what?  The circumstances plus test results show you didn't catch HIV, so that's not an issue.

3) Since you know you didn't catch HIV, it is pointless to ask your partner to be tested, and people rarely lie about HIV status when asked directly.  Stop bugging him.

"I am extremely hypochondriac."  That is very obvious.  There is no rational basis to be "fearing for your life".

I recommend against any additional testing.  You should continue to follow up with the health care provider who ordered the tests -- or if uncertain about his or her expertise, ask for a second opinion.  But I think most of your problem, and most of your symptoms, are more emotionally than physically based.  Ask your doctor about that possibility then follow his or her advice about it.

Regards--  HHH, MD

[paranoiac]

wrong forum - I apologize

[H. Hunter Handsfield, M.D.]

Well, at least CMV and EBV are often sexually transmitted.  I let your question stand in this forum on that basis.  But no follow-up questions or discussion about HIV, please.

[paranoiac]

Doctor I was wondering whether this post could be moved to the HIV prevention forum as it was originally my idea to post it there?
The fact is that my partner recently admited that hes not sure of his HIV status and hasnt been tested for a quite a while. Given my serious and worrisome symptoms could you explain to me how, biologically, can my case suggest HIV infection? I read in a random hiv related website that pharyngitis and throat inflammation can increase the risk (I had an irritated throat in that circumstance), but I take it that you wouldn't refer to mine as risk? An hypothetical infection would contradict everything I've been reading in here, I believe. Doctor I'm going bonkers.

[paranoiac]

I should have mentioned that I believe the partner in question to be quite promiscuous, and that I was born 7 weeks early therefore I'm somewhat weaker and more susceptible to illnesses etc. Still, in that study conducted in Spain where no one was infected out of 9000 instances of oral sex (often including ejaculation in the mouth), someone should have had a sore throat from time to time or have been a preemie, given the lenghty period of time and how many people particiipated. still no infections. I guess if I was indeed infected, I would be THE case in 200,000 or I don't know what the chances are. I would definitely prefer getting hit by a meteor all the way.http://www.medhelp.org/posts/show/781993#

[H. Hunter Handsfield, M.D.]

Your negative HIV antibody test at 27 days is strong evidence you didn't catch HIV and you have lots of options to confirm that.  Talk to your provider about additional testing.  You could have a p24 antigen test or possibly a PCR test for HIV RNA at any time; if those are negative, it will prove for sure you weren't infected.  Or just have another antibody test 6 or more weeks after the exposure.  And since your partner isn't sure of his HIV status, why not encourage him to be tested?  If he is negative, it will prove you didn't catch it from him.  And stop searching the internet.

There is no point in seeking further opinions on this or any other online forum.  You're obviously having trouble accepting my reassurance and I doubt there is anything more I can say to make you believe you don't have HIV.  So let's not try.  That's all for this thread, unless you want to return once more (and only once) to report your final negative test results.  And please do not start a new thread in the HIV forum.  It would only duplicate this one and therefore would be deleted without reply.