HIV Acute Retroviral Syndrome (ARS)

Dear Doctor Handsfield:

As someone who has had a high-risk exposure similar to many of the people who have written (i.e., sex with a prostitute with a latex condom), I have become more aware of my body and the potential of ARS.   I noticed that many of the questions surrounding ARS have to do with swollen lymph glands (or are they called nodes?)  I'm wondering if you could briefly address a few questions regarding ARS and swollen glands.

#1--I keep reading that one single swollen lymph node is not suggestive of ARS in any way shape or form.   How can we be so sure about that?  

#2  What about cases of two swollen lymph nodes?  For example, I can feel ONE swollen node in my axilla, and ONE swollen node below my left ear.  The swollen node  below the ear was swollen for almost a week before the one in the axilla came along.   No other nodes are swollen.  Is this typical of ARS for lymph nodes to swell in waves (i.e., one swells this week, then another one next week, etc)?

#3--Is it true that ARS is a constellation of symptoms with fever, swollen lymph glands (i.e., flu-like symptoms)?  Or can ARS present itself with one symptom, such as ONLY fever, or ONLY swollen lymph nodes.

#4--I have also read that swollen lymph gland as a result of ARS are not painful.   How can this be so?   I thought that if lymph nodes swell due to "infection," then such swollen nodes are almost always painful (at least for a few days).    Or do you answer questions regarding "painful node" and ARS solely based on your experience with your patient (in other words, there is a possibility that other doctors have experienced patients with painful nodes during ARS.  


As you can see from my line of questioning, I'm a little anxious.  

Thanks,

WadeM.

[H. Hunter Handsfield, M.D.]

OK, your specific questions one by one.

1) We're sure about that because in clinics that regularly evaluate people with ARS, we just about never see a patient with only one swollen node.  Not all people with ARS have enlarged lymph nodes at all, at least none we can feel.  (Many or most of the body's lymph nodes are deep inside the abdomen and chest where they can't be felt.)  But if they have enlarged nodes, there are several of them.  There may be exceptions, but they are rare.

2) Now we're splitting hairs.  I can't judge whether 2 enlarged nodes is more likely to represesnt ARS than only 1 node.  But medically untrained people are generally incapable of accurately determining whether or not their lymph nodes are enlarged, or whether a lump is a node or something else.  Many things other than lymph nodes can cause lumps in the groin, armpits, neck, or eslewhere.

3) Most people with ARS have multiple symptoms, such as sore throat, fever, and skin rash--with or without lymph node enlargement.

4) Lots of infections cause painless lymph node enlargement.  Syphilis, tuberculosis, and infectious mononucleosis, in addition to ARS.

I answer all questions on this board according to my understanding of the data, not just my personal experience or word of mouth.

Bottom lines:  1) From your opening comment, it seems your risk of HIV is very low.  2) If you think you have lymph node enlargement, you need to stop trying to figure things out on your own and see a health care provider.

Good luck--  HHH, MD

[SeattleMan]

Hello, Doctor:

I realize that we are only to post ONCE.  Can you make an exception for just one follow-up question, please?  

I have a follow-up question regarding point #4:  that lymph node swelling associated with ARS is not painful when touched (or not tender to touch).   Is this something that is debated within the HIV-medical community?  I'm asking, because I have read some postings on TheBody.com archives of doctor responding that lymph nodes swelling of people with HIV can be tender.  I think that's where all my confusion and panic came from.

Since I am in the 2-4(or sometimes 6 weeks) window period for ARS, I started thinking the worst when I felt pain on this "lymph node" or whatever it is (lump).  

Even having my arm down at my side (i.e., natural positin) makes this armpit lump hurt.  And the lump even feels like it has a VERY subtle "heartbeat" (i.e., pulsates).

Thank you, and like I said, I'm done with questions.  (I want to play fair just like everyone else who ask questions!).

--WadeM

[JohnnyV]

Since you're 2-4 weeks into the window, why not just take the initial test at 4 or 6 weeks, and then clear your mind and go through the formality of the 12 week test? HIV tests are painless and easy. Protected sex with a prostitute is so low-risk that the HIV tests should be like getting checked for testicular cancer or verifying that the lightning rod on your house is functioning; it's just a routine to give you a heads-up in case a strange medical aberration has occurred, but it's nothing that should cause you stress.

Unfortunately, neither Dr. Bob nor Dr. H will be able to tell you that you don't have HIV over the internet, and most doctors will be reluctant to tell you that unless you have an HIV test. That's the nature of the disease and its asymptomatic dormancy. They'll all tell you that your chances are lower than winning the lottery or having a flying house fall on you on a sunny day, but none of them will be able to tell you you don't have HIV with 100% certainty, especially if you tell them you have swollen lymph nodes. The only thing that can do that is the HIV test, which you can do for free almost anywhere in the US.

J

[SeattleMan]

Yeah, I think you're right.

I guess the possibility of having HIV has paralyzed me.  Still trying to figure out if its because it with a sex worker or what.  I can recall, many moons ago, in calling having tons of unprotected sex with girls on campus, and never ONCE feeling anxious (not even for one second).  Kind of like:  are the symptoms real or is this anxiety, and like you said only HIV-testing will answer that.

But really, the only reason I was writing was to figure out this thing about whether or not lymph node swelling during ARS was "painful" (or "tender").   Aside from that, I know that only a test can give me the answers.

[SeattleMan]

Dear Dr:

I just wanted to clarify that one reason that I thought that lymph node swelling due to HIV ARS was that in this Forum, on
07/07/2005, you responded to a similar question as follows, stating that the "node may be painful or not."

"The medical term is lymphadenopathy. If lymph nodes aren't swollen enough for you to notice without looking, they almost certainly aren't enlarged. When people get lymphadenopathy, the swelling goes on for weeks or months, it doesn't come and go; the nodes may be painful or not."

Respectfully,

WadeM

PS, I will just get my test.  Only solution

[Imdumb]

I think many people on here start with a false assumption that vaginal sex with a prostitute with a condom is high risk. It is in fact low risk. Vaginal sex with a condom regardless of who owns the vagina is not high risk. If the condom does not break it is so low risk it can be called zero. We are talking one in several million chance. It just doesn't happen. If we all would start with that fact and stop with the false assumption that hookers are more risky than bar sluts we would be better off.

[SeattleMan]

Thanks "Imdumb" (except that you don't sound dumb at all!)

Okay, two things that nag me (and maybe it's because I did it with a commercial sex worker (prostitute, if you will).

1.  Everyone keeps saying that "if the condom does not break," then the risk is very low.   I thought HIV does not pass through intact latex.  So, if the condom does not break, and if it's used for the ENTIRE sex act, would the risk be ZERO (after-the fact).   Or is it simply that the only ZERO risk is no sex.  Just like there is a small risk in crossing the street.  Thus, the ONLY ZERO risk with respect to crossing the street is "no crossing."


2.  Secondly, about condom breakage:  Of course, if a condom breaks at the tip, it is obvious, because the penis will be visibly exposed.     What about tears anywhere along the shaft?  Will it be as obvious????  I've only been with two women in my life, so I don't know.  My guess is that is would be evident, because a condom on the penis is just latex being stretched thin.  Thus, a tear along the shaft will not just be a subtle tear.  Educate me on this please?

[Imdumb]

You could pour all of HIV infected vaginal juce on the side of your penis your want to, any you will never get HIV.  No more than if you poured it on your hand or leg.  HIV will not go through the intact skin.  If you have an open wound, it could get in.

I think the reason the Dr. says "near zero" or "virtually zero" is because in science, you just cant't speak in absoloutes.  Lets say you have a big sore on the base of your penis that the condom didn't cover and the vaginal juice flowed over it. It is "Possible" the virus could pass through there.  

If you eventually find out you have HIV from your expouser, call the CDC and DR HHH because you would be one in 40 million to get HIV though a latex condom that was used properly.  I'm sure they would be interested to hear about it.

On a final note, how much do you worry about other things that have 1 in 40 milliom odds?

[SeattleMan]

Fair enough.

But I'm not circumsized.  So, I don't think pouring HIV infected fluid on my shaft would be safe. :(

[Imdumb]

Why not?  Your shaft doesn't mean your ureatha. The virus still has to get into your body, circumsized or not.  I think the reason they say uncircumsized men MAY have a higher isk is only because the juice can get trapped in the forekin and remain at the ureatha opening longer, giving it more time to get in.  It wouldn't habe anything to do with the shaft.

[SeattleMan]

You asked me, "On a final note, how much do you worry about other things that have 1 in 40 milliom odds?"

Well, generally NEVER.  But in this case:   I feel like I symptoms for the past four weeks.  Generally, different kind of symptoms from 3 days of stuffy nose during the 1st week, to just yesterday ONE swollen node in the armpit (but could be a cyst)...to anything you name it.   I just think it's too coincidental that I'm feeling all these things in my body.  Of course, I want to be negative.

[Imdumb]

It's not coincidental at all. It coincides with worry and anxiety.  I had the same thing. I swore I had swollen nodes.  Went to the Dr. and he said nope.  ASk HHH, you should never try to doig up your nodes on your own.

[artma2004]

WadeM, you should listen to everyone. You were fully protected, unlike me.  I made the terrible mistake (which I hope I do not end up regretting with bad blood results) of having sex with a prostitute. We used a condom, but we used Lubriderm as a lubricant.  Granted sex only last between 30-45 seconds, but I read report that oil-based product can desintigrate latex within seconds causing them to be porous.  I hope this is not the case.  Otherwise, I'm screwed.

Artma2004

[Imdumb]

Artma200- you should also listen to everyone, especially the DR.  You did not get HIV from the lubiderm thing.  If the condom didn't break there is no chance. If it did break there is a chnace that is so small it is not measureable.  You are not screwed you are fine.

Do this.  Go back through the archives of this forum and of the body.  Look at the 100's of posts like yours of people with low/no risk hiv/std exposures who them, despite the dr's telling them there was no chance, can back and said, "Dr, you were wrong. I got an STD and or HIV"....you can't find ONE!!!!

[artma2004]

So, let's get something straight.

You're saying that someone could have unprotected sex with an HIV positive person.  Then 2 weeks later, have the flu, and turns out that it's just the "the flu," and not be infected.

But I suppose that symptoms are not a way to diagnose HIV. Afterall, does not the CDC estimate that 400,000 people have HIV but do not know it.  BTW, how does the CDC get such figures?  I means, how would they be able to estimate amount of people who do not know they have HIV.

Lastly, does everyone agree that sex worker are more dangerous.  Like what about those Asian sex workers that work in massage parlors.  Wouldn't they be more dangerous.  Not because they are Asian (I'm just using that as an example), but because most of them barely speak English and may not have access to HIV prevention education.  Interested in hearing your opinion.

[Imdumb]

first off, you did not have unprotected sex, and second, no not everyone agrees sex workers in the USA are higher risk.  In fact, most sex workers know more about safe sex than most.  The is no evidence to suggest sex workers have HIV at any higher rates than the general population.

As the Dr. says, the chances of a man getting HIV from an HIV infected women by having unprotected sex is 1 in 1000.  You had protected sex and she had a 99% chance of not having HIV.  You can choose to worry if you want to, but I would love to see one more post from you after you negative test (and it will be negative) saying you needlessly worried yourself to death.  Will you post that for me in the future?

[artma2004]

I will post in the future.   Let me tell you why I got afraid:  I saw this response in The Body from Ryan Kull (August 2002) regarding oil-based lubricants and condoms.  Mr. Kull wrote:

"Oil-based lubricant won't only make the latex condom prone to breakage, but it can decrease the condom's ability to prevent HIV and other STIs from passing through the barrier (or as you say, makes it permeable). So if you use oil-based lubricant with a latex condom and it doesn't break, that does not mean that the condom was effective in preventing disease transmission.

I do not know specifically how long it takes for the condom to lose it's effectiveness when oil-based lubrication is used, but it can happen quickly. Regardless of the timeframe, you should not consider the condom to have been 100% effective."

That's what was driving all of my anxiety (the "porous" claims).

[artma2004]

PS:  I did write Dr. Bob, and I did receive more optimistic response about Lubriderm and condoms.

[Imdumb]

How long ago was the lubiderm incident?  When can you get tested?  That is the only way to ease your mind.  

And on the "asian massage prostitute", I do not agree they are more likely to have HIV.  I have been to them and they are very conscience of safe sex.  Have you ever heard any where "massage parlor found to be link to HIV in the city" news stories?  Forget law enforcement, the health department work shut them down in no time flat.  Much like the bath houses in San Fran 25 years ago.  I have never had massage parlor girl not insist to use a condom.  This was 5 years ago, I have since managed to stay away from them.  The reason I have been on here is I "relapesed" in May and almost killed myself with guilt. I had every smptom of every std...I tested negative for all of them and now I am back on track and taking even more measures to stay "clean".

I hope you can relax a bit.  But if you are like me, only a negative test will clear your head.

[artma2004]

Do you have your original thread handy.  I would be interested in hearing about the event and subsequent anxiety and symptoms.  You can just tell me how to find it.  I think this thread will probably be closed down at the end of the day for getting too long.

[artma2004]

Let's just say that I keep praying that the masseuse actually had KY or Astroglid in a bottle of Lubriderm so as to incriminating evidence in the event that they get busted.  I would be amazed if they actually used lotion as a lubricant, especially since lotion is not good for a woman (for hygenic reasons).

I'm at the end of Week #4.  I'm thinking about going in for a PCR tomorrow ($399--ouch).

[Imdumb]

Sorry - I don't have it.  But like the Dr. often points out, sear for "HIV Anxeity" in the forum.

I really am try to help you, but I gurantee no matter what you read and no matter how many people tell you you have no chnace of HIV, only a negative test will help.  I just hope you aren't one of those that needs 10 tests out to 18 months and still thinks they have HIV.  

You do not have HIV, get a test to ease your mind and move on.  That is the only way for you to get past this.

[SeattleMan]

Dear Doctor:

My thread had become uncontrollable (maybe you can lock it).   But I was hoping (if you had time) an answer to this (which I wrote) but got lost in the shuffle:

Dear Dr:

I just wanted to clarify that one reason that I thought that lymph node swelling due to HIV ARS WAS PAINFUL was that in this Forum, on 07/07/2005, you responded to a similar question as follows, stating that the "nodes may be painful or not."

        "The medical term is lymphadenopathy. If lymph nodes    aren't swollen enough for you to notice without looking, they almost certainly aren't enlarged. When people get lymphadenopathy, the swelling goes on for weeks or months, it doesn't come and go; the nodes may be painful or not."

Respectfully,

WadeM

PS, I will just get my test. Only solution.  But if I misread you, please let me know.

[H. Hunter Handsfield, M.D.]

Thanks for pointing out the discrpancy; in that earlier reply I should have said "the nodes generally are not tender or painful, although mild tenderness may sometimes occur if the nodes swell up pretty quickly."  A lymph node that enlarges quickly may be somewhat tender.  But it rarely would be particularly sore to the touch.

As per my original response, when the chance of HIV is just about zero based on sexual lifestyle and exposure, then whatever happens afterward almost always is due to something other than HIV.

But you're on the right track:  get tested.  All this guesswork is only going to heighten your anxiety until you get your negative test result.

HHH, MD

[SeattleMan]

Thank you, Doctor.  I am going to get tested.

And yes, my "lump" or "bump" is more than just "tender."  It's quite painful to the touch.  I'll get it checked out, but I'm suspecting that it's a cyst.  I just started using antiperperant 4 weeks ago, instead of the regular deoderant.  

Have a good night!

[artma2004]

It seems to me that the common solution for everyone is simply to get tested.  Otherwise, you will drive yourself nuts.  Take me for instance.  On the one hand, it seems that medical and health care professionals (such as HHH, Dr. Bob, my primary care physicians, and even most of the HIV hotlines--Yes, I'm anxious), have told me that I really did not put myself at risk for using Lubriderm hand lotion on the condom for 30-45 seconds to have sex with a CSW.

On the OTHER hand, I went as far as telephoning condom stores such as Condomania and Access (in Seattle), and both of these stores said that I compromized my protection from using this Lubriderm, because Lubriderm has OIL as one of its component.  Also, if you do a search on GOOGLE, such as <<oil-based and condoms>>, you will find pages stating that "oil eats rubber within 60 seconds" or "oil-based lubricant will render a condom useless within seconds.

Thus, instead of driving yourself crazy like I have for the past 4 weeks, best thing to do is get tested, which is what I'm doing first thing tomorrow morning. Truth be told, I'm terrified.  For the past for weeks, I have felt symptoms from a stuffy nose, to pelvic heaviness, to armpit pain...etc.   That's and I have not gotten any sleep for the past 28 days.  I can't live like this.  It's a PCR by DNA test (Qualitatite), and it's supposed to be conclusion. Wish me luck--I'm terrified.

This will be my last posting, because I'm feel like I'm at the edge of a cliff right now.  So, bet for me to stay away.

--Artma2004

[charles315]

A related discussion, is below 99 faren fever is possible in ars... was started.