Hiv or not doc

[hypochon]

Hello Dr HHH

Ill keep this as simple as possible

Im a white male living in South Africa

Had a negative elisa test at 8.4 weeks after unprotected vaginal and oral sex but we are more at risk in this country!!!  Although its more prevalent amongst black africans rather than white africans.

I developed what looked like a median rhomboid glossitis on the dorsum of my tongue 5 weeks after the incident.  It sort of cleared up with anti fungal medication. No other symptoms apart from a sharp pain through my right side of my neck which might have been glands. Still get that pain now and again 3 months later.

Bad part is that my tongue has been furry or a little hairy on top(dorsum) for about 3 months now. It gets very white and creamy from the fur holding up debris and bacteria

questions

1.  is this furry tongue which still remains slightly red but not sore indicative of a virus in the body.  

2.  Wouldnt problems with the tongue come much later in hiv than 3 months

3.  I know you say 8 week hiv test is conclusive but thats to americans where hiv is uncommon.  Because Im in S A should I go for another test.

4.  Do my symptoms sound common for Hiv or am I being an idiot.

5.  Anything you can comment will help

thanks
Regards

[H. Hunter Handsfield, M.D.]

Question 3 first, because it is central to your other questions:  You are right.  The higher the risk of HIV exposure, the more important it is to be tested later rather than earlier.  Although your negative result 8 weeks after possible exposure is highly (probably almost 99%) reliable, because you are in a country where heterosexual transmission of HIV is very common, you should be tested again at 3 months.  (See other threads on "time to positive HIV test" for information about why the level of risk influences this.)

1 and 2) Having said that, the test result remains infinitely more reliable than symptoms as an indicator of HIV infection.  "Furry" (or coated) tongue has lots of potential causes in addition to HIV.  And yes, tongue abnormalities are much more likely with late than early HIV infection.  4) You aren't being an idiot by any means, but your symptoms do not suggest HIV.

5) Other comments?  First, your 8 week test result makes it extremely unlikely you acquired HIV during the exposure you describe--but get tested again in another month.  Second, for goodness' sake, what the heck are you doing having unprotected sex (assuming this was a non-monogamous context) in South Africa??!!  Don't do it again.

Best wishes.  Get (and stay) safe.   HHH, MD

[ThoughtlessRage]

my mother is a dental hygenist and thats why i am answering your question. she has a book with pictures of different oral problems and hairy tongue was one of them so i found a website that talks about this that you can take a look at.http://www.emedicine.com/derm/topic639.htm
pay attention to section 3 Clinical, while it is seen in patients with HIV it is not a symptom of HIV. it is mostly seen in people who drink a lot of tea or coffee or use tobacco products. also can be in result to poor oral hygiene

[Willl]

I guess down there you should make sure the tests are checking for HIV-1 and HIV-2, I would be surprised if they weren't.

[Willl]

I wonder why it is so prevalent down there, and like you said with black Africans particularly. I don't see how the 1/1000 or 1/2000 average risk for heterosexual contact could apply in that region, it's not enough to sustain that kind of infection percentage. Either everyone is having sex when the viral load is really high or there are a lot of other std's being spread around causing the elevated transmission risk. And why the racial division?

[hellohello]

I have a question regarding the regional geography risks involved.  You recommended another test at 3 months due to the persons geographical location, however was this also due to the activity performed?  Lets say a person has protected vaginal sex or protected oral sex in Africa, would your testing recommendations differ if the person was say in North America?

[H. Hunter Handsfield, M.D.]

Search the threads and archives.  common in some parts of the world than others (i.e., in some populations than others), and the risks of vaginal intercourse higher, has been discussed.  (Try searching old threads for "HIV transmission risk".)  It's quite complex, but the expalanations include circumcision status of men, background STD rates, "dry sex" and other sex practices, average viral load, stage of the HIV epidemic (related to viral load), relative infrequency of antiretroviral therapy, and others.

HHH, MD

[ThoughtlessRage]

i took a geography class the quarter before last and the professor talked about the spread of HIV in africa and he said that just as people are well aware of it was first contracted by monkeys and apparently a bunch of truck drivers delivering various things across africa all had HIV and then gave it to prostitutes in remote areas along their route they know this because right along the route in completely remote tribes there were people with HIV. so the men gave it to the prostitutes and the prostitutes then gave it to the men in these tribes. you have to realise that while you make think "oh just wear a condom" people in different cultures dont think this way. in some cultures sexual protection is seen as being wrong and its not like you can just go to africa and hand out condoms and say hey wear these, it just wont happen.really the reason it is a high amount of exposure across a wide area, and lack of education when it comes to STDs and things like that.

[hypochon]

the reason why hiv is so prevalent in South Africa is due to the fact that most black people live in poverty and are highly un educated.  They drink and have multiple partners every night. In some cases they would sleep with 4 or 5 woman on one night in the locations or poverty stricken areas. There is also a lot of rape. They dont use condoms, many have std's and there sex is much rougher than the white race. It spreads like wild fire amongst them.  Unfortunately it has started to spread amongst the white people too.  I would say that about 15 to 20 percent of black people are infected and possibly somewhere between 1 to 2 percent of white people are infected.  But also remember that the blacks in S.A outnumber the whites about 10 or 20 to 1.  Unfortunately this situation has come about due to poverty and over population.

Thanks Doc now Im shitting myself.

[monkeyflower]

I find your last comment quite offensive, particularly this sentence: "Unfortunately it has started to spread amongst the white people too."

Hope things work out for you.

[hypochon]

Its not meant to be offensive monkeyflower. Unfortunately black africans are far far different in their ways actions and beliefs than black people in other countries

[H. Hunter Handsfield, M.D.]

Perhaps it isn't my place or monkeyflower's to critique your perceptions of your own culture.  But I will say that sophisticated research in South Africa, and in black African populations throughout the continent, disprove much of what you say about poverty, hygiene, education, and sexual lifestyles.  Those may be elements in some cases (well, not hygiene)--but according to my understanding, from South African Colleagues, those factors are not the dominant issues.

HHH, MD

[hypochon]

unfortunately doc that is the reality.  And Im not trying to be racialistic, in fact I have black colleagues who work for me who are hiv positive and cannot afford the medication which I fund to try and help them.  The situation is not their fault. It is from years of silly apartheid in this country which left many of them hopeless.  it got better with the release of Nelson Mandela but this countries situation will take years to eradicate the problem.  And why dont you speak to your colleagues and ask them about our deputy president Mr Jacob Zuma(black.  He was fired from his post and is in a rape trial accused of raping an hiv positive woman of which he knew her hiv positive status before having sex with her.  In court he testified that he didnt think he was at risk of contracting the disease if he showered afterwards.  Sad Sad example to set for your knowledge starved people who are in this epidemic.  And thats our ex deputy president.  All you need to do is live here for a year to understand whats going on.  Dont believe what you hear. The whites are not heartless and racists like you hear.  We dont like seeing poor people dying of this disease all the time and poor innocent babies infected daily.  Its a horrible situation and like I said its not their fault, it was the years of apartheid in this country.

[Sizo]

I am extremely offended by your comment regarding black South Africans vs White South Africans. You should be ashamed of yourself. Ask the doctor and other users a question about your concerns and use the condom if you are going to be promiscuous! IYou really do not know who is reading these threads! I am a White South African in the US and have lost friends and family to AIDS. I love my country and all South Africans. How dare you!

[H. Hunter Handsfield, M.D.]

I share sizo's concern; and would point out that no single case like the deputy president's can be extrapolated to an entire population group.  (Especially someone in an adminstration whose president has denied the role of HIV in AIDS or the utility of antiviral treatment!)

But this discussion is over.  Politics and broad social issues, beyond STD/HIV, are not accepteable in this forum.  Further comments along those lines will be deleted.

HHH, MD

[JohnnyV]

Dear Dr. H,

I respect your work on this forum tremendously so I don't want to write anything that sounds critical. But I think that some of those social/political questions are inevitable, because a lot of the advice you give on the forum goes beyond medicine and rests upon assumptions about population groups.

For instance, I remember one thread in which a woman was told it was okay to perform oral sex on straight men, but risky to perform it on bisexual men.

Gay men who have had unprotected sex are routinely told to get an HIV test at 3 months, while straight men who have had unprotected sex are told they don't need to get tested at all.

While the advice varies, sometimes heterosexuals are told it's enough to get tested at 6 weeks and call it a day, while "gay men" are told they have to get further testing; without any real weight attached to whether the individuals involved are promiscuous or not.

While I agree with everyone on this thread who expressed outrage over the seeming racism of the white South African's comments, I can't see much difference between his reasoning and the general reasoning of the advice on this forum, when people are told that gay and bi men are innately at greater risk of HIV, merely by *being* gay and bi.

Given the same statistics, it would be just as easy for a doctor to advise, as many do, that people show the same level of caution, and test with the same timeframe, based on the sexual act and its associated risk; not based on the social identity of people involved. Stereotypes and politics play a big role.

I won't harp on this point since I've posted about it like 10 times or so on here. I just think that people ought to show the same sensitivity to sexual orientation stereotypes, that they show to racial stereotypes.

Hope the springtime finds everyone well.

Best wishes,
J

[hypochon]

I retract my comments and apologize to all those who I have offended. I think some may have taken it the wrong way.  
Thank you for your help Dr HHH

[monkeyflower]

While I basically agree with your reasoning, I don't really think he's stereotyping gay/bi guys at all. I think he bases his responses on statistical risks, and statistically speaking gay/bi men are at higher risk than straight guys. Particularly on this forum, where the straight encounters tend to be virtually zero risk. I also don't think his advice about testing after oral varies from gay-straight, although I might be wrong. I tend to just skim those posts. I don't personally consider oral high risk for anyone :-)

[Willl]

The reason I hang around this forum is because it is based on facts/research, and not on tiptoeing around certain groups of people like at aidsmeds.com. If the topic involves an exposure with a higher risk group (street prostitutes, whatever...) where research has been done that proves a higher risk encounter, then this should be discussed if it affects the recommendations given. And therefore it is helpful if someone presents this information in his or her question to begin with. I think the tone of hypchon and the perceived speculation is what offended people regarding his comments. If it is a relevant question and not a critical statement, then too bad if it offends someone. Go to aidsmeds.com if you want BS.

[Willl]

Sorry if they seemed directed at you Johnny, it was not.