Swollen lymph nodes in the leg

Hi doc,

I had an unprotected sexual encounter with a SW here in india around 4 days back.She did ORAL on me and I couldn't notice any sores,cuts or bleeding gums since it was dark there.Today in the morning i noticed a lymph node in my left leg besides the knee has got swollen with slightly red coloured skin on it.What could it be and could be a symtom of HIV?When should i get tested for HIV through p24 antigen or a DUO?Will it be effective and which other STDs should i get tested for.....i am posting this under extreme anxiety and would require your help urgently so that i can have some mental balance in place...this is running me mad...I have been having sleepless nights as well and have not been able to concentrate to my family affairs and job also...pls help

[Edward W Hook, MD]

If I read your post correctly, you do not have a swollen lymph node.  There are not palpable lymph nodes either behind or on the side of the knee which can be felt by anyone so the spot that you are worried about is something other than a lymph node.  Perhaps some sort of skin infection or other process.  If it concerns you, you should seek the advice of a trained clinician.  The Indian medical community is superb and I am sure that by asking around you can find an appropriate referral to a physician who can examine you and take care of this.

As far as your risk from the receipt of oral sex 4 days ago, it is low.  Oral sex is an inefficient way to transmit STDs.  Of the bacterial STDs only gonorrhea and nongonococcal urethritis (NGU) are transmitted through oral sex; chlamydia is not and without an obvious sore or lesion on your partner’s mouth, the chances of syphilis and herpes is likewise tiny.   If you had gotten gonorrhea or NGU you would have most likely developed symptoms of urethritis (penile infection).  Even if your partner had an STD (any STD and it is likely she did not), most exposures do not lead to infection.  If you do not develop symptoms I would not worry.  (HIV is not a concern either.  HIV transmission during oral sex is very inefficient. The mouth is a hostile environment for HIV.  There are enzymes and other components of saliva which make it a difficult place for HIV to survive.  Studies suggest that the risk of getting HIV from oral sex, if your partner was infected, are less than 1 in 10,000 and others feel that even this risk is too high and that there is no risk of HIV at all from oral sex).

You have little or nothing to worry about. If you want to get tested for HIV, wait until 4 weeks after your exposure.  At that time, given the specifics of your exposure, the results of the duo test will be conclusive.  You can get tested for the other STDs I mentions (gonorrhea, NGU) at any time.  The results will be reliable.

EWH

[aries2008]

Hello Doc,

A very Happy new year to you.Just wanted to know whether can i go for a P24 antigen test by the 12th of this month which would be around 16days after the possible exposure?and how reliable the results can be?I am tensed and can't just hold on to things and am losing my mental balance...also would like to know can symtomes come up in 4 days time?i would be visiting a skin specialist in nthe evening today and would keep you posted on his comments..

[Edward W Hook, MD]

Please read my original answer.  It has not changed. (and HIV symptoms can not come up after just 4 days) EWH

[aries2008]

Hi Doc,

Thanks for the response.I had visited the skin specialist y'day and he achknowledged that the swollen place is not a lymph node.He also diagnosed the case as ECHYMOSIS for which he has given 2 ointments for 5 days.I know I am bothering you now but this is the last question i would put-what is ECHYMOSIS?He said that it is because of an injury 24hrs back to the appearance of the spot.should i consult someone else as well?
Thanks Doc in advance.

[Edward W Hook, MD]

You should have asked the doctor this question.  An echymosis is a medical term for a bruise.  You do not need to consult anyone else, you  now need to move on and forget this.  EWH

[aries2008]

Thanks Doc for all the nice words of reassurance.I underwent the test y'day (DUO)which had ECLIA technique which happened to be 31 days post exposure.It required immense courage to go there and get tested although i had your confidence with me.The medic there at the lab was considerate and helpful but occurred to be less informed on the window periods of specific tests.I got the results today and the same was NON REACTIVE.The test was called HIV EARLY SCREEN,SERUM.
HIVP24 ANTIGEN+HIV 1&2 ANTIBODIES - NON REACTIVE
The technique used was Electrochemiluminescennce immunoassay(ECLIA).
Do i move on Doctor now....and can i celebrate the results....thanks a ton for the support and advice.Was the test correct?

[Edward W Hook, MD]

I would urge you to move on at this point.  let me tell you why:

1.  At this time (31 dasy) the antibody detection portion of your test would have detected over 90% of infections acquired 31 days earlier.
2.  The antigen detection portion of the test further increases the total number of infections that would be detected by now.  Fiurthermore, if your swollen lymph node was HIV related, it would be expected that just about everyone would ahve a positve test by now.
3. It really is not clear that anyone has ever gotten HIV from oral sex

Putting all of these FACTS (there is no debating them) I am sure that you do not have HIV.  If you choose to have further testing, please realize that you are doing so to address you anxiety over the matter and do not have a medical reason for being tested.  Take care. EWH

[aries2008]

Doc,The swollen node was actually a bruise as diagnosed by the skin specialist and is not there any more.Just wanted to know whether ECLIA techinique is the right one for DUO test or not and is it the one used for DUO test?They had mentioned about serum testing in the report as well.what is that?The test here was carried out by Ranbaxy labs who are well known world over.Promise that this is the last one in the thread and no more questions after this.I have not experienced any other symptoms but am sure that if i continue surfing the net i would surely be anxiety driven to consider all small things as symptoms and sulk.Yes you/Dr.HHH are great and knowledgable people who are helping the worried wells gather courage to rebuilt their shatterred confidence in moving on with life.I think the contribution is simply precious and no money can equal this.Thanks a ton.

[Edward W Hook, MD]

Please believe and have confidence in the test. The DUO test is a well standardized, well recognized test.  EWH