38 year old male diagnosed with shingles - should I be as worried as I am?

[ans123]

4 rashes are on the back right side of my neck each smaller than an inch across.  The lymph nodes in that are very tender. I'm concerned after noticing articles relating shingles to an HIV infection. I'll begin with my sexual history. I had unprotected sex with 2 girlfriends back in the early to mid-90's.  Both are now married, have children and seem to be doing well. The last time I had unprotected sex was in 2000 with my ex-girlfriend of 3 years.  She was a bit promiscuous prior to meeting me.  I'm not sure of her current health but I do know she is pregnant, appears healthy and has a significant other.  Since 2000, I have had sex with about 5 different women and have always used a condom. We did partake in unprotected oral sex,cunnilingus and digital penetration. I do bite my fingernails and cuticles but I have always checked to make sure they were healed (of course that is subjective) before an encounter.  I currently have  a girlfriend and we have always used a condom but we have had unprotected oral sex, cunnilingus and digital penetration.  She was recently tested for HIV and her results were negative.  Her malaise was the reason she was tested. My medical history:

Youth:
1976 - chicken pox
1977 - pneumonia, asthma and allergies
1984 - I have always had fingernails that sometimes grow a bit "dented" or "pitted" and I have also always been plagued with canker sores a few times a year.
1994 - Epididymitis
1998, 2007 - prostatitis  
1999 - Mitral Valve Prolapse
2008 - Alopecia Areata
2009 -Gastritis

- Given my sexual history, what is my risk of being positive?  I'm concerned about the unprotected sex-vaginal, oral,cunnilingus & digital penetration-in relation to the timing of my rash.
- Does anything else in my medical history have any relation to HIV?
- Do you think a lot of my ailments(canker sores, pitted nails, alopecia areata, gastritis, perhaps others...even this outbreak of shingles) could be interrelated to an altogether different autoimmune issue?

[Edward W Hook, MD]

Your sore lymph nodes are almost certrainly due to the shingles, not HIV.  A negative HIV test at about 3.5 weeks means little however, as I've already said, in your case you really don't need testing for any specific exposure anyway.  Your risk is virtually non-existant.  The only reason for you to get further HIV testing is for your own peace of mind, not becasue there is any medical reason.  EWH

[Edward W Hook, MD]

Your risk for HIV is very, very small.  Your partners are low risk for HIV and you  have done a good job of practicing safe sex.  There is no risk of HIV from digital penetration and as far as oral sex, in either direction is concerned, the quoted figure for HIV risk, if one has oral sex with an infected partner is less than 1 in 10,000 and, in my estimation that is too high. Some experts state there is no risk at all from oral sex.  Neither of us on this site have ever seen or reading the medical literature of a convincing instance in which HIV was passed by oral sex.

If your rash is shingles, that in no way suggests that you have HIV. Remember, "shingles" is a recurrence of chicken pox which is a very common occurrence and does not suggest that there is anything specifically wrong with you.  Thus while persons who are immunosuppressed such as persons with HIV may get shingles a bit more often than persons who are not, the vast majority of shingles occur in persons who are otherwise normal and is just a matter of bad luck.  

Your other problems do not come together for me to suggest an specific disease state or autoimmune disease.

Suggestions.
1.  Be sure this is shingles.  If it is, your doctor should treat you with antiviral therapy which will help it to resolve more quickly than if it is not treated.   If it is not shingles, perhaps your doctor can help to indentify if for you.
2.  If you are concerned about HIV, get tested.  I am confident the result will be negative and that will give you peace of mind.  

Hope this helps.  Take care.  EWH

[ans123]

Hello Doctor.  

Thanks for the reply.  My doctor did diagnose me with shingles and put me on famciclovir.  The shingles were on the back, right side of my neck.  My lymph nodes in that area were swollen and tender along with my neck muscles going down towards my right shoulder.  After about 6 days, almost all the symptoms I described have disappeared.  

I was also tested for HIV.  The test results came back non-reactive.  The test performed, according to the paperwork I have, was "Anti-HIV 1+2 Assay Group - HIV 1 and 2 Ab".  The test was taken 24.5 days after my last sexual encounter which included protected vaginal sex and unprotected oral and digital penetration.  

I'm still a bit worried due to the timing of my shingles outbreak and the other symptoms - tender, swollen neck lymph nodes and sore neck and shoulder muscles.  Those symptoms started to appear about 19 days after my last encounter.   The fact that my non-reactive test result came from a test taken only 24.5 days after my last sexual encounter also has me a bit worried.

Could the tender, swollen lymph nodes and sore muscles been part of an acute infection?

Do you think I should get tested again or am I worrying over nothing?

Thanks for your help!