To Dr. Hook or Handsfield Need some advice

[Justwondering7]

Here is my story in brief- 23 year old grad student had one time unprotected vaginal sex with a 20 year old female of unknown status- developed what my doctor referred to as "jock itch" a few weeks after however it was not cultured, just viewed quickly. Started in groin, scratched a lot, ended up under scrotum and a bit on penis.  Could be yeast- candidas? Was prescribed 1% clotrimazole cream used a couple weeks did very little to improve, bought some miconazole nitrate spray and gold bond which has helped itching a fair bit but slight rash remains. Go to gym frequently and sweat a lot so may not help matters.  A few weeks after "jock itch" had a bad cough and slight tightness in lungs which lasted 3-4 weeks and stuffed up nose (smoke occasionally but stopped to help cough feel better).   -No Fever at any point that I am aware of, no swollen lymph nodes I could find, no lack of energy, no body rash, weight loss or any other symptoms that stood out.   Went for sti testing at approx. ten weeks (72 days I believe) after the incident, HIV came back negative. However I have been internet surfing too much I think and am still worried. Not sure what test was used, believe it was standard 3rd gen. antibody test I think.
Basically my questions are- Should I be worried about the "jock itch" which I have read normally doesn't affect genitals, so possible candida? Would that typically occur so early in onset such as ars? - Could this girl have simply had a yeast infection that I acquired? Overall I am a healthy young male so I was a little worried overall, took antibiotics at one point but that was months ago.. If my groin problem and cough were indeed hiv related, wouldn't a test at 10 weeks be positive or at least indeterminate likely?
-How reliable is my 10 week test? Should I return for another one or what should be my next move basically?
Thanks for your time, great service you guys provide.

[Edward W Hook, MD]

While candida infections can occur more commonly in persons with weakened immune systems, msot candida infections occur in normal peole. Thus a candida infection is not a sign of weakened immunity.  

There is no need for further testing.  The "generation" of the test is irelevant for your purposes

It appears that you are getting your information from the interenet. This is all too often unreliable.  EWH

[Edward W Hook, MD]

Welcome to the Forum.  The exposure you describe was low risk and now, with your test results you can say conclusively that you did not get HIV.  Test results at any time more than 8 weeks following exposure are definitive.  There is no need for further HIV testing.  The recommendations for testing at 3 and even 6 months are the result of two factors- data from older tests no longer used (you really do not need to worry about which generation of tests you were tested with, at this time virtually all tests are far more sensitive that they were even 2-3 years ago when the 3 month recommendation was made) and secondly, the fact that some, mostly governmental agencies which have to provide recommendations for virtually everyone without the sort of interactions such as those you get with your doctor or on personalized sites such as this one, feel they cannot "afford" to be wrong and therefore make recommendations and guidelines which leave most people unnecessarily nervous for 4-6 weeks longer than the 6-8 weeks it takes virtually everyone to develop HIV antibodies.  

As for your specific questions:
1.  Candida is a fungal infection, just as "jock itch".  This can be difficult to treat and may take some trial an error but is not something to worry about. The other question which comes to mind is whether or not you might be focusing on this rash so that you notice symptoms that might not be so problematic if you were not concern.  Perhaps knowing that your tests are definitive will help.

2.  Test reliability. See above.

Hope this helps. EWH

[Edward W Hook, MD]

That you were treated for chlamydia does not put you at higher risk.

That your partner may have had many other partners by no means indicates that she has HIV.  

Testing beyond 8 weeks is very rarely done and is inividualized. NOTHING you have mentioned raises ANY concerns or suggests the need for further testing.  Your unwillingness to believe that you do not have HIV however does trouble me.  Perhaps you should discuss your unwarranted anxiety with a counselor. EWH

[Edward W Hook, MD]

Sorry, we need to limit the lenght of these interactions. You do not have HIV.  You can test as much as you want but it will not change the result.  I have nothing more to say. EWH

[Justwondering7]

thank you doctor. I was concerned this was one of those circumstances where you might recommend further testing because nothing i seem to do regarding my candida is making a difference I went to my family doctor that is where the diflucan and cream came from, I dont know how long it takes diflucan to work but it hasn't helped yet. Also bought garlic tablets and acidophilus. I am cocerned I may have a systemic yeast infection due to my sinus problems as well and that directly relates to a weakened immune system from what I have heard. Plus it only started 2-3 weeks after the incident I explained so I find it hard not to question a 10 week result

[Edward W Hook, MD]

There is no reason for you to be worried about HIV.  If the rash has not improved with antifungal therapy it may be some other dermatological process masquerading as a fungal infection.  I would suggest that you ask your doctor or see a dermatologist for clarification. this is not HIV- believe the test results. EWH

[Justwondering7]

sorry to reiterate dr. hook but i have been on diflucan for 2 days and tried a different cream which has yet to do much of anything in terms of my yeast problem. I went for a complete cbc and glucose check etc. no diabetes, wbc and rbc is all in the normal range. do you think HIV can still be ruled out of the equation regardless of my candida problem that doesn't seem to want to go away?
does that not indicate an immune system problem to you or some horomonal imbalance? you think a fully healthy individual would be able to fight this problem

[Edward W Hook, MD]

Glad to help. Take care. EWH

[Justwondering7]

i will learn from my experience and always use protection in the future and possibly for further peace of mind get another test in a few months or whenever I am sexually active although I can expect it to remain negative. Your advice has helped me greatly

[Justwondering7]

ok thanks doctor, I thought the presence of a bacterial infection as such put me at a much higher risk.  However I will move on with my life and take your advice. Thanks again, I will not comment again.

[Justwondering7]

Sorry for the repeated comments but i failed to mention i was treated for a bacterial infection chlymadia which the nurse said was very common and much easier to transmit. Does this suddenly put me in a high risk group with regards to my situation and is another test past 72 days needed

[Justwondering7]

I will also mention we had sex a week later however protected (9.5 weeks) and unprotected oral which I read isn't a very high risk?  
But the one time vaginal occured at approx. 72 days before testing. Just to clarify.

[Justwondering7]

one final question and the thread can be ended dr.  when do you recommend testing past the 8 week mark with modern elisa testing? you said my risk was low risk but I believe this girl is at least somewhat promiscious, and the candida rash worried me as you can see. Maybe I was looking for symptoms, but at 5 weeks approx. I did have a bad whooping cough for 3 or 4 weeks. Are there any instances where past 8 weeks is needed? I will learn from my mistakes and there is a girl I really like and wish to start a relationship with, therefore I was curious why your opinion differs from some other doctors in the field and if I can truly move on with my life.
Thank you, you can end the thread.

[Justwondering7]

Thank you very much doctor, I was fairly confident in my approximate ten week test result at first, but the nurse I was with stressed 3 months and a 6 month repeat, and all over the internet stresses 12 weeks , 12 weeks, so I was worried that my results may change or that the candida could show my immune system was weakened and I needed a retest due to a false negative, but as you can see anxiety got the better of me.  Most websites, even though they seem reputable stressed the fact that "normal people" can usually fight off yeast/fungi furthering my anxiety, but I will let it rest and move on with my life.  Thank you very much Doctor.   I did not want to be irresponsible and not retest if it was actually needed but I will take your advice.  Thanks again.

[Justwondering7]

okay I really appreciate your advice and prompt reply.. I was just very worried with regards to the whole candida thing, because I read it primarily only affects people with a weakened immune system and I consider myself a very healthy individual overall.  Is a candidal or fungal infection common from your view with people going through ars or acute infection?
Basically everywhere I looked online said candida - or yeast reflects a horomonal imbalance or something going wrong in the body and I kept seeing HIV and AIDS pop up and jock itch normally doesnt affect the genitals at all which this has migrated to a bit.
Also the bad cough I had probably 5-6 weeks after the incident had me worried as well
I have seen very conflicting views over the window period, and just wanted to clarify that I believe this was a third generation elisa if that changes your opinion or not. I was scared as to whether or not I might be a "late converter", so you do not think I need another test? Regardless of the yeast infection?   But thank you very much doctor.