Am I at risk? Freaking out

[Johnny1999]

Approx 3 ½ weeks ago, I went away on vacation and I ended up having sex w/ a girl I had met there.  The sex was protected (w/ a condom).  She also gave me oral sex (which was unprotected).  Little known to me, this girl had also had sex w/ 2 of my other friends (both without using protection).  This immediately put me in a state on anxiety the next day when I found out. I should also note, we had partied for 3 nights lots of alcohol, no sleep, and poor diet.
3 day mark, I had a sore throat, and a bit of a cough.  Noticed  tiny red “prick like” spots on my chest, arms, legs, back + legs. Freaked out - went to see my doctor.  He basically said that my tonsils were a little red, my lymph nodes in my neck were a little swollen and a white tongue.  I never really had a fever, but I often felt like I was getting the chills.  He dismissed the red spots as Cambell de Morgan spots.  Dr ran a bunch of blood tests (took a swab of my throat), + HIV test.  Everything came back negative.  The only thing was that my ABS lymph count was low (0.8).  This didn’t seem to raise any alarm for my dr.
Week 1 – 2 CBC’s done, all normal but lymph count was 0.8 (day 4 and 1.6 (day 6)
Week 3 – Negative HIV, CBC all normal, but ABS lymph count 0.9 (day 15)
3 drs. dismissed red spots as Campbell de Morgan spots
Q/A:
Possible to develop HIV symptoms (mentioned above) after only 3-4 days?  
Is it possible that if one of my friends has ejaculated in this girls mouth before she gave me oral sex, that I could have acquired HIV from her – if one of my was friends is positive?
Given that I had protected sex (and only received unprotected oral sex), is it at all possible that I could have acquired HIV?
Is my chronically low lymph count indicative of me being infected, or has my stress and anxiety been the culprit here?
Can I request a PCR test at 4 week mark (too late to be accurate)?

[Edward W Hook, MD]

Mental stress and the stress of a viral illness are very different things.  I meant to indicate that there was no impact of mental stress and assumed you would take it htat way.  No it is spelled out for you.  Nothing furhter to say on this matter other than, once again, you should not be worrying as much as you are.  EWH

[Johnny1999]

Dr. Hook -  I am receiving some what of a mixed message from you regrding lymphocyte counts and their impacts as a result of stress.  You stated above that stress has no impact on lymphocyte counts, and yet I read in your response to another question in the forum that "In addition, particularly after stress or a recent sore throat, an 18% lymphocyte count is not at all worrisome either".

I have also read on a number of sites that low lymphocyte accounts can occur during times of starvation and times of extreme stress.  Can you please speak to whether these are correlated or not.  Thank you.

[Edward W Hook, MD]

There are any number of things that can cause low lymphocte counts including day-to-day fluctuation or almost any community acquired viral infection.  Stress is not one of the things that would be on the list.  The sore throat/tonsilitis you had is yor most likely cause of decreased lymphocytes.  Your doctor is not worried, nor am I - perhaps you should not be either.  EWH

[Johnny1999]

One final question Dr.  Does stress and anxiety play a role in the low lymph count?  I'll admit - I have been a reck these last few weeks, so I would suspect it does, but can you please confirm.

Also - these "newly acquired" Cambell de Morgan spots.  I know that I have developed these over the last 3.5 weeks (as I have seen them appear in areas that I know I did have them previously - I know this 100%).  Most of the dr's have told me that I "probably just never noticed them before", but I know for a fact that I did not have most (if not all of them).  I have read that these spots (like Cherry angioma spots) can sometimes be triggered by stress - I am 1 29 year old male by the way.  Is this true?

[Johnny1999]

One final question Dr. - does stress and anxiety play a role in the low lymph count?  I'll admit - I have been a reck these last few weeks, so I would suspect it does, but can you please confirm.  Thanks.

[Johnny1999]

Thanks a lot everyone.  I have a scheduled appointment at the STD clinic today.  I will ask them to conduct the HIV test (now at the 4 week mark) to finally put my mind at ease and move on.  

This is a great forum - thank you so much for all your help + support.

[horneyboy]

Like the good doctor said "you have gotten trapped in a cycle of self-perpetuating anxiety"  Remember, you did things right.  You had protected vaginal sex.  Your risk from oral sex on this case is so low as to be less than winning a lottery ticket.  Get used to the fact there is always some risk in everything we do in life, including sex.  We all go through this anxiety but if we are going to have sex outside of a monogamous relationship it just comes with the territory.  So get used to it.  I get HIV tested once a year by my doctor because I am sexually active (I always use a condom but I do have unprotected oral)  The 24 hr wait for the result each year is the longest wait of my life.  I hate it but I just accept it.  The waiting is not fun but in your case you already know that with a 3 week test being negative your chances are about .01 X .001 X .33 of getting HIV.  I'd take those odds at Vegas any day.  In fact your chance in dying in a plane crash on the way to Vegas is three times higher.  Now relax.

[Edward W Hook, MD]

Your efforts to "assess all possible scenarios" suggests that you have gotten trapped in a cycle of self-perpetuating anxiety.  Get over it - your risk is very low.  Let's deal with some of your concerns:

1.  Could your partner be HIV infected - unlikely.  It is just not that common among heterosexual women.
2.  What do your HIV test results mean -they further reduce the chance that you have HIV.  By 2 weeks about half of HIV tests that are going to become positive will be and at 4 weeks, the figure rises to about 85-90%.  Thus your 3 week test was performed at a time when well over two-thirds of tests that are going to be positive will be.
3.  Is your somewhat low lymphocyte count meaningful.  No.  A low lymphocyte count is non-specific and not concerning.
4.  Were your symptoms the ARS.  Again, no.  The initial symptoms began too early to be ARS and the syndrome you describe really does not fit the ARS descriptions.
5.  Should you get a PCR test. i would not advise this. There are more false positives with the PCR assay than with the antibody tests.  Just repeat the antibody test.  At 4 weeks, as I said above, 85-90% of antibody tests would be positive and by 6 weeks the figure is over 95%.
6.  I will not dignify your question about the results of following one of your friends in receipt of oral sex from this woman.  Too far out to even consider.

Bottom line, you have very little to worry about.  Rest easy.

Hope this helps.  EWH

[Johnny1999]

Sorry - just a point of clarification regaridng my friends.  It should say:

Is it possible that if one of my friends has ejaculated in this girls mouth before she gave me oral sex, that I could have acquired HIV from her – if one of my was friends WAS positive?  

I don't know the HIV status of my friends (I suspect it is negative), but am trying to assess all possible scenarios.

[Johnny1999]

I should add in that I did "make out" w/ at least 3 girls during this trip - so I suspect my chances of getting something (other than HIV) from one of these girls is probably the cause of any symptoms I may have developed that early on.  Please confirm.