early hiv signs

[alpacino]

Doctor,

About 6 weeks ago I had sex with a prostitute very briefly when I noticed the condom had ripped and I immediately stopped.

Since then I've experienced these symptoms...

Abdominal pain, hot and cold spells, strange sweating, diarrhea over 3 weeks, mild headaches, feels like sinus. Sneezing and running nose in the morning, white mild ulcerations in the mouth and inner lip.

Ive also experienced dizziness, loss of balance, very cold feet, sensitivity to heat and cold, seems nuerological. Ive been suffering from an severe allergic reaction to fluroquinolones for over a year. An HIV infection could of brought some of these nuerological symptoms back, I am thinking.

I got HIV tested at 21 days out and showed negative. I am HSV2 positive which I have known for a year.

I just had an endoscopy done for the stomach pain and diarrhea and I was told I have mild gastritis which is causing this.

It is very possible that reading up on all these symptoms has caused me severe stress, anxiety and may be causing psychosomatic symptoms. I feel that I read about something and 2 days later Im experiencing it.

One of my questions is, Ive read in several places that white spots in the mouth are early signs of HIV, and then I've read that they are much later signs of HIV. Which is true? These spots seem more like scraps or cuts of where my teeth may have rubbed up on my inner mouth but Ive never really had this. They seem to heal in 2 days. Cause this be an early sign?

I'm extremely stressed, cant sleep, can barely eat or think straight from the anxiety of this. Do you think I should take  PCR test and HIV again at 7 weeks?

[Edward W Hook, MD]

The symptoms of the so-called Acute Retroviral Syndrome (ARS) are TOTALLY non-specific and when people experience "ARS symptoms" they are much more likely to have something else, usually some other, more typical virus infection.  When this has been studied in the US, less than 1% of persons seeking medical care for "ARS symptoms" are found to have HIV, the remainder having symptoms due to other processes. In contrast, over a given year, there is almost no one who has not had a viral illness, night sweats or both (sometimes on multiple occasions).  In addition, it is also important to realize that many persons who acquire HIV do not experience the ARS.  For a person to try to judge their HIV risk based on "ARS symptoms" is a waste of time.

In your case while some of the symptoms you describe are PART of the ARS, they do not match up well with the entire syndrome and you have an excellent alternate explanation for many of your symptoms (gastritis/anxiety/stress).  Furthermore at 21 days over 2/3-3/4 of person who had acquired HIV 3 weeks earlier would have positive tests, particularly if they have had symptoms for a week or more.  

Finally, white spots in the mouth are non-specific.  They may represent aphous ulcers which occur in person with or without HIV or something else.  As HIV progresses (over years), the frequency of a variety of oral problems increase.  On the other hand, these problems are unusual early in HIV.  Given the particulars of your situation, yours are almost certainly not an indicator of HIV.

In general we do not recommend routine PCR tests. They are expensive and have more false positive results than the standard antibody tests, despite claims to the contrary claims by those who sell/market the tests (not surprise there)

Bottom line, your risk for HIV is close to zero, given you history and test results.  You may wish to re-test at 6-8 weeks following your exposure for a final, definitive test which I predict will be negative.  At that time you can be sure that you don't have HIV, as I am now.  I hope these comments help.  EWH

[Edward W Hook, MD]

Taking your questions in order:

1.  You are correct. Studies show that persons who have HSV have increased risk for HIV if exposed.  Remember however to take this in context.  A 30% increase in risk of vaginal sex increases risk from a single exposure from 0.1% to 1.15% --stll low

2.  There are no data to suggest that HSV-2 delays time to postive blood tests for HIV

3.  At 5 weeks, no, not with any menaingful frequency

EWH

[alpacino]

Thank you doc, I feel better reading this.

My problem I think is reading too much about HIV symptoms online.

I've read that HSV2 infected people can bring the risk of contracting HIV up by 10-30%?
I've also read that HSV2 can cause HIV tests to show negative until 3-6 months?
I also just read that HIV can cause Gastritis? But 5 weeks out?

Have you heard of all this, and considering the above do you still think I am in the clear?

Thank you again!