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Mono like symptoms, waiting for test results
Hi Dr. HHH,
I wrote to you 2 weeks ago. For three weeks and four days I have had swollen glands, and some other flu like symptoms such as night sweats and a sore throat. Now the sypmtoms are dissipating. One week prior to this onset I had insertive unprotected oral sex with I guy I have been dating (I am gay). The insertive oral lasted about 2 minutes. Yesterday I went to the doctor who said that I had a swollen gland in my groin (he did not feel them in my armpits or neck, but I think they have gone down since the onset) and my spleen was swollen he said. I went yesterday for an anonymous hiv test, which will take 2 weeks to get results from my local clinic. (I think I may go this week for the rapid test to know sooner). My question is this- I thought these sypmtoms could be the sign of many viral infections, but I have been made to feel like Hiv is the strongest candidate over Mono and countless others. I always thought that being the insertive partner in oral sex was extremely low risk. Most studies on the matter are examining the receptive partner. Is that true? I have thought myself very safe over the years, never engaging in anal sex but once with a condom years ago, and being very selective in my choice of men to date. Does it still seem possible to you that there could be other causes for my swollen glands and spleen besides hiv? I had kissed a few guys in the month prior to the infection. I am so scared. Thanks.
I wrote to you 2 weeks ago. For three weeks and four days I have had swollen glands, and some other flu like symptoms such as night sweats and a sore throat. Now the sypmtoms are dissipating. One week prior to this onset I had insertive unprotected oral sex with I guy I have been dating (I am gay). The insertive oral lasted about 2 minutes. Yesterday I went to the doctor who said that I had a swollen gland in my groin (he did not feel them in my armpits or neck, but I think they have gone down since the onset) and my spleen was swollen he said. I went yesterday for an anonymous hiv test, which will take 2 weeks to get results from my local clinic. (I think I may go this week for the rapid test to know sooner). My question is this- I thought these sypmtoms could be the sign of many viral infections, but I have been made to feel like Hiv is the strongest candidate over Mono and countless others. I always thought that being the insertive partner in oral sex was extremely low risk. Most studies on the matter are examining the receptive partner. Is that true? I have thought myself very safe over the years, never engaging in anal sex but once with a condom years ago, and being very selective in my choice of men to date. Does it still seem possible to you that there could be other causes for my swollen glands and spleen besides hiv? I had kissed a few guys in the month prior to the infection. I am so scared. Thanks.
MEDICAL PROFESSIONAL
It is true that about one quarter of HIV infected persons (not half) in the US don't know it, somewhere around 300,000 people. But there is very good evidence that the availability of anonymous testing is not going to make any realistic difference in bringing those persons to diagnosis. (It hasn't done so thus far, has it?) The fact is that discriminatory outcomes exist only in anecdotal reports in small numbers; objective data indicate such outcomes are rare.
It isn't fear of disclosure that interferes with the 300,000 unknowing persons not getting HIV tested. It is fear of knowing the result (whether confidentially or anonymously); unreasoned denial of risk; and truly being unaware of risk (e.g., the woman who doesn't know her partner is infected or at risk). These statements are not based on idle opinion, but strong data from surveys and epidemiologic analyses.
These are part of the reason that CDC is in the process of developing new national HIV testing guidelines, which probably will be released in mid-2006. The new recommendations will be for routine HIV testing of ALL adults in all health care settings, without collecting risk information; without required routine pre-test counseling; and with "opt out" consent. (Opt-out means people will be routinely tested unless they specifically request HIV testing not be done; and that HIV-specific written consent generally will not be required. Opt-out is the current standard for routine testing of pregnant women, which has been highly successful by every measure.)
The HIV epidemic has been with us for a quarter century. Many of the strategies that maximized control and prevention in the early years no longer meed the need. Anonymous testing arguably is one of those strategies. Some need undoubtedly will persist, but increasingly it will cease to be the norm.
HHH, MD
It isn't fear of disclosure that interferes with the 300,000 unknowing persons not getting HIV tested. It is fear of knowing the result (whether confidentially or anonymously); unreasoned denial of risk; and truly being unaware of risk (e.g., the woman who doesn't know her partner is infected or at risk). These statements are not based on idle opinion, but strong data from surveys and epidemiologic analyses.
These are part of the reason that CDC is in the process of developing new national HIV testing guidelines, which probably will be released in mid-2006. The new recommendations will be for routine HIV testing of ALL adults in all health care settings, without collecting risk information; without required routine pre-test counseling; and with "opt out" consent. (Opt-out means people will be routinely tested unless they specifically request HIV testing not be done; and that HIV-specific written consent generally will not be required. Opt-out is the current standard for routine testing of pregnant women, which has been highly successful by every measure.)
The HIV epidemic has been with us for a quarter century. Many of the strategies that maximized control and prevention in the early years no longer meed the need. Anonymous testing arguably is one of those strategies. Some need undoubtedly will persist, but increasingly it will cease to be the norm.
HHH, MD
Hi,
Just wanted to add that if you go to gay.com, they have had a message board running about the new change to CDC regulations, which requires that states disclose the actual names of people who got tested, in order to receive federal funding for HIV testing programs.
The vast majority of the men who posted on that forum are dismayed by the change and it sounds like it will make them less likely to seek testing. They represent the population most at risk and most attuned to these privacy fears.
J
Just wanted to add that if you go to gay.com, they have had a message board running about the new change to CDC regulations, which requires that states disclose the actual names of people who got tested, in order to receive federal funding for HIV testing programs.
The vast majority of the men who posted on that forum are dismayed by the change and it sounds like it will make them less likely to seek testing. They represent the population most at risk and most attuned to these privacy fears.
J
Having worked in the health care industry for many years, in both large and small towns, in both offices and hospitals, I can assure you that no one pours over random medical records looking for juicy tidbits to gossip about. No one secretly records and releases anyones sexual habits to any other group for any purpose. If there is a compilation of the names of gay men going to the government...that's news to me. Not saying it couldn't happen in conjunction with government funded testing and treatment programs, but it doesn't happen in the private sector, nor in any public clinic that I know about or have been associated with.
It is easy to imagine that HCW's are shocked or otherwise titilated by the sexual habits of those whose sexual orientation is outside the "norm", but honestly---I couldn't care less, nor could anyone I've ever worked with. We see it every day, day in and day out. It just isn't something to be gossiped about anymore. And trust me--HIPPA has stifled any urge to gossip. I couldn't get info on my own mother when she was in the hospital last year.
If you don't work in the field, you probably will never believe me. But bisexuality and homosexuality are increasingly common and just not frightening or shocking to the vast majority of HCW's. Who's gay or who is HIV pos is just not something we get worked up about. Does HIV or sexuality discrimination occur? Sure. But it is not common, and does not originate in the doctors office. I look to the religious right when I think about discrimination of that nature. And people who tenaciously cling to those beliefs generally do not last long in the health care field, as we must be impartial and caring to all, not just those whose choices or beliefs we agree with.
Good topic!
It is easy to imagine that HCW's are shocked or otherwise titilated by the sexual habits of those whose sexual orientation is outside the "norm", but honestly---I couldn't care less, nor could anyone I've ever worked with. We see it every day, day in and day out. It just isn't something to be gossiped about anymore. And trust me--HIPPA has stifled any urge to gossip. I couldn't get info on my own mother when she was in the hospital last year.
If you don't work in the field, you probably will never believe me. But bisexuality and homosexuality are increasingly common and just not frightening or shocking to the vast majority of HCW's. Who's gay or who is HIV pos is just not something we get worked up about. Does HIV or sexuality discrimination occur? Sure. But it is not common, and does not originate in the doctors office. I look to the religious right when I think about discrimination of that nature. And people who tenaciously cling to those beliefs generally do not last long in the health care field, as we must be impartial and caring to all, not just those whose choices or beliefs we agree with.
Good topic!
Hi Dr.,
I was not trying to start a new thread on the same subject, but rather ask a new question. I'm sorry. My concern is with my sick Dad, and whether or not HIV can be transmitted through a shared razor with no visible blood, used a day apart. Thanks.
I was not trying to start a new thread on the same subject, but rather ask a new question. I'm sorry. My concern is with my sick Dad, and whether or not HIV can be transmitted through a shared razor with no visible blood, used a day apart. Thanks.
Sorry, I was trying not to jump into too many threads lately, but I had to pipe in about the anonymous HIV testing.
I agree that Lone Ranger's comment might sound a little high-strung, but he is absolutely right. Who-is-this might work as a health care professional, but all of us who work in offices know that laws about handing information are one thing, and what office workers do is another.
Hospitals and cliinics are supposed to be governed by all sorts of quality-control laws and a large number of them don't comply with them. Ostensibly a worker who broke a company rule (about confidentiality or something else) would get fired for infractions, but because it is hard to replace nurses and doctors, that wouldn't actually happen that often.
Local health departments are supposed to investigate health care provider officers routinely but nobody really does those checks.
The federal government is supposed to act responsibly with people's information, but we know from the FEMA disaster and the president's recent acknowledgement of his breaking privacy rules that their supposed responsibility is far off from their real behavior. Large companies are supposed to manage their records responsibly, but there are widespread cases of hacking, phishing, insider trading, and countless other behaviors that show that information is not invioalte.
The military, immigration, and other bureaucratic offices have rights to get access to people's HIV records. Once they have the access, if the information is passed on without a written record, then there's no way to trace who said what to whom, and there is no way for those discrimination cases to be actionable.
If you live in a small community or your job is tied to a bureaucracy that's hard to control, then having a file indicating your HIV status is obviously daunting.
Getting health care once you have HIV is another issue. People can choose to move to another community or see a doctor far from home, in other words, make a life-changing decision, based on a factor as big as that. But on the small level of testing, it is natural not to want people to know what's put you at risk, which does get recorded.
Lastly, the fact that only half of adults have been tested for HIV is surely linked to all these concerns, which are far from ridiculous. I'm a fairly logical person and I do get tested often -- and I do give my name when I get tested, because I'm open about my bisexuality with people to an extent -- but I am unusual and wouldn't recommend the average American to get tested at a large office unless it's anonymous. Confidentiality has too many loopholes.
J
I agree that Lone Ranger's comment might sound a little high-strung, but he is absolutely right. Who-is-this might work as a health care professional, but all of us who work in offices know that laws about handing information are one thing, and what office workers do is another.
Hospitals and cliinics are supposed to be governed by all sorts of quality-control laws and a large number of them don't comply with them. Ostensibly a worker who broke a company rule (about confidentiality or something else) would get fired for infractions, but because it is hard to replace nurses and doctors, that wouldn't actually happen that often.
Local health departments are supposed to investigate health care provider officers routinely but nobody really does those checks.
The federal government is supposed to act responsibly with people's information, but we know from the FEMA disaster and the president's recent acknowledgement of his breaking privacy rules that their supposed responsibility is far off from their real behavior. Large companies are supposed to manage their records responsibly, but there are widespread cases of hacking, phishing, insider trading, and countless other behaviors that show that information is not invioalte.
The military, immigration, and other bureaucratic offices have rights to get access to people's HIV records. Once they have the access, if the information is passed on without a written record, then there's no way to trace who said what to whom, and there is no way for those discrimination cases to be actionable.
If you live in a small community or your job is tied to a bureaucracy that's hard to control, then having a file indicating your HIV status is obviously daunting.
Getting health care once you have HIV is another issue. People can choose to move to another community or see a doctor far from home, in other words, make a life-changing decision, based on a factor as big as that. But on the small level of testing, it is natural not to want people to know what's put you at risk, which does get recorded.
Lastly, the fact that only half of adults have been tested for HIV is surely linked to all these concerns, which are far from ridiculous. I'm a fairly logical person and I do get tested often -- and I do give my name when I get tested, because I'm open about my bisexuality with people to an extent -- but I am unusual and wouldn't recommend the average American to get tested at a large office unless it's anonymous. Confidentiality has too many loopholes.
J
MEDICAL PROFESSIONAL
PT: You can't start a new thread on the same topic. If you try again, you will be blocked from any participation in the STD forum.
Everyone: I am not going to participate in a prolonged debate on anonymous HIV testing. In general, I agree with who-is-this's comment above. I understand the concerns that some people have, and believe most health departments therefore should continue to offer such testing. However, the original reason for it was that having an anonymous option would lead to more people at risk being tested. There are now strong data that this no longer is the case; and that in fact it interferes with HIV prevention efforts.
HHH, MD
Everyone: I am not going to participate in a prolonged debate on anonymous HIV testing. In general, I agree with who-is-this's comment above. I understand the concerns that some people have, and believe most health departments therefore should continue to offer such testing. However, the original reason for it was that having an anonymous option would lead to more people at risk being tested. There are now strong data that this no longer is the case; and that in fact it interferes with HIV prevention efforts.
HHH, MD
That's pretty ridiculous.
HIPPA laws forbid casually discussing your health history between people in a medical office or anyone there "remembering" you or your risk factors and discussing them outside the office. And there is no conspiracy (for lack of a better word) that would dictate sending your results or risk factors to an "office" or offices elsewhere willy-nilly.
Believe me, HC workers take HIPPA very seriously. I am a HCW and can't get access to my own lab results except via my own doctor. I had a female coworker who had a pregnancy test at our hospital and went online (via the in house lab) to get the results OF HER OWN TEST. She was contacted the next day by the HIPPA privacy officer for our hospital, and told if it happened again she would be fired on the spot. NO ONE can access or discuss your results without your consent and knowledge.
I think you are building up a network in your own mind that doesn't exist. I've worked in medical offices and hospitals. The sort of behind the scenes gossip and and lab result sharing you are thinking of doesn't exist anymore.
Anyone can refuse to give blood during a blood drive. Or, If there is pressure to donate, anyone can donate and ask that the blood not be used. They give you a little form to fill out privately prior to giving blood and you can indicate that you don't want the blood to be used. They do this because there IS often pressure to donate blood at blood drives. How ridiculous to say that someone didn't give blood and it "affected his job". chances are that something else was affecting his job and he laid the blame on the fact that he didn't give blood.
And to say that your housing and socializing would be affected? Last time I rented an apartment or bought a home, your HIV status or risk factors weren't something that you had to put on the application. And I generally wouldn't think you have to wear a badge or something proclaiming your health status when you go to a party or meet friends for dinner. Even if you test anonymously and are positive, this isn't something you must disclose unless you are sleeping with someone.
Sorry to go off on you, but I felt I had to say something lest the paranoia became contagious.
HIPPA laws forbid casually discussing your health history between people in a medical office or anyone there "remembering" you or your risk factors and discussing them outside the office. And there is no conspiracy (for lack of a better word) that would dictate sending your results or risk factors to an "office" or offices elsewhere willy-nilly.
Believe me, HC workers take HIPPA very seriously. I am a HCW and can't get access to my own lab results except via my own doctor. I had a female coworker who had a pregnancy test at our hospital and went online (via the in house lab) to get the results OF HER OWN TEST. She was contacted the next day by the HIPPA privacy officer for our hospital, and told if it happened again she would be fired on the spot. NO ONE can access or discuss your results without your consent and knowledge.
I think you are building up a network in your own mind that doesn't exist. I've worked in medical offices and hospitals. The sort of behind the scenes gossip and and lab result sharing you are thinking of doesn't exist anymore.
Anyone can refuse to give blood during a blood drive. Or, If there is pressure to donate, anyone can donate and ask that the blood not be used. They give you a little form to fill out privately prior to giving blood and you can indicate that you don't want the blood to be used. They do this because there IS often pressure to donate blood at blood drives. How ridiculous to say that someone didn't give blood and it "affected his job". chances are that something else was affecting his job and he laid the blame on the fact that he didn't give blood.
And to say that your housing and socializing would be affected? Last time I rented an apartment or bought a home, your HIV status or risk factors weren't something that you had to put on the application. And I generally wouldn't think you have to wear a badge or something proclaiming your health status when you go to a party or meet friends for dinner. Even if you test anonymously and are positive, this isn't something you must disclose unless you are sleeping with someone.
Sorry to go off on you, but I felt I had to say something lest the paranoia became contagious.
I still give a false name when I get tested for HIV and there are very good reasons why people are worried about being tracked for having the virus. Everyone I know would probably still discriminate against an HIV person if it came to employment, housing, or socializing. Also, if people know you went and got tested, then they also know that somewhere with your name on it is a file listing what your risks were.
In any office there are clerks, secretaries, messengers, people walking around, who could for any reason see your name and pass it along. Then if you're in a state where they send your names to a database somewhere, imagine how many more offices like that there are. Then if there's a record of the risks you reported at one point in time, you're legally responsible for anything that people accuse you of later, like if an ex-girlfriend tries to accuse you of giving her HIV.
I know where I work, there was a man who didn't give blood because he wanted to know his HIV status first. He tried to be discreet about it but people in the office treated him differently and it affected his job.
Doc I know you mean well but the question of anonymous or confidential testing is still a very big problem for people and I think it's terrible that anonymous testing sites are not going to be available anymore.
In any office there are clerks, secretaries, messengers, people walking around, who could for any reason see your name and pass it along. Then if you're in a state where they send your names to a database somewhere, imagine how many more offices like that there are. Then if there's a record of the risks you reported at one point in time, you're legally responsible for anything that people accuse you of later, like if an ex-girlfriend tries to accuse you of giving her HIV.
I know where I work, there was a man who didn't give blood because he wanted to know his HIV status first. He tried to be discreet about it but people in the office treated him differently and it affected his job.
Doc I know you mean well but the question of anonymous or confidential testing is still a very big problem for people and I think it's terrible that anonymous testing sites are not going to be available anymore.
MEDICAL PROFESSIONAL
On the surface, avoiding your parents' insurance policy seems a good reason for anonymous testing. But whatever clinic tested you anonymously obviously isn't collecting insurance reimbursement either way. Almost certainly they would have tested you, without billing insurance, if you were tested under your own name. This is the policy of just about every health department and every community-based organization that offers HIV testing.
This isn't personal criticism of you. I just want all forum users to understand that there is no longer any important reason for anonymous HIV testing--and as time goes on, more and more health departments are no longer offering it as an option (although most probably still do so).
HHH, MD
This isn't personal criticism of you. I just want all forum users to understand that there is no longer any important reason for anonymous HIV testing--and as time goes on, more and more health departments are no longer offering it as an option (although most probably still do so).
HHH, MD
Unless there are a lot of other people on your parent's insurance I think they would be able to figure it out pretty easily.
The 2 week waiting time is ridiculous. I can't believe that is still the standard at many places.
The 2 week waiting time is ridiculous. I can't believe that is still the standard at many places.
Dear Dr,
The guy I have been dating in question just e-mailed me that he is certain he is negative for all STDs including HIV. He also said we didn't do any risky behavior. I can't agree with him 100% on that, although most gay men deny the risks of oral sex. His assurance that he has tested negative, however, is encouraging. He seems very confident on this matter and he is a very smart guy. The only other encounters for this whole year have been kissing and masterbation, so let me hope that this virus I have is not HIV. I will go Monday for a quicker test; I did anonymous because I was concerned with my parent's finding out, as we are on the same insurance. I guess that would be inevitable. Thanks for your encouraging comments!
The guy I have been dating in question just e-mailed me that he is certain he is negative for all STDs including HIV. He also said we didn't do any risky behavior. I can't agree with him 100% on that, although most gay men deny the risks of oral sex. His assurance that he has tested negative, however, is encouraging. He seems very confident on this matter and he is a very smart guy. The only other encounters for this whole year have been kissing and masterbation, so let me hope that this virus I have is not HIV. I will go Monday for a quicker test; I did anonymous because I was concerned with my parent's finding out, as we are on the same insurance. I guess that would be inevitable. Thanks for your encouraging comments!
It has been limited to 2 testing sites, but I would be afraid there may be something equivalent to a bad batch of tests that are making their way around the nation.
Thanks Willl, I definitely don't want that!
If you go get a rapid test, be aware that Orasure is currently under a self investigation regarding the Oraquick Advance product having a higer number of false positives than projected. I wouldn't want you to have a heartattack over a false positive.
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http://investor.orasuretechnologies.com/ireye/ir_site.zhtml?ticker=OSUR&script=410&layout=-6&item_id=797812
MEDICAL PROFESSIONAL
I have nothing to add to my comments on your previous thread, and on innumerable other threads with variations on the same question. All I can do is use scientific data and my clinical judgment to address the odds people in your circumstance might have HIV. Those things tell me the chance you have HIV is low. But I cannot predict whether any particular person might be the exception.
There are plenty of places you can get the standard (non-rapid) HIV tests without waiting 2 weeks for the result. Or you can seek rapid testing. Yes, there is an increased risk of false-positive results, as indicated by a response below. But such cases are rapidly resolved with additional testing, typically within 1-2 days.
And by the way, why anonymous? Anonymous testing makes no sense anymore: there are virtually no documented cases of discrimination based on negative HIV test results; and if the result is positive, you will need to immediately get medical care, and proper health care for HIV cannot be obtained anonymously. Anonymous HIV testing made sense at one time, as a way of encouraging people who were hesitant about testing in the first place. But those times ended a decade ago.
HHH, MD
There are plenty of places you can get the standard (non-rapid) HIV tests without waiting 2 weeks for the result. Or you can seek rapid testing. Yes, there is an increased risk of false-positive results, as indicated by a response below. But such cases are rapidly resolved with additional testing, typically within 1-2 days.
And by the way, why anonymous? Anonymous testing makes no sense anymore: there are virtually no documented cases of discrimination based on negative HIV test results; and if the result is positive, you will need to immediately get medical care, and proper health care for HIV cannot be obtained anonymously. Anonymous HIV testing made sense at one time, as a way of encouraging people who were hesitant about testing in the first place. But those times ended a decade ago.
HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
