Myriad of HIV symptoms

[Ra1nMan]

Doctor,
In early January I came down with a shingles infection (I'm only 24) - this was at the same time I was traveling to Thailand.  I saw a doctor in Thailand and was prescribed acyclovir (did not help).
At around the same time my shingles began to erupt, I had an unprotected insertive vaginal exposure to a female sex worker.  I only intended to hang out with her and her friends and grab dinner, unfortunately I had let myself get too inebriated.  One thing led to another and I came to my senses shortly after I had penetrated her (roughly a minute, maybe less) and pulled out.
5 days after exposure: rolling fevers, fatigue, sleeping 12-14 hours a night, night sweats, cuts on gumline of two teeth, diarrhea - symptoms resolved after 8 days
17 days after exposure: tender swollen axilary and cervical lymph nodes, went down in 4 days
19 days after exposure:swollen lymph node under ear, intermittent diarrhea persisted until day 19
19 days after exposure: Had a CBC and rapid HIV - CBC normal, HIV negative
21 days after exposure: Swollen spleen, became full quickly when eating, spleen remained uncomfortably swollen for 2 weeks, visible series of capillaries under sternum, 3 petechiae on chest and abdomen
5 weeks post exposure: Series of night sweats and mild sore throat, transient itchy rash on chest and abdomen that would come and go in matter of minutes to hours
45 days now and my symptoms have gone.  The rash comes and goes in a matter of about 45 minutes, sometimes it's splotchy and not itchy, sometimes it's itchy and solid.  It tends to show up in the evening.

Have you seen a similar presentation in your experience?  I can only imagine it being acute HIV infection or mono.  

I will be testing at 8 weeks (next week).  I have not seen a doctor since 19 days post exposure due to concerns about my confidentiality.  Unfortunately I am overseas at the moment.  I am traveling to another country for an assessment.  I am aware that I am risking my health by doing so.

[Ra1nMan]

Just a follow-up:

8 week test was negative.  I also tested for Hep C and syphilis which were both negative.

I had a CBC done that showed mild neutropenia and monocytes/WBC's in the higher range (but not abnormal).  The doctor did not seem too concerned - he believed it was EBV/mononucleosis.  The only symptoms I have now are occasional hives and mild feeling of fullness under my left lower ribs.

I will test at 3 months just to be sure though.

Thanks for all the help

[Edward W Hook, MD]

Please, if there are further questions, they must be on the HIV site.  Short answers, then that's it.

Clinical splenomegally is not common in early HIV.  In fact, most doctors have difficulty diagnosing it.  The rash of early HIV does not come and go and is non-specifc.  It typically lasts only few days, at most.  EWH

[Ra1nMan]

Sorry, I was not clear - I know full well that my shingles infection was unrelated.  I only mentioned it to give an idea of where my immune system was - my hope is that my shingles may have lead to the later symptoms I described and not HIV.  (Or have been a manifestation of something more serious going on)

I was curious about enlargement of the spleen and if that was at all common in acute HIV infection.  I was also curious about the nature of the rash I have and if it's similar to the rash common in acute HIV infection.

Thank you for your time - I am going to get checked out regardless.  I have been in a miserable state of worry for the last month.  Any relative information from your experience or guidance on what I should ask the doctor would be appreciated.  I will be sure to update this post once I am evaluated at the hospital.  

[Edward W Hook, MD]

You have posted on the wrong site.   Questions about HIV belong on the HIV prevention site.  I will do my best to answer your questions with this reply but, if you have additional questions or follow-up they must be on the HIV Prevention site.  Sorry

" I can only imagine it being acute HIV infection or mono."  with all due respect, I do not know where you are getting your information and I fear that it is that most unreliable or sources, the internet.  The symptoms you outline are almost certainly not due to HIV (your earliest symptoms are certainly not)   an could be due to any of an enormous list of possibilities, many of which occur commonly in travelers.  Mono is a possibility, as is hepatitis and any number of other acute viral illnesses, many of which are not typically spread through sexual contact.

Shingles is more common in persons who have HIV than persons who do not however, most cases of shingles do not occur in persons with HIV.  You are relatively young to get shingles but it is not all that unusual and should not be taken as an indicator that you have HIV.  

Your symptoms and their chronology would be unusual for HIV. When persons have sypmtoms from recently acquired HIV they tend to all occur at about the same time and typically last about a week, not about a month as has been your experience.

Your negative HIV test result at 19  days indications that your shingles and initial symptoms were not due to HIV.  If they had been, your test would have been positive at 19 days.  Inclusion of HIV testing at 8 weeks is a reasonable approach however I would urge you not to limit your evaluation to this but to seek evaluation by an experienced internist or travel medicine specialist.   There are many possibilities to explain your symtoms including other, non-STD infections, drug reactions, etc.  

Hope this is helpful.  Please let us know what the doctor says following your evaluation.  EWH