[Question #1009] 4th Gen testing and lingering symptoms

86 months ago
 I'm a 49 year old married male and in March had an encounter with a CSW (appointment kind) in Vegas. We had protected vaginal intercourse twice with condoms, she performed 2-5 mins of unprotected oral on me between intercourse. Before anything started she kissed me with tongue for maybe 5-10 seconds, I was not expecting that and stopped it. From what I could tell the condoms didn't break as she removed them both times carefully. The next day I had a burning in my throat that lasted a week. I saw my doctor and he said my risk was low. Regardless my fear / guilt got to me and at 34 days I went through STD check an online service, they used my local Quest Labs the same place my doctors office uses.  I had a 10 panel test done with a 4th Gen Duo HIV test and also added the RNA HIV test. Everything came back negative except HSV 1 which was >5. I was told not to worry so many people have HSV1 and I don't ever recall an outbreak, nor have I had one since. Although I occasionally get fever blisters.
I felt good after that although I was occasionally getting this shaky / cold feeling. I hesitate to call them chills and though they were allergies. 3 weeks later I was also getting a lot of pain in my neck and shoulder muscles. Logically I knew this wasn't a symptom of anything but fear / anxiety kicked in again.  At 12 weeks (technically 83 days 10 hours if we count time zones) I decided to test again, same panel minus the RNA. This time same results except HSV 2 came back equivocal at 0.92. My first score was negative so they didn't provide the number only that is was <0.90. I asked Ms. Warren about this on her forums. She said it was unlikely from my encounter I had HSV2 and I haven't had any outbreaks (at about 20 weeks now)

I felt good for the last 3 weeks, my shoulder muscle joints are still sore and I still seem to get cold in situations I haven't in the past. i.e. Air conditioning. It's weird I feel good for a few weeks and then terrible for a few days to a week then good

86 months ago
My questions are as follows: 
1. My HIV testing is conclusive correct? There is no chance I have it and don't need to test again?

2. Is there anything I'm missing from an STD stand point that could account for my symptoms?

3. I failed to mention my throat also hurts when this cold feeling comes on. Spicy food burns my throat now from time to time. I thought HSV1 was on the outside of the mouth, it's not in my throat right?

4. I haven't had sex with my wife since, can I go back to unprotected sex and feel comfortable I won't give her anything.

I know that my symptoms could all be anxiety but it just seems odd that they come and go every few weeks. I'm hoping you can make me feel assured. Also is it possible to have this use my username and not my name?
H. Hunter Handsfield, MD
86 months ago
Welcome to the forum. Bottom line:  no worries, and it is past time to resume sex with your wife. 

This was a low risk exposure, especially for HIV. HIV is rare in most female sex workers in the US; condoms work; oral sex has never been proved to transmit HIV mouth to penis; and the 4th generation test is 100% reliable any time 4 weeks or more after exposure. That result overrules everything else:  even if you had a very high risk exposure (you didn't) or if your symptoms were typical for a new HIV infection (they are not), the test proves you did not catch it. The RNA test was superfluous; it added nothing except the damage to your wallet!

You might misunderstand HSV1 and oral herpes. Roughly half of all adults your age have positive HSV1 blood tests, so your result is not a surprise and goes along with your fever blisters:  you have oral herpes. (Fever blisters ARE herpes outbreaks.) As for HSV2, your tests prove you weren't infected, and I agree exactly with Terri Warren that there was almost no chance you were infected anyway.

You have been overtested for STDs. Most infections in a 10-test panel are not possible from a single exposure of the sort you had. For example, in my STD clinic we would never test someone in your situation for HSV or viral hepatitis, only for chlamydia and gonorrhea (which require a urine test or urethral swab), syphilis, and HIV.

Those comments pretty well cover your specific quesitons, but to be sure there is no misunderstanding:

1) Your HIV test results are conclusive. 

2) No STD causes the sorts of symptoms you describe.

3) Fever blisters means you have typical oral herpes due to HSV1. In this circumstance, you are immune to a new HSV1 infection and to new symptoms like a sore throat. Something else is the cause, probably just a common cold virus.

4) You could have safely resumed sex with your wife once you had a negative chlamydia/gonorrhea test, which would have been conclusive any time more than 3-4 days after exposure. The risk of anything else was too small to be a significant worry. Even if you wanted to be hyper-careful, you could have safely resumed sex after your 34 day test results. For sure you should do so now.

As for your final comment about symptoms and anxiety:  this is exactly what is expected! Symptoms that come and go are more typical for anxiety than anything else.

So all is well. You can move on and not give this exposure another thought. Best wishes--  HHH, MD

86 months ago
Thanks you doctor, I feel a little better now. I guess what threw me was I went to see an Endocrinologist because of this sudden intolerance to cold like air conditioning and the achy muscles and one of the thins she asked me was it possible I had HIV.

Based on your response I can assume this was just a standard question from her?

It's been thought to get over this and I hope your response helps. After all 2 conclusive test plus the RNA, nevermind the low risk to begin with and I should feel confident. It's just these lingering weird symptoms make it harder.
H. Hunter Handsfield, MD
86 months ago
I'm glad my reply has started to help you feel better. Thanks for the thanks.

For any new medical problem of almost any kind (except injury or other obvious sugical problem) most good doctors automatically ask about HIV and risks for it, and often test for HIV. It's the smart thing to do in view of the worldwide HIV/AIDS epidemic, and the obvious fact that many HIV infected people don't know it and often don't even know they have been at risk. That's all that happened here.

Test resutls ALWAYS overrule symptoms, no matter how typical for HIV the symptoms might seem to be. In your case, your symptoms are not typical anyway. Your test results prove you don't have it. If they continue and you remain concerned, continue to work with your doctor to find the cause and treatment, if needed.

86 months ago
Doc thank you again for your response. My logical mind already knew I was fine health wise. With two tests being unfortunately the non-logical mind was winning. Hopefully your reassurance does the trick.

Since this is my last follow up and I know test overrule symptoms let me just ask 2 things. With my wife's age 44 she likely doesn't have the HPV vaccine but she gets checked yearly so is there any concern here?

Second could months of stress, fear, guilt etc. manifest itself into real issues like my muscle and joint pain? Thanks again!
H. Hunter Handsfield, MD
86 months ago
It is rare for anyone to acquire a new HPV infection beyond age 26, which is why HPV vaccine is not recommended in people older than that. No concern.

Stress and anxiety can cause many symptoms, including the ones you hae had. But I have no way of judging the cause in you. This is something to discuss with your personal physician.

Best wishes and stay safe.