[Question #10806] Clarification / HIV / Symptoms

19 months ago

HI doctors,

I (M) went to strippers in Canada. Naked black girl rubbed intensively on me and I had very thin pants. I'm sure the top of my uncircumcision penis had a lot of fluid. Then she sat on my face a moment and got a vaginal fluid in my mouth. I bit myself hard and then shut down. I have several strange symptoms since. Still persistent lymph nodes (1 left groin & 2 under the neck) make me thinks the worst. I also always need to drink a lot more of water than a used to be.

8 days: Top urethra with cold sensation (never gone)
1 month: bump and pain in left lymph node in groin, soft diarrhea (still there), tiredness, zoster, balanitis, lost 10% weight
33 and 86 days: Syphilis/HIV 4th gen test negative (1st public and 2th private clinic)
8.5 months: Full STDs test. HIV 4th gen is still negative (public health system)

Since exposure:

Saw a urologist and said everything is fine with redness for my urethra. She said maybe it’s because of Clotrimaderm cream (1%)
Still have a swollen lymph node in my left groin. I had 2 ultrasounds and my doctor thinks it's an inguinal hernia. Waiting for a scan. Weird timing
Lymph nodes below my neck are very large/hard when touching. No pain when eating/drinking but for several months feeling that something blocking my neck. Also some ulcers on my tongue which never had before. My tongue is also really red. Never had kind of symptoms before the exposure

Question:

Is it possible a HIV PCR test is necessary in case a HIV 4th gen test does not come out positive when a person is truly infected?
Symptoms (1 left groin and 2 under the neck) persist hypnotize me. Other than HIV, what could explain my symptoms? Is there anything other than EBV and CMV? Already been vaccine for Hepatitis

Thanks

19 months ago

I did a typo regarding "My tongue is also really red". I was talking about my throat, not my tongue.

Have a nice day

Edward W. Hook M.D.

19 months ago

Welcome to our Forum. Thanks for your confidence in our service. I'll be glad to comment. The encounter you describe was an entirely no risk event for STIs, including HIV. STIs are not transmitted through cloth/material, even when the material is wet with genital secretion. Further, even if your partner's genial secretions accidentally entered your mouth while she sat on your face, this would not cause infection- direct contact with the infected site is required, not simply ingestion of secretions. Thus:

Is it possible a HIV PCR test is necessary in case a HIV 4th gen test does not come out positive when a person is truly infected? Absolutely not. The testing you have already had proves that you were not infected.
Lymph node swelling is non-specific and has many, many causes. You have proven that the swelling you have noted is not due to STI. As for other possible caues there are many. Personally I would not worry about it in the least. Most people have lymph nodes which can be felt if you look hard enough and are nothing to worry about unless they are tender. If tender, you should work with your doctor to determine what they might be due to. It is not an STI however.

I hope that this information is helpful. If anything is unclear, please use your up to two follow-ups for clarification EWH

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19 months ago

Thank you very much for the fast response Dr. Edward. I really understand that my event had no or very low risk. I summarized the event but didn't mention that I was really way too much drunk. So I may have did a fast culiningus. One thing is certain, my penis has never come out of my pants.

The issue is that I have/had lots of symptoms since then and the ones that persist are linked to my swollen lymph nodes. I know something is going with my body but I can't find it. As you know, Google is the #1 enemy of your patients, including me.

Concerning the very very rare people who cannot create antibodies (I think they are called "HIV seronegative"), these people become ill much more quickly than the average.

Here is my other question, can you tell me if HIV 4th gen test through vein can detect 100% of them? Does the antigen remain present and detectable as long as the antibodies are not created?

Thanks again for your time Dr. Edward

19 months ago

I forgot to ask about HIV2. As we know, it's extremely rare in North America but if somebody is "HIV seronegative" (I kn ow it's really really rare) and he got infected by HIV2, how can he knows if he only do HIV 4th gen test? As you know, antigen P24 is only for HIV1 and not HIV2.

Thanks in advance

Edward W. Hook M.D.

19 months ago

Thanks for the additional information. It in no way changes my assessment. Cunnilingus is a close to no risk event in the unlikely event that your partner had HIV.

When we are anxious we tend to look for signs and notice things that would otherwise be overlooked. This is particularly the case with respect to lymph nodes. Further, if you had HIV, a 4th generation test would be positive. Symptoms are caused by the virus and antibodies to it and, as a result, when symptoms are due to HIV, tests are always positive.

Person who do make antibodies find out early in life- they have recurring infections and/or die. Concerns that if you were infected you would not would not have a positive test are misplaced.

Current 4th generation tests are amongst the most sensitive tests in all of medicine. The results are completely reliable.

Finally, for you HIV-2 is an internet-fueled non-concern. If you had HIV-2 your tests would indicate it with at least an equivocal result which would then be explored by the laboratory.

Please don't worry. EWH

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18 months ago

Hello Dr Hook,

I have read and reread your responses, but I can't get HIV out of my head. My symptoms persist over time (left groin pain, swollen salivary glands, always dry and a lot of pressure in the ears, recurrent pimples in the throat, recurrent balanitis).

In the meantime, I did a viral load test (20 copies/ml) 2 weeks ago for HIV-1 and it was negative. From what I read by Dr. HHH, the viral load is rarely below 250 when a patient has HIV and is not taking ART, which is very positive for me.

In summary, I did 3 x 4th generation tests with venous blood tests (4, 12 and 37 weeks) and HIV viral load at 41 weeks for HIV-1, I have 100% confidence that HIV-1 is not my problem. Knowing that there isn't a lot of information for HIV-2 on the internet, I doubt that might be what I have.

#1: Is there a tiny chance that a 37-week 4th gen for HIV-2 can be false negative? My understanding is that antibodies can take much longer for HIV-2.

#2: Are you aware if there are cases of HIV-2 in Canada recently (2022-2023) or in the USA?

#3: How do I know if I am not a patient who develops antibodies very minimally and the test cannot detect it?

Thank you for your time Dr. Hook,

Sincerely yours

Edward W. Hook M.D.

18 months ago

Final Responses:

You have over tested. You have proven you to not have HIV on any kind from the virtually no risk exposure you described.

#1: Is there a tiny chance that a 37-week 4th gen for HIV-2 can be false negative? My understanding is that antibodies can take much longer for HIV-2.

No chance whatsover

#2: Are you aware if there are cases of HIV-2 in Canada recently (2022-2023) or in the USA?

In both countries HIV-2 is extraordinarily rare. I do not know current figures but have no concern

#3: How do I know if I am not a patient who develops antibodies very minimally and the test cannot detect it?

Even minimal antibodies would have been detected if present. You are worrying needlessly

This completes this thread. There should be no need for follow-ups. If you post again on this topic your question may be closed without a response and without return of your posting fee. I hope you will move forward

EWH

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