[Question #12] Still really scared

41 months ago
Dear Doc HHH,

I wrote to you last Friday to relieve my fears but over the weekend my fears have gotten worse.  Since Saturday morning I have a tingling pain in my penis that is intermittent. No discharge and no real pain on urination. I am going to to get tested today.  Also really scary, I have found a swollen lymph node behind my ear, can 8 days to soon for ARS.  I have also felt really run down but that could just be from anxiety.  I am really nervous and scared mostly about HIV, I am nervous about testing positive for Chalamydia because that may mean that it would of been more likely to have been infected with HIV.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
This is a psychological issue, no longer one of STD/HIV risk. In our previous discussion, I told you how low your risk is, especially for HIV, and I gave you the reasons. I have nothing to add -- I would suggest you re-read those comments. You can be sure I am not minimizing things but giving you an accurate assessment, with good reasons why you should not be at all worried.

In the unlikely chance your test for chlamydia (or gonorrhea) is positive, it will not elevate the chance you caught HIV. You know your partner wasn't infected. As for the lump behind your ear:  First, I suspect it has been there all along and you're only noticing it because of your elevated anxiety. Second, most likely it isn't a lymph node, or maybe a "burned out" one from some distant past infection, which could be as minor as a pimple in the area. Third, 8 days indeed is too soon for any symptoms related to HIV. Fourth, a new HIV infection would never cause a single enlarged lymph node without other symptoms.

So my advice is not only to re-read our previous discussion, but if your anxieties continue despite all this reasoned, science-based reassurance, that you consider professional counseling to work your way through it. I suggest it from compassion, not criticism. Your fear really is beyond the normal range. I'll bet not one person in the entire US in the past year has turned out to have HIV after the events and symptoms you have described.

Feel free to report you test results as they come in -- but again, keep in mind that only two more follow-up comments are possible, and I don't want you spend still more good money to hear the same things one more time. So consider saving one comment for your negative HIV test result in a few weeks.

Best wishes--   HHH, MD
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Forgot to comment about penile tingling. No STD causes such a symptom. This also is probably anxiety, along with feeling "run down".---
41 months ago
i dont mind paying for such a great service, but in the interest of time I will try to limit my correspondence to these last two posts.  I will get the results in the next couple of days, I was treated with zithromax and rocephin. Of course I don't know if this is in my head but I have noticed a decrease in "symptoms." I described it incorrectly it is more of a penile pain (like a sometimes sharp and then dull refereed pain ). Would that be possible 15-16 hours after treatment? Or is my guilt still playing tricks on me....This sucks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
I remain confident your test results will be negative and really do believe your own last explanation ("guilt still playing tricks") is the best. No antibiotics work that fast. It would take at least 24 hours to see any change for gonorrhea symptoms and 2-3 days for chlamydia.---
41 months ago
Hey Doc,

Well you were correct, I did test negative for Chlamydia/Gonorrhea.  I am still waiting on the Trich test which apparently I was given ( I didn't even know that could be tested...can it?).  I know from reading your past responses that you don't recommend RNA PCR Test for hiv  based on how expensive it is, but for the sake of putting this behind me as quickly as possible I am thinking about taking one ( I dont really care so much about the money). I will be 14 days out when I take it, Would that be conclusive? 

Two other things, one related to me the other is just a general question out of interest.  Last week I had terrible night sweats, Im assuming that it is a side effect of percocet that I was prescribed for an elbow condition....I really only take it at night in combination with sentraline 100mg which I take daily. I dont remember having a fever.  Can both of those drugs cause bad night sweats? This question is just to help me quell my fears about ARS.

In reading the old medhelp archives I saw you say a number of times that no one has ever reported testing positive after writing to you with a concern.  But then I read this post: 

http://www.medhelp.org/posts/HIV---Prevention/Worried-about-symptoms/show/719990

Do you know if this was a fake, or what the deal was? I know it doesnt relates to me or my risk but I did find it odd and thought I would ask about it.  

Thank You so much for helping get through this hard time
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
You're searching very hard to find evidence that you have HIV and that all my reassurance is for naught. It's as if you hope to have it to prove your fears are avlid. (In terms of psycholgoical motivation, not consious thought -- but I do believe this might be what's going on.)

That past case MedHelp is irrelvant. Anal sex among men is a whole different world in regard to HIV risk, with inherently 100 to 100 times higher risk than yours. Second, what if had been a heterosexual exposure like yours? What difference would it make whether I have ever had such a patient or if MedHelp has a question about an extremely rare event? If I once took care of a patient struck by lightning, or if you read a forum question about it, would that elevate your risk of being struck? Or would you say "I'd better stay out of thunderstorms and not point a gold club at a stormy sky" (i.e. use a condom for non-monogamous sex)?

I'm glad your tests so far are negative, and you can count on a negative for trich as well. You are right that I definitely would not recommend a PCR test, but if you go ahead with it, a negative result at 14 days will be nearly but not quite conclusive (probably 95-98%). You will still need an antibody test (or combo test) at 4 weeks to make it 100%. So why not just wait? But entirely up to you -- it's your money.

Please don't spend still more on another question here. Of course you are welcome to do so, but you can be sure you'll not hear any opinion or advice different than you've already had and I hate to see money wasted! In any case, best wishes and continue to stay sexuallly safe.
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
That's 100 to 1,000 times higher risk.---