[Question #12551] Generalized Lymphadenopathy / PEP
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7 months ago
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Greetings Doctors
I was able to read through many similar encounters, so I think I have a good idea of what your advice will be. I found your answers to be extremely thoughtful and helpful.
- I engaged in unprotected oral sex with a promiscuous woman, it was unprotected oral and anilingus (I received); both very brief
- I engaged in unprotected oral sex with a promiscuous woman, it was unprotected oral and anilingus (I received); both very brief
- I was a bit worried after the encounter as I did not plan to do anything unprotected and only wanted a handjob
- I began taking PEP at around 24 hours (only Truvada, as it was all I had at the time), and I was able to add in Tivicay on Day 5
- I began feeling lymph node irritation on Day 2, with no other symptoms - it is in my pelvic area, arms and neck - the right side of my neck to be exact. The ache in the right side of my neck fluctuates, coming and going. I have no swelling and no fever.
1) Would my symptoms be ARS? I have read that this could be considered generalized lymphadenopathy.
2) Would my just starting with Truvada as PEP provide protection, even though I did not have the Tivicay?
1) Would my symptoms be ARS? I have read that this could be considered generalized lymphadenopathy.
2) Would my just starting with Truvada as PEP provide protection, even though I did not have the Tivicay?
3) Is it possible to experience ARS symptoms while on PEP?
4) Is testing while on PEP and experiencing symptoms accurate?
5) Since my lymph nodes are my only "symptom" could the PEP be keeping everything else "at bay" but my body is still fighting the infection?
4) Is testing while on PEP and experiencing symptoms accurate?
5) Since my lymph nodes are my only "symptom" could the PEP be keeping everything else "at bay" but my body is still fighting the infection?
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Edward W. Hook M.D.
7 months ago
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Welcome to our Forum. Thanks for your questions. I appreciate your looking at prior interactions on the Forum for information. It appears that you have either misinterpreted them or chosen to ignore the information that would be found through reviewing them. Almost everything you describe is contrary to the advice we would provide. The encounter you describe was virtually no risk- there are no proven cases is which HIV has been acquired from either receipt of oral sex or analingus, we would not have recommended PEP in this situation and we would counsel you against diagnosing possible lymphadenopathy your self. In response to your specific questions:
4) Is testing while on PEP and experiencing symptoms accurate?
5) Since my lymph nodes are my only "symptom" could the PEP be keeping everything else "at bay" but my body is still fighting the infection?
1) Would my symptoms be ARS? I have read that this could be considered generalized lymphadenopathy.
Absolutely not. The ARS is the combination of high fever, severe sore throat and widespread muscle or joint aches and would not have begun within 2 days of an exposure. Generalized lymphadenopathy is a non-specific finding with many, many possible causes and swollen lymph nodes in the regions you describe can even be normal. Abnormal lymph node swelling is best diagnosed by an experienced clinician.
2) Would my just starting with Truvada as PEP provide protection, even though I did not have the Tivicay?
It would probably be beneficial if you had needed it and starting Tivicay as you did was a waste of time. Would it work as well as recommended PEP- unknown.
3) Is it possible to experience ARS symptoms while on PEP?
Sure, if the PEP was failing.
4) Is testing while on PEP and experiencing symptoms accurate?
It can accurately detect if the PEP has failed'
5) Since my lymph nodes are my only "symptom" could the PEP be keeping everything else "at bay" but my body is still fighting the infection?
No
EWH
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7 months ago
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Thank you for you reply, Doctor. Good to hear that you do not see this encounter as high risk.
1) is it possible that the discomfort that I am feeling is due to the Truvada?
2) I have also had loose stools - based on some of your previous posts, if these symptoms were ARS and tested, then the result would be positive, even if I am on PEP, correct? So, would a negative RNA or Antigen test prove that at least the current feelings that I am having are not related to ARS?
3) Is there something else that i could've caught from her during this encounter? I do have some minor itching in the anus area, discomfort that comes and goes.
1) is it possible that the discomfort that I am feeling is due to the Truvada?
2) I have also had loose stools - based on some of your previous posts, if these symptoms were ARS and tested, then the result would be positive, even if I am on PEP, correct? So, would a negative RNA or Antigen test prove that at least the current feelings that I am having are not related to ARS?
3) Is there something else that i could've caught from her during this encounter? I do have some minor itching in the anus area, discomfort that comes and goes.
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Edward W. Hook M.D.
7 months ago
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Straight to your follow up questions
1. It would be unlikely for the symptoms you described to be due to Truvada
2. Loose stools can be part of the ARS and if you were experiencing the ARS test positive. However, isolated loose stools with her without swollen lymph nodes. Do not suggest the ARS, particularly following a virtually no risk exposure.
3. Your perceived “ symptoms” occurred to be due to any STI acquired 2 days before.
You have 1 follow up remaining, then the thread will be closed. EWH
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7 months ago
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Thanks Doctor - I am having a difficult time understanding your response to questions 2 and 3. I think that a few words were mistyped. Would you mind clarifying?
For example, for question 2) you wrote "However, isolated loose stools with her without swollen lymph nodes. Do not suggest the ARS, particularly following a virtually no risk exposure." - what do you mean isolated loose stools with her without swollen lymph nodes?
For my next follow-up question:
For example, for question 2) you wrote "However, isolated loose stools with her without swollen lymph nodes. Do not suggest the ARS, particularly following a virtually no risk exposure." - what do you mean isolated loose stools with her without swollen lymph nodes?
For my next follow-up question:
1) How long does ARS last? I have been feeling this discomfort for about a week now.
2) Right now the symptoms I am feeling are loose stools + discomfort in the areas I mentioned. You mentioned ARS is typically has multiple symptoms together - would these be enough to be considered? Other than these symptoms, I generally feel well - no fever, no rash, etc.
3) Should I discontinue taking the PEP?
4) What STI could I have received that could be causing my symptoms? or does this sound like a common virus?
2) Right now the symptoms I am feeling are loose stools + discomfort in the areas I mentioned. You mentioned ARS is typically has multiple symptoms together - would these be enough to be considered? Other than these symptoms, I generally feel well - no fever, no rash, etc.
3) Should I discontinue taking the PEP?
4) What STI could I have received that could be causing my symptoms? or does this sound like a common virus?
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Edward W. Hook M.D.
7 months ago
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Sorry for the typos although I would have though it would be easy to sort out that they were typos and what was meant. Corrected responses followed by responses to your most recent, rather repetitive questions after which the thread will be closed:
2) Right now the symptoms I am feeling are loose stools + discomfort in the areas I mentioned. You mentioned ARS is typically has multiple symptoms together - would these be enough to be considered? Other than these symptoms, I generally feel well - no fever, no rash, etc.
4) What STI could I have received that could be causing my symptoms? or does this sound like a common virus?
Typos corrected:
2. Loose stools can be part of the ARS and if you were experiencing the ARS an HIV test would be positive. However, isolated loose stools with her without swollen lymph nodes do not suggest the ARS, particularly following a virtually no risk exposure.
3. Your perceived “ symptoms” occurred to soon to be due to any STI acquired 2 days before.
Responses to your final follow-up questions:
1) How long does ARS last? I have been feeling this discomfort for about a week now.
The ARS typically lasts about a week to 10 days.
2) Right now the symptoms I am feeling are loose stools + discomfort in the areas I mentioned. You mentioned ARS is typically has multiple symptoms together - would these be enough to be considered? Other than these symptoms, I generally feel well - no fever, no rash, etc.
No, as mentioned above " The ARS is the combination of high fever, severe sore throat and widespread muscle or joint aches and would not have begun within 2 days of an exposure." "Discomfort" in the areas you mention does not suggest the ARS and diarrhea is only occasionally part of the ARS.
3) Should I discontinue taking the PEP?
You did not need PEP to start with so there is no reason to continue. Taking PEP however is always a personal decision. I would not have started it.
4) What STI could I have received that could be causing my symptoms? or does this sound like a common virus?
No STI would start within 2 days of an exposure. This could be an "every day" viral illness of the sort people get every day.
End of thread. EWH
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