[Question #1734] HIV/STD concern

43 months ago
On Dec 6 i visited massage parlor she fingered me with some sort of condom on both of her fingers, 2 weeks later i visited a different place and the woman performed oral sex (bj) with a condom i also noticed that she had braces which could cause some bleeding in her mouth. few days after the first visit i found a pimple on my penis and it popped when i pressed it with some pus coming out. i'm almost positive it was completely healed by the time i visited the other woman on the second time but im still afraid  the condom didn't cover the area where i had the pimple since it was towards the bottom of my penis.  its now been a bit over 2 month since the first time and 7 weeks since the second time. i got really scared and started browsing the internet after the second visit. i had few days with real fatigue nausea, blurred vision,general weakness and sore throat that  going on and off ever since for 3-4 days each time (i normally suffer from my throat often in winter time) i also had one swollen  lymph node behind my left ear for 5 days.  i had myself tested multiple times. first time 13 days after second exposure with RNA test which came negative. i then had myself tested at 3, 4 and 6 weeks after the second exposure with 4th generation HIV-1/HIV-2 Ag/Ab assay all came negative.At the 4 weeks (6 weeks after 1st visit) test i also tested for all other common STD which all came negative besides herpes 1. i also had myself tested with oral quick few times with last test 2 days ago at 7 weeks which came negative. i noticed some pimple in my groin last night it little hurt when i pressed it with my finger and i also noticed some pus coming out when i squeezed it. this morning it looked a little better and barely hurt when i press it.i know that i most likely clear but i need reassurance from one of your experts since i'm still going crazy thinking what if. do i have anything to concern about? can i have sex with my wife? shes pregnant and it concerns me a lot.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome to the forum. Thanks for your question.

The modern HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. The results are 100% reliable if done sufficiently long after the last possible exposure, which varies from 4 weeks to 3 months, depending on the particular test or combination of tests. For the standard antigen-antibody (4th generation) tests, that time is 4 weeks. Results after those times are always conclusive and outweigh all other factors, such as exposure history and symptoms. Your result at 3 weeks made it almost 99% you didn't catch HIV, and the 4 week and 6 week results were conclusive.

The exposure you describe was low risk (oral sex almost never transmits HIV, even without a condom) (congratulations for having very safe sex!). And your symptoms are not suggestive of a new HIV infection. But even if those were highly risky or highly typical for acute HIV, the test results rule. You are home free, do not need any further HIV testing, and can safely continue (or resume) unprotected sex with your wife.

I hope these comments are helpful. Let me know if anything isn't clear.

Best wishes--  HHH, MD
---
43 months ago
Than you so much Dr. as I was reading your posts at the other website medhelp and I was wondering how can I reach you since you're aren't posting there, I'm so glad I found you here.
My only other question is if I should be concern for any other type of STD. Since my wife is pregnant I really don't want to expose her to anything harmful. As I mentioned on my first question I did perform a 10 test panel for the most STD at 4 weeks after the second exposure I had. They all came negative except herpes 1 which is obviously Very common. I also had general blood work taken last week at the 6 week and all came back good thank god.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Sorry, I forgot to respond about other STDs. My apologies.

Given the entirely safe nature of both massage parlor events, I would have advised against a panel of 10 tests. It must have cost a pretty penny, and most tests included prrobaly were unnecessary (and probably accounted for most of the expense). I'm not sure I would have recommended any testing at all, at most a urine test for gonorrhea and chlamydia and a blood test for syphilis is all that might have been worthy of consideration, in addition to the HIV blood test. Also, 4 weeks is too soon for reliable results for most if not all blood tests:  reliable syphilis testing needs to be at 6 weeks or later, and HSV 3 months. That said, the risks for any of these -- and undoubtedly for other things inclinded in the panel -- were zero for all practical purposes. Even with a pregnant wife, if somehow I were in your situation, I would not have any further testing.

---
43 months ago
Hi Dr.
So because my throat has been bother me pretty often in the past 2 month or so. (A little sore swollen on and of every time it last for 3-4 days) I went to ENT Dr. he informed me that my throat looks a little red and he took a culture to send out to a lab. He also said that my lymph nodes are swollen in a few spots on my face and neck. (Not something that makes him concern but it's definelty swollen)
He said that it seems to be an infection in my throat. he did a rapid strep test that came out negative.
He made me really concern and I'm actually going crazy thinking that the 4th generation test I had on 3-4-6 weeks weren't conclusive. I took another test yesterday at quest diagnostics (the other tests I had I took at Enzo Lab)It's now 8 weeks and I'm waiting for the results to come. 
Is there any different at all between the tests those 2 labs performing if they both considered 4th generation Hiv-1 hiv-2 Ag/ab assay? Is there anything I should be concern about as far as HIV? I'm freaking out. Please calm me down. Thank you!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
No STD is a likely cause of sore throat or mild lymph node inflammation as you describe. As I said above, the HIV tests prove for sure HIV is not the cause:  it is impossible you have HIV, and the new HIV test also will be negative. There are no differences in HIV test performance between different laboratories. I am also confident that whatever the cause of these problems, they are not due to any infection of any kind from the events of last December.

---
43 months ago
Hi Doctor,

So my Culture results came back with Citorbacter Koseri, My Dr said that it could be the reason im having swollen lymph nodes and some sore throat.
he prescribed me with antibiotics for 10 days.
is this could be the reason for my swollen nodes in my neck and sore throat that comes and goes? 
i was searching online and found that this kind of infection has to do with urine and mostly happens to women's.

Can you please explain to me im really concern.

Thank you!!   
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Culture of what? Urine? Throat swab? Somewhere else? Citrobacter in the urine could mean a urinary tract infection or bacterial prostatitis. These are not STDs and would have nothing to do with your massage experience. In the throat, Citrobacter probably is harmless and I doubt it has anything to do with your lymph nodes and sore throat. You should not expect those symptoms to get better with the antibiotic:  probably they will not.

For those reasons, this information does not change my professional opinion and advice above.

Normally threads are closed after two follow-up comments and replies, but I'll leave this open for one more cycle so you can tell me what kind of culture found the Citrobacter. Also tell me what antibiotics, if any, you have taken since all this began.

---
43 months ago
Sorry for not being clear it was a throat swab, and the Dr prescribed me with ciprofloxacin 500mg for 10 days. One more thing I forgot to mention is the Dr also said the culture results showed some thrush. He said when he checked my mouth and throat he didn't see any thrush so it's very minimal. I have these symptoms of swollen lymph nodes (mild as the Dr said) and some sore in my throats that comes and goes for over 3 weeks now. I'm reallly worried is there anything you would suggest me to do like a test or any type of diagnostics?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Please also answer my question about what antibiotics, if any, you have taken (for any reason) in the 2+ months since your massage adventure.---
43 months ago
I didn't take antibiotic at all since that massage, Yesterday  I started taking the antibiotic the dr prescribed me . The only pill I  took in the past 2 months  is zantac for hurtburn I have from time to time. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
OK, thanks. I asked because Citrobacter is somewhat unusual in the throat, but more commonly present after antibiotic treatment. Thrush also is more common after antibiotics.

However, "ususual" doesn't mean serious or dangerous. Citrobacter is an entirely normal bacteria in everyone's intestines and harmless in the throat. It's a fairly common cause of urinary tract infection, and it rarely can wound infections after surgery, serious bloodstream infections (sepsis) in people on cancer chemotherapy, and so on. It probably is not the cause of your sore throat or lymph node enlargements. I hope the new antibiotic helps, but I don't expect that it will make any difference.

As for thrush, even though online information tends to emphasize HIV and other immune deficiencies, it occurs commonly in entirely healthy persons. 

So you haven't described a single symptom or lab test that suggests you have anything serious. For sure you do not have HIV, and whatever medical condition you have, it is definitely not an infection of any kind that you caught from the massage incident. Continue to work with your doctors if you remain concerned. But I have to suspect that the major problem here is anxiety about a sexual experience you regret and that has been GREATLY magnified in your mind beyond its real importance. It really was a trivial event without health consequences. Do your best to separate your guilt, shame, etc over a sexual decision you regret from medical consequences of the event. They aren't the same.

So now we're well beyond the two follow-up comments and replies normally included with each question, and so ends this thread. I hope the discussion has been helpful. Keep working with your doctors if your symptoms continue or you otherwise remain concerned. I'll emphasize once again that you definitely do not have HIV.

Best wishes and stay safe.

---