[Question #2928] Scared

42 months ago
Hi Dr,
Im male, very depressed with a exposition with female CSW (protected vaginal and anal sex, but unprotected oral – i received blowjob). I regret this encounter immensily. 2 days later I was so worried that asked a medical doctor to give ne antibiotics (took azithromycin and Ciprofloxacin and Benzathine benzylpenicillin). Also got tested for major stds, all negatives. I was told that I had no risk at, but 3 weeks later my girfriend developed a rash near the shoulder that was diagnosed as zoister (we had unprotected intercourse after 3 days of i took meds). I tested negative with cmia 4gen at 29 day.  But on day 36, i feel swollen lymp nodes in my body (arms, knees, arm pit). The ones in my arms (elbows front side) was really sore.it lasted 2 days.  No fever. Please, what is your medical adivise? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Welcome to the forum. Thanks for your question and your confidence in our services.

Based on your description, there is no basis for you being "depressed" over these events. First, oral sex is safe sex, even unprotected -- low risk for all STDs and zero risk for some. Second, the antibiotic treatments you received would have prevented all plausible bacterial infections. (The risk was low enough that I would have recommended against those treatments.) It's zero risk for HIV.

As for your partner's herpes zoster (shingles), I assume you are worried about HIV.  There's no need! Herpes zoster  is fairly common in entirely healthy people and its occurrence rarely indicates any underlying immune deficiency. In addition, this happened much too soon to have anything to do with HIV or anything else from your CSW encounter. Your symptoms are not suggestive of a new HIV infection, and self evaluation of lymph nodes by medically untrained persons is extremely unreliable; unless confirmed by a physician, I'm skeptical you actually have inflamed nodes. But if you remain concerned, or convinced about swollen nodes, see your doctor.

However, if you would like the additional reassurance of a negative HIV test, feel free to be tested. With the antigen-antibody ("duo", "4th generation") tests, the results are nearly conclusive at 4 weeks and 100% conclusive at 6 weeks. But please understand I don't recommend testing because I believe there is any realistic chance you have HIV; I definitely do not. However, I suspect a negative test result will be even more reassuring than my advice based on probability and statistics. But in the meantime, stay relaxed:  if you are tested, you can definitely count on a negative result. Your and your partner's symptoms are not due to HIV or any other infection from the CSW events.

I hope this information is reassuring for you. Let me know if anything isn't clear.

HHH, MD
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42 months ago
Thank you for the reassurance Dr Handsfield, it really made me feel less anxious.
I just wrote you the symptoms that scared me most, I had others during the last weeks (hope it doesnt change your assessment): itchness on pubic area, including penis and anus, disconfort on pelvic area, on day 23 started a flu, with sore throat, cough, mucus, low fever sensation (not measured). Still have cough with strange with mucus (tongue also became white from time to time), and also feel some pelvic disconfort. The nodes are sore enought to me know that they exists, with exception of the arms, that was really sore (they hurt just by shaking hands with other person). 
And yes, the symptom that bring my anxiety to the edge was singles, it is so hard to believe that this is just a coincidence. The fear and guilty took the best on me.
I will take the test by the end of this week and let you know. Thank you again.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
I'm glad to have helped so far, and happy to hear you recognize the contributions of fear and guilt. Entirely human and entirely normal reactions!

Acute HIV infection doesn't cause cough or mucus, and those symptoms started later than usual for ARS (typical onset 1-2 weeks after exposure). And since shingles almost never occurs as a result of anyone's newly acquired HIV or other STD, that problem in your wife definitely was a coincidence, nothing more.

Stay relaxed as HIV testing time approaches. You can count on a negative result.

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42 months ago
Hi Dr,

Those are my tests results:
29 days after exposure: Hiv 4th gen test, hep b, hep c, shyphilis - all negative
43 days after exposure: hiv 4th gen test, hiv 1 pcr rna, hep b, hep c, syphilis - all negative and indetectable

Based on that, the symptoms and your experience:

1) I do no acquired any STI from the CSW?

2) is there any chance that I could have infected my wife, even though my tests are negative? Eg I was cured by the meds, but since we had intercourse at 3 days after meds, it was not really cured. Or virus was not able to infect me, but I served as a bridge? 

3) should I be worried with Hep b, c, as those have a larger window period? How about hiv? Local drs say i must retest at 2 and 3 months after exposure.

4) Can i forget about it, learn from this mistake, and move in with my life without those worries?

Thank you very much for your services, it is really helping me to go over all od this.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Your test results prove you did not acquire any of the infections included in those tests.

1) No. The treatments you had are 100% effective against gonorrhea, chlamydia and syphilis, and they prevent the possibility of transmission within 24 hours of receiving treatment.
2,3) No:  you cannot transmit an infection you do not have. You were tested after the window periods and do not need any more tests to be 100% certain. 
4) Yes. Believe it and move on with your life.

Thanks for the thanks. I'm glad to have helped. We answer up to two follow-up questions and have done that, so that concludes this thread. Best wishes to you and your wife. 
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