[Question #2962] Need Help

41 months ago
Hi doctor. My favorite outlet for sex has always been CSW. I always used condoms and I've never had one rip. I've even slept with 4 transexuals,  and its always been condom protected. My last sexual encounter was in January with a friend of mine who was pregnant at the time. Sex lasted 5 minutes and I came inside her.  Around May I got shingles. I panicked and bought an Ora Sure Hiv test and it was negative. I'm only 35 and all I read online is that Shingles occurs with people with HIV. My doctor told me it wasn't so. This year has been tough on me. I had a sore throat for almost 3 months. I never had a fever, but the doctor said I had tender nodes. I had phlegm stuck in my throat the whole 3 months. My phlegm was clear. I went to ENT doctor and he said it was acid reflux and allergies and gave me medicine but it didn't go away. One day it was gone. So for two months I was okay and then I developed a cough. Not a constant cough, but I do have coughing episodes. And the phlegm in my throat is back. My asthma has been worst and I been wheezing.  Doctor listened to my lungs and said they sound fine. At times I feel pain where I had my shingles. My question is what's the probability that the orasure test was wrong. I use condoms, and like you mentioned before that most CSW don't have HIV. That would mean my condom failed and I got HIV through one exposure which I know is highly unlikely. That means they would have to be HIV positive and have a high viral load. I've only had unprotected sex with 4 women. My ex wife, ex fiancee, long term girlfriend and my friend who was in jail for 10 years.  She was pregnant and I asked her status and she said she was negative. She got tested cause of the pregnancy. It was a one time encounter that lasted 5 minutes. I just find it odd that after that encounter I got shingles, throat problems and now my breathing problems. I never had a fever through this whole ordeal. Just a constant red throat with clear phlegm. I took the orasure 4 mon
41 months ago
I took the orasure 4 months after last encounter
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Welcome to the forum. Thanks for your question.

Congratulations on your diligence in consistent condom use, given your chosen sexual lifestyle. It doesn't reduce your HIV risk to zero (unrecognized condom failures do occur), and your risk is higher than for the averge monogamous person in a committed relationship. But it's very low and you are very unlikely to ever have HIV.

You have misread or misunderstood what you read about HIV and herpes zoster (shingles). You are correct that it is more common in people with HIV or other serious immune deficiencies (e.g. cancer chemotherapy). However, it's a frequent condition in people without HIV as well. I've had it myself, and so did my son (at age 13), and the vast majority of people with herpes zoster have no immune deficiency. (Similarly, pimples, headache, and sore throat are more common in people with HIV, but probably you don't worry you might have HIV every time you have a few zits or get a tension headache.) Cough is similar -- probably more common with HIV, but the vast majority of people with unexplained cough also don't ahve HIV. And by the way, shingles is NOT more common in people with new HIV infections, i.e. it is rarely or ever the first evidence of HIV. It's a problem primarily in people with longstanding HIV infections.

The oral fluids HIV test (OraSure) isn't the best HIV test. It's good, just not as good as others. People in your situation --- i.e. and ongoing but low risk of HIV --- should have a lab-based blood test once a year. (You also should be tested at roughly yearly intervals for other common STDs, especially gonorrhea, chlamydia and syphilis.) But the oral fluids test is much more reliable than a history of shingles, cough, or any other unexplained symptoms.

In other words, you can be very confident you do not have HIV. Your recent herpes zoster is just a coincidence, having nothing to do with any particular sexual experience. But as noted above, you might want to have a lab based antigen-antibody ("4th generation") HIV test, both now and once a year until and unless you develop a committed, monogamous relationship. You can continue to expect negative results, but better safe than sorry. And anyway, why not use the best test available?

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD
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41 months ago
Thank you for your prompt response. The reason I took the oraquick test was because I have a phobia of needles. When I got shingles it was very mild but I did panick. As far as CSW go I only do this 3 to 4 times a year. I examine the condom 80% of the time. At times I even wake up with a sweaty neck which i know its also is a HIV symptom. It seems like every symptom is due to HIV. I was jogging and I tripped foward and landed on my hands. I had a sore hand for 3 weeks and someone told me that when your body takes that long to heal it could be cause HIV. I've read your post in the past and I feel like I've gain some knowledge. I know my risk was never 0, but it's low enough to put my mind on ease. I know phlegm in your throat is not an HIV symptom. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
I'm glad you (mostly?) understand. Not one symptom you have mentioned, now including  your new non-symptom (time to wound healing), suggest new HIV infecitons. See my comments above about pimples, cough, headache, etc. The ONLY symptoms that would suggest a new HIV infection, and only if they all occur together, are sore throat with fever, swollen lymph nodes in several areas of the body, and non-itchy skin rash all over the body. Without these, never worry about HIV because of any symptom you may have. Rely instead on periodic testing, preferably with lab-based tests.

I'm glad to have helped put your mind at ease. Best wishes and stay safe.
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