[Question #2971] New Exposure at Hospital

40 months ago
Hello, I apologize for returning again but I was recently newly exposed and need some advice.  I am currently a pre-med student (I know, seems ridiculous given how anxious my questions are and I'll probably never make it with this hypochondria) and I was shadowing a physician at the hospital.  One of the patients he saw (doc is a pulmonologist) was confirmed HIV positive and was visiting the clinic (a scheduled appointment type of visit, not an ER visit) for some chronic cough type issues.  Anyway, the exam room was relatively small and about 15 minutes prior to entering the room, one of my cuticle broke and was very lightly bleeding.  I am pretty sure that it stopped visibly bleeding within a few minutes (and by the time I was in the room with the patient), but my fear is that since the patient coughed one of his cough particles maybe contained blood which could've made its away onto my wound if it was still open and infected me.  This happened last week Tuesday.  It is Monday night now (6 and a half days later) and I am coming down with a flu like illness.  Oral temp of about 100F and I feel achiness throughout my body (flu type achiness) and my throat, while not very sore, is very muscusy and I have to constantly clear it.  Aside from my hospital exposure, I was also at a football game this Saturday with an attendance of around 65,000, so I maybe just caught a garden variety illness there.  So far, no body rash and my lymph nodes don't SEEM swollen (not a doc so not sure but nothing visible).  The HIV+ patient was on HAART according to the doc, but I do not know his viral load (but CD4 was in the mid 500s) and the visit was not related to HIV as far as I know.  Please let me know if I should get tested and whether my symptoms 6.5 days past exposure are worrisome.  Also, Friday morning (3 days after exposure), I threw up several times but felt much better after a nap and this was likely because I was hungover as I went out drinking Thursday night.  Thnx
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Welcome back. But yet again I am disappointed you found it necessary.

It is clear you are obsesessed and/or otherwise overly frightented about zero to minimal HIV exposure risks in your chosen profession. You're going to have to overcome it in order to complete your training and practice successfully. I strong urge professional counseling:  hearing the standard scientific evidence that refutes your fears is not going to solve the problem. It's not an issue or knowing (intellectually) what the risks are; it's a mental health/perception issue.

No health care provider ever caught HIV from the sorts of events you describe. The only professional exposures that result in HIV transmission are traumatic injuries with sharp instruments contaminated with fresh blood, usually in the context of an injury while provding care. The patient's viral load in this situation is irrelevant. Your various symptoms are not due to HIV from these events. You have accurately discerned the much more likely causes. I do not recommend testing for HIV.

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

HHH, MD
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40 months ago
Hello and thank you for the prompt reply.  I really do appreciate your willingness to answer such questions despite the fact that they may very well be irrational.  I am accepting that this is just a run in the mill infection due to my nasal congestion and other typical cold/flu symptoms (also, many fellow classmates are sick as well but I guess this is the nature of living in college dorms).   I do have some additional questions.  As you remember, my prior questions on this site concerned the reliability of HIV tests in detecting strains/subtypes picked up in foreign regions such as SE Asia and South America, and also the reliability of online std testing sites such as stdcheck.com.  Nonetheless, your answers reassured me that these results can be trusted.  However, for the past year or so (beginning in a trip to Peru that involved a single protected insertive vaginal encounter, but tests were done 3+ months after this), I have experienced some chronic symptoms. 
1. I get on and off muscle aches that are not really the aches you get when coming down with a cold or flu (this is how I first become aware I was getting sick yesterday, as the pain is different).  They are alleviated by stretching and don't seem to concentrate in a particular region, but seem to affect arms and legs, fingers and toes, neck, shoudler, etc.  and feel "tensiony". The pain migrates and is not always there and is not accompanied by fever (oral temps range from 98.0-99.4 ish).   Is this typical for HIV?
2.  I am a contact lens wearer and despite not sleeping with them, I suffered a corneal ulcer a few months ago which was successfully treated.  I read that people with HIV are at higher risk for this but I imagine this is insignificant since I tested neg and since HIV is a risk factor for probably just about anything?
3. I also did get a canker sore recently.  I do not sleep much with school work and all (maybe 4-5 hours a night during the week) and am stressed, so are canker sores normal?
4.  My physical in Jan. included a cbc w/plat w/diff and comp. metabolic panel.  Everything was normal except low vitamin D and high triglycerides.  I realize that diagnosing my symptoms is beyond the scope of this forum, but given my normal bloodwork and negative std tests, is it possible that constant stress and worry can cause some of these very nonspecific symptoms I suffer?  My own doc and others I have personally seen don't have an explanation for my symptoms other than I should stop worrying and that, based on my bloodwork, there's nothing really wrong with me.
5.  If I do choose to seek counseling (I realize that this may not be your specialty), do you think on campus therapy/counseling could point me in the right direction for help?  I have never sought counseling before so don't know where to start. My chronic physical symptoms are really just annoying more than anything, but it's the mental stress that's the worst.  Thanks so much and I really do hope that this thread is the last you'll need to hear from me (and I know forum rules prohibit more activity)
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
1-3) Almost any symptom associated with a couple of hundred health problems can also be caused by acute retroviral syndrome (acute HIV), including some of the ones you mention. However, ndividual symtoms are meaningless in judging the possibility of a new HIV infection. It's the pattern and combination of symptoms that matters. Your pattern doesn't fit at all, and some symptoms are wrong anyway. For example, ARS doesn't cause nasal congetion.

4,5) Most people with ARS have entirely normal CBC and blood chemistries. Your symptoms are entirely typical for the physical manifestations of anxiety, stress, etc. I find it hard to believe your doctor[s] didn't consider this possibility, whether or not they said it directly. This would fit with their advice that you should stop worrying and that nothing physical is wrong. As for counseling, I imagine on-campus services available to students would be a good way to start; complaints and problems like yours are very common among university students. Or ask your personal physician for her advice about it.
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40 months ago
Thanks again.  For my last follow up: Just to clarify, my chronic muscle pains that I described have been going on for over a year now.  I just wanted to clarify this since you mentioned ARS and this symptom for me has been chronic rather than acute and unrelated to my current cold/flu that I came down with. 
1. Is it still possible that  psychological distress can cause or at least amplify this sort of myalgia for that long (seems to afflict thighs, fingers, arms, etc. non specific, on and off, seems more intense when more stressed, no fever and stretching helps)?
2. I also have had for quite some time now a rash that comes and goes on the top of both of my wrists.  It looks like tiny red, every so slightly raised dots.  It does not itch and at the most may feel a bit dry at times, but that's it.  A dermatolgist PA I saw thought it was so mild that she dismissed it as possible atopic dermatitis.  Is there any STD that causes this sort of on and off, non painful rash on the top of wrists?
3.  In the context of this thread and my prior threads (since which I had no sexual encounters meaning that my negative std results for HIV, HEP A/B/C, HSV1/2, syph, chlamydia, and gonorrhea through stdcheck.com done at Quest labs are all done after my last sexual encounter), would it be safe to begin a sexual relationship with a new partner in regard to her sexual health (as in can I rest assured I won't spread anything to her)?

Thank you and this concludes my questions.  I really do appreciate the service and I realize that it is not appropriate to come whenever I have anxiety driven questions.  I really will do my best to seek help and refrain from such behavior.  Happy Thanksgiving!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
1. Yes, not only possible but very likely. Also, be clear that the pain is real; this is not something "in your head". As you will learn in your medical training, psychological stresses may not often directly cause physical symptoms, but they can dramatically amplify minor symptoms or normal body sensations that otherwise would not be bothersome or might not even be noticed.

2. No STD, including HIV, causes a rash like this.

3. You cannot transmit an infection you don't have! And so yes, it would be neitrely safe to start a new sexual relationship.

Thanks for your closing comment. You have anticipated the standard policy statement I was about to add:

The forum does not permit repeated questions on the same topic or exposure, especially when the questions are obviously driven by anxiety or when there is apparently difficulty in believing or accepting advice already given. Having posted two questions, this will have to be your last one; future questions on this topic will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce the temptation to keep paying for questions with obvious answers; because experience shows that continued answers tend to prolong users’ anxieties, when professional counseling often would be a better approach; and because repeat or anxiety driven questions have little educational value for other users, one of the forum’s main purposes. Thank you for your understanding.



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