[Question #3226] Follow up to 3071

91 months ago

Since my earlier post, I'm still having the same symptoms of swollen groin lymph nodes and oral thrush. I haven't had any further hiv tests so the most recent was still at 14 weeks post risk. I wanted to ask for your advice on whether there are any other stis that I should test for that could cause similar symptoms? I tested for gonorrhea and chlamydia at 3 weeks and syphilis at 14 weeks as well and they've all come back negative. Thanks

H. Hunter Handsfield, MD

91 months ago

Welcome back to the forum -- but sorry you found it necessary! I reviewed your discussion last month with Dr. Hook and agree with all he said.

For sure you do not have HIV. Your multiple negative antigen-antibody ("4th generation") HIV blood tests, including one or more at least 6 weeks after exposure, are conclusive and overrule any and all symptoms and exposure histories. And your symptoms are not as typical as you might think. The enlarged nodes that occur with HIV are body wide, never limited to 1 or 2 body sites, such as the groin. And it sounds like your dentist was not convinced your oral symptoms are due to a yeast infection (thrush). (White coated tongue, for example, rarely is a thrush symptom, but is an exceedingly common minor symptom.)

As for other STDs, it sounds like you have been adequately evaluated -- especially if, in addition to the tests mentioned, you have been clinically evaluated both at an NHS GUM clinic and a private sexual health clinic (Freedom Health, perhaps?). How significant is the lymph node problem in the groin? Most adults have lymph nodes that can be felt in that area. If there are definite large swellings (e.g. olive or walnut size), quite tender, or with overlying redness etc, then further medical evaluation may be necessary. But even with these findings, and lasting 3+ months, only two STDs are potential causes, syphilis and lymphgranuloma venereum (LGV, a type of chlamydia). Presumably syphilis has been excluded, assuming a negative blood test; and heterosexually transmitted LGV is exceedingly rare, even though there has been a resurgence of it in men who have sex with men.

The large majority of conditions that cause inguinal lymphadenopathy are not STDs of any kind. Any number of other, non-STD infections can do it. Do you have any infection or skin inflammation of any kind on your legs or feet? Do you own or otherwise have contact with cats? An infetion called cat scratch fever is fairly common and one of the most frequenst causes of this sort of problem.

The bottom line is that I am convinced, as Dr. Hook was, that your symptoms are unrelated to the sexual exposure you described in your other thread and are not caused by HIV or any other STD. If the problem continues and/or you remain concerned, work with your doctors or clinics. Either the GUM clinic or Freedom Health (or other private sexual health clinic) are fully capable of undertaking any further expert diagnostic tests or other clinical assessments that may give answers.

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

HHH, MD

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91 months ago

Thank you, it's very helpful to know that I've likely excluded an STI. The private clinic was nuffield health.

I'd say the lymph nodes in the groin are about pea sized, with one out two a bit larger. Not olive sized though, and they're painless and aren't noticeable without feeling for them. I had an ultrasound a few weeks ago and they described them as slightly reactive and I don't think they've changed since.

I've got a dog but no cat.

Thanks very much again for your advice.

H. Hunter Handsfield, MD

91 months ago

Thanks for the additional information. I'm not familar with Nuffield Health.

Most "pea sized" inguinal nodes are meaningless, detectable in many adults, probably a majority. I'm a bit surprised someone thought they were significant enough to warrant evaluation such as ultrasound, but in any case "slightly reactive" sounds normal. If you were my patient (or in personal terms, if it were me or a family member) I would ignore it.

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91 months ago

Thanks again. I think they may have sent me for the ultrasound because I was so anxious about it!

About the oral thrush, my dentist seems pretty sure that's what it is, but my gp is less sure, in particular because it hasn't responded to anti-fungal treatment. Would it change your assessment at all if it were oral thrush for sure?

I just wanted to add my appreciation for the service you offer here as well. It really is incredibly helpful.

H. Hunter Handsfield, MD

91 months ago

I almost included a comment in my last reply, speculating that the ultrasound was done largely as a result of your concerns.

Non-response to antifungal treatment is strong evidence against yeast (thrush). And anyway, oral yeast infection can occur in entirely healthy persons (I had it myself once); and contrary to common beliefs, yeast infections rarely accompany ARS. It's primarily a manifestation of advanced immune deficiency in overt AIDS, i.e. many years after acquiring HIV.

Thanks for your appreciative comments. That's why we're here!

That completes the two follow-up comments and replies included with each question and so concludes this thread. Please don't be tempted to ask again about this exposure and your HIV/STD concerns from it. There is no way our advice and opinions will change!

Best wishes and stay safe.

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