[Question #3717] Razor Cut follow up

87 months ago

Hi Dr's,

Dr. Hook helped me last time but I'm obviously fine with either of you answering here. My exposure was mutual mastur bation with exchange of fluids as lubrication and I cut myself a decent amount shaving privates the morning of (10 hours prior). Have some follow ups.

1. About my son. My event occurred early December. In January, he had a pretty bad fever for a few days. Once the fever broke, he broke out in a rash for another 24-36 hours. Pediatrician said that was normal and going around. Whole order was less than 5 days. Now, his rash was diagnosed as eczema on Saturday and I read that eczema is a symptom of childhood HIV. I know it can be common in all kids, but usually that presents earlier than 2 years old. Any reason I should look into this more in terms of his risk?

2. Lymph nodes. I know HIV lymph nodes are non-specific. My question is - Would HIV related lymph nodes be easily viewed as 'abnormal'. Meaning, even if you can't feel them and say it's HIV or not, would a trained pro be able to view them and think they need more examination? Like, they could be some type of infection vs nothing? Sorry if that doesn't make sense. I just want confidence that if there was SOMETHING wrong with them they'd be determined while a physician palpates them. My biggest one kind of feels like a worm. The others are pea shaped or smaller. All in the 'posterior region'...4 in the right and 2 or so left

3. I choose to rely on this rather than forums where non-professionals or people who have the virus are the 'experts' for obvious reason. I realize their views can be slanted or based on anectdotal truth. However, I have read on those that the virus dies instantaneously when it hits the oxygen. So fluids or blood is not infectious after it leaves the body, down to the moment. THe hotlines I've called have said the same thing. Would you Doctor's agree with that? Or is it too broad of a statement to be that definitive?

Thank you very much. I'll make this thread my last.

H. Hunter Handsfield, MD

87 months ago

Welcome back, but I'm sorry you found it necessary despite the reasoned, science based reassurance from Dr. Hook. I'll be answering this time, but I have reviewed your previous thread. I agree with everything said by Dr. Hook.

The fact is you were not at risk for HIV from the exposure described. You have that professional opinion from two physicians you saw plus Dr. Hook. That also is my view. Since you could not have acquired HIV, your questions about symptoms, risk to your kids, or anything else are irrelevant. You are reaching far too hard online or elsewhere and, like most anxious persons, are being drawn to bits of information (often out of context) that inflames your fears and missing or even avoiding all the highly reassuring information that also is present. The main facts of importance are 1) your partner probably didn't have HIV, 2) healing cuts, even those only a few hours old, do not significantly increase HIV risk if that skin is exposed, and 3) nobody in the world has ever been known to be infected in this manner and you will not be the first. All the stuff you see online, saying their might be risk, and various biological reasons for it (e.g. how long HIV might survive in moist fluids) don't matter. If this has never happened, it isn't rational to believe you could be the first.

1) There's no way you have HIV and thus no way your son could have it. In any case, there is nothing in his recent brief illness that suggests HIV.

2) If someone has enlarged lymph nodes due to HIV, any doctor doing a routine physical exam would notice them.

3) It indeed is generally believed that HIV dies as soon as infected blood or secretions dry out. But as I also said above, the biological reasons for the low risk don't matter.

I hope these comments finalize the reassurance you seek and that everything is clear. Best wishes. And do your best to just put all this out of your mind!

HHH, MD

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87 months ago

Thank you Dr., and nice to 'meet you'.

A few follow ups based on your response.

1. Just a background on my son...the brief fever/rash (which sounds like the timeframe for ARS) occurred in January. However he just now developed a rash that was deemed to be eczema. So to me, I see ARS and then a few months later symptoms of HIV presenting. Is there any reason to discuss testing with my pediatrician?

2. Thanks for assurance on lymph nodes. That's been my concern. I've read too much that any lymph node in the posterior triangle that can be felt is problematic. These have been examined by my PCP as well as an ENT and neither think they are even swollen. So, if HIV was the cause, they would be clearly swollen by their estimation?

3. I had to get 2 physicals this year which is rare for me because of a job change and health insurance required an update in 2018, even though my bloodwork was from November. Anyway, this past November my white blood cells were in the 8 range (4-11 being normal). Just a few weeks ago, for new job, they ran my blood again and it was still normal but 4.75 (4-11). I'm assuming/hoping fluctuation like this is not significant but wondering if this is a red flag?

4. Your thoughts on oraquick false negatives? Does taking 2 tests eliminate that possibility?

Thanks. I hope you both had a nice Mothers Day weekend. Mine was wracked with anxiety!

87 months ago

ah and sorry to nitpick but

3. related to your lymph node answer previously. You said any dr. would notice them. My question is that after I pointed out where they were the Drs did notice them and acknowledged that they were lymph nodes, but they did not think swollen. So the question is not just if they would notice but would they be clearly swollen to them and not just 'palpable but normal'?

H. Hunter Handsfield, MD

87 months ago

This additional information does not change my evaluation, opinions, or advice. Oraquick is the least reliable of all HIV tests, with a couple percent of infected people never developing positive results. Since you weren't at risk, however, it doesn't matter. But if you must have a 100% reliable test, have a lab based antigen-antibody (4th generation) blood test.

Your last question is splitting hairs and I don't even understand what you're asking.

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87 months ago

Ok, I'll try to make more sense with these follow ups and hopefully with your answers I can move forward.

1. The lymph node issue. Basically- I had doctors feel them and while both agree that they are in fact lymph nodes they both think they are 'normal' and not at all concerning. While I know that you can't feel a lymph node and immediately connect it to HIV - if HIV was the culprit would it be easy to tell that it is at least 'abnormal'? To put it another way, I'm hoping that HIV caused lymph nodes don't feel normal and that since these doctors say they aren't concerning that that should be enough for me to know HIV isn't the cause, despite when I first felt them and their location.

2. Please let me know about my WBC count. I don't have any medical training and never paid attention to this before. Is that drop over 5 months time abnormal or concerning? The lymphocyte count was down as well but the percentage was the same, so I'm assuming that its simply down because WBC is down.

3. My child developing eczema at 2 years old is just a coincidence and not because of HIV infection?

4. It seems that you and Dr hook disagree a little on oraquick. He said my results are completely reliable at the time that I took them. Regardless, I take a product that contains some biotin and I've read about biotin interference in immunoassays. To your knowledge if I want to avoid that, are the pcr/RNA tests affected by biotin as well? If not, I might want to go that route to remove doubt. Thanks.

If you could please answer these as opposed to a blanket statement I will do my best to take your educated advice and move forward. I appreciate it.

87 months ago

And lastly, I had just gotten over a pretty nasty upper respiratory infection. I finished a zpack the day before the risk. Would a compromised immune system from that infection at all make me more vulnerable to a small amount of virus? I'm glad I remembered that I don't want any but ifs coming up. Thanks.

H. Hunter Handsfield, MD

87 months ago

1) Repeat question. If you had inflamed lymph nodes from HIV, they would be easily felt, prominent, and no doctor would call them normal.

2) WBC and virtually any other element of the blood count, and all blood chemistry tests, have a range of normal values. Variation within that normal range occurs all the time and is always meaningless.

3) Oh good grief. Eczema in children is common, affecting millions, and almost nobody with eczema has HIV as an underlying cause. You cannot go through life attributing every itch and tingle, in you or family members, to a single sexual choice that you regret. If you continue to obsess about it -- which you obviously have been doing -- professional counseling would be in order. I suggest it from compassion, not criticism. (And I do not believe for a minute that just having definitive science based replies is going to be sufficient to get beyond your fears. This is an irrational thought process, so further rational replies are not likely to help.)

4) No disagreement at all. Let's say someone's chance of HIV is only 1 in a million or lower (like yours). After a 99% reliable negative result, the odds the person has HIV becomes 1 in a hundred million. I hope you would agree that's zero for practical purposes. In that sense, Oraquick in your situation is conclusive, and I imagine that's the sort of thinking in Dr. Hook's mind. But you insisted on pressing (me) for more detail. And now the scientific details have raised your anxiety once again. This is EXACTLY what I mean in the statement to follow, that repeated answers for anxious persons often increase rather than reducing anxiety. In any case, neither biotin nor any other health product or medication has any effect on any HIV test, whether antibody, antigen, or RNA. Here again you have found information online that you have interpreted out of context and incorrectly.

5) A respiratory illness or antibiotic has absolutely no effect on susceptibility to HIV if exposed or on the reliability or timing of test results.

Please note the forum does not permit repeated questions on the same topic or exposure. This will have to be your last one; future similar questions from you receive no replies and no refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand.

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