[Question #4411] Please help...Dr. Handsfield (or Dr. Hook), follow-up on Question #4358

28 months ago
I said Dr. Handsfield first because my previous question(s) was answered by Dr. Hook. I would have asked for Dr. Hook if Dr. Handsfield was the one answering my previous question (just wanting to get opinion from both of you)

I am sorry for coming back. It is about my fear and not insulting your advice. Your advice did help me but I ran into other symptoms and I am back again. Dr. Handsfield, if you are answering this one, please read my previous conversation with Dr. Hook.

I now noticed several swollen lymph nodes in my groin area on the morning of 10/18, and that again got me concerned. Some of them hurt a little bit. So I went in the next day and did a combo test on the morning of 10/19 and it came back negative. This is (the test) after 20 days and 21 hours (almost 3 weeks) after my sexual encounter (on 09/28). It has been 22 days now, and these (described in the previous question and this one) are my only symptoms so far. So my questions are:

1] Does a combo test always turns positive if there is ARS symptom? In other words, given my latest combo test is -ve, hopefully the swollen lymph nodes are not ARS?
2] Irrespective of everything, in general, my negative RNA and first combo test at 12 days and 20 hours, and second negative combo test at 20 days and 21 hours, the three test results combined, are they a good indicator that one is not infected and clear of HIV scare? Is any further testing needed assuming I don't run into any other symptoms?

All your replies have put my mind to rest until I discovered other symptom. I am trying not to pay too much attention on the lymph nodes in the groin and other areas anymore and instead wanting to focus on the test results hoping they have more merit in them. I would be grateful to hear back from you.

With my best regards
28 months ago
This is all for the possible risk that the girl might have been infected and might even be in the window period when we had sex. She has denied so, but this relationship is so unconventional, that I feel horrible and that I made a big mistake in that I had unprotected sex in this context.
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Clients are not permitted to choose who replies to their questions.  Dr. Handsfield and I share the site and have worked together for nearly 40 years.  During that time, while our verbal styles differ, our assessments have never disagreed.  We would not disagree on your situation either.

The swollen nodes detected in your groin are mostly to indicate your continued anxiety and guilt over your infection.  Given your repeat testing, if you had symptomatic HIV, your most recent combo test would certainly have been positive and you negative test serves to, again PROVE and confirm that you did not acquire HIV from your encounter of concern.  Inguinal lymph node swelling is a non-specific finding which does not suggest HIV and the tenderness you have experienced may result from repeated self examination.

I assure you, your test results prove that you did not acquire HIV.  I urge you to move forward without concern.  EWH
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28 months ago
Respected Dr. Hook,

Trust me, given your advice, I was at peace living happily. I however never asked you straight to consider worst case scenario: "The girl is at her infectious worst, subtly bleeding and I uncircumcised while having unprotected vaginal sex". I explain the scenario below. To avoid for you to go back and read my posts on this and on my previous one (#4358) I would briefly recap everything here.

I met a girl on a sugar dating web-site on 09/01. We dated for a couple of weeks and did complete testing including HIV on a combo test on 09/14 and came back negative. Had the only sexual encounter, unprotected vaginal on 09/28. Got concerned so did 1] HIV RNA and combo at 12 days 18 hours 2] Combo at 20 days and 21 hours after exposure.

Now the new stuff. I discussed this with my sugar baby and she agreed to do another testing. We both tested again 4 weeks after the exposure, combo test and came back negative. So for her, she basically has tested negative twice; on 09/14 and then on 10/26 within 6 weeks. I also came to know that she has recently, before our encounter, had an IUD put in and she never gets periods but spots/bleeds randomly/occasionally. She says she might have been spotting or bleeding subtly while we were having sex. Further, I am uncircumcised. The oral/mouth issue I mentioned to you previously was officially diagnosed as Thrush by my dentist and I am on medication since 10/30. Another 3 days of medication left and I don't see it clearing with that and I wonder if that is a problem with the HIV situation. I also had swollen lymph nodes in my groin region around the same time as thrush as I mentioned previously. I have stopped paying attention to them, so don't know how they are now.

I would REALLY appreciate you considering the worst case scenario that she was at her infectious worst, subtly bleeding, me uncircumcised while we were having sex and advise me on the following as it relates to HIV risk:
1] Was my HIV RNA at 12 days and 18 hours by itself conclusive?
2] Is the combination of my HIV RNA and 4 week combo test conclusive in itself? Dr. Handsfield seems to suggest this to someone (on Question # 4426), but the context may not be equivalent, so I thought I would ask separately.
3] Is somehow the combination of the fact that she tested negative 2 weeks before and we both tested negative 4 weeks after the exposure is conclusive by itself?
4] Does any of the combination of facts in 1, 2 and 3 above (or all of them taken together) make it conclusive that I am in clear with HIV?

If I am in the clear with HIV, then I am happy. I want to try some odds calculations for my situation, similar to what I have read you and Dr. Handsfield do. I would appreciate your comments on these and I am using conservative and generous estimates some of which I have read in your posts and the tests estimates come from STDCheck.com, the service I used for testing

Item                                                                                                                                        Conservative        Generous
Girl infected at exposure and -ve on combo test after 4 weeks                    5/100                 1/100
Risk that I get infected                                                                                                           1/2000              1/2000
Increased risk being uncircumsied                                                                                    2                         2
Increased risk because she is in highly infectious period/bleeding etc     100                    100
My HIV RNA is false negative                                                                                            5/100               1/100
My 4 week duo result is false negative                                                                        5/100                1/100
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Total Odds                                                                                                                                   1/80,000        1/10 million
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These odds are assuming that the girl was infected in the first place. For that, she would have to had sex with somebody else within the first two weeks when we were dating and before she took her first test with me. That I am sure would further improve the odds. Where, in your opinion, my odds are realistically, assuming worst case scenario?

Finally, any reason for considering 6 weeks duo test? I don't want to do it. And if the thrush does not clear with the medication, HIV has nothing to do with it?

The whole reason this train of thought started is because my previous girlfriend is visiting me for a week, and she may want to get intimate with me. I told her everything and she says she is not worried and is not going to use a condom. We never did as she is allergic to condoms. Of course, it would be her decision but I would appreciate being able to give her your expert advice.

Feeling grateful for having the two of you to advice us!

28 months ago
Sorry for the long post, appreciate your patience and kind understanding.
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
You have missed the point entirely.  When we calculate the odds of infection, this relates for persons who have not had HIV test.  In contrast, both you and your partner have negative tests whose combined information leads to an absolutely conclusive outcome.  The FACT that you both have negative tests 4 weeks after sex is 100% conclusive.  Issue of spotting, circumcision status, etc. are entirely irrelevant,  There is absolutely no need for further testing and no need for concern.  You need to move forward. EWH---
27 months ago
Respected Dr. Hook,

I am grateful for your responses, and have been at ease since then. However, I have been asked to travel to India for work for a couple of months and going to an alien land brings back my concerns of this past episode. I don't want to be there, not knowing any doctors and so on and then dealing with something that might remotely relate to HIV. I have been feeling assured after getting your responses but if I may, just a few quick things because of my possible travel and I think I would be cool.

1] Before your previous assurance above, I was anxious and hence lost sleep, didn't eat well and so on and lost like 5 lbs within two weeks. My Thrush continues to bother me. The dentist gave me Fluconazole 100 mg two tablets for the first day and then one each for next 6 days. However, I felt it did not clear. I went to him but he insisted that he doesn't see anything. Then after a week I again went back and then he prescribed 5 more days of the same thing. He kept hinting that "there might be other reasons why this is happening, is there any change in your medical history" and so on. So I then went to my PCP and I narrated my sexual encounter and the tests I have done. He suggested another test which was done 6 weeks after exposure and it came back negative. He is not concerned about HIV. He prescribed me Nystatin 4 times a day for 7 days. Feeling better with thrush, but not yet gone. 1 more day of medication left and I think I would go in tomorrow again to see if he wants to give me more medication. Does any of this change your opinion on HIV? 

2] Given the trouble with thrush, any way in hell I need to be worried about HIV 2? I did a random search on this forum and I think I found either you or Dr. Handsfield or both allude to the possibility that the window period might be 8 weeks in case of HIV 2 as the combo test does not test for the HIV-2 antigen?

3] I would happily go to my work visit if you give me the green signal. There, if I indulge in some sensual fun, just wanted to know what potential risks I might face as for possible STDs if I get a sensual massage and handjob A] Without body-to-body rubbing B] With nude body-to-body rubbing with both of us possibly wet with massage oil. I know HIV not possible. But what about syphilis, herpes, chlamydia, gonorrhea etc.

4] Finally, I am at 8 weeks now post exposure. If you would suggest I do another combo test with the possibility of HIV-2, then if possible, please leave this post open for me to post results. I don't go do testing unless I am asked to.
27 months ago
Nystatin is oral suspension that I have to swish in my mouth and then swallow.
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
this thread should have been closed after my third response.  Thus my responses to your questions will be brief, particularly in consideration of the fact that you have PROVEN that you were not at risk for HIV form your exposure of concern.  

1.  No change in my assessment of advice.  Most people with thrush do NOT have HIV.
2.  Negative tests in you and your partner rule of the possibility of HIV of any sort, including HIV-2.
3.  Minimal if any risk for the sorts non-penetrative exposures you describe.  
4.  Further testing is not needed,.  You already know that your partner did not have HIV.  Testing of course is a personal decision but I see no need for testing related to the exposures you have described.

End of thread.  Take care, please don't worry. EWH
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