[Question #456] Oral HPV So Worried

34 months ago

Dear Dr’s,

I have a question that has been concerning me for quite some time.

I have had oral sex with 4-5 women in my life, some of them high risk (sex workers). (Going down on a female - I am a male)

I have also had genital warts unfortunately that have been successfully (according to my dermatologist) treated with podophylyn. I know 100% that I caught them from receiving oral sex from a massage parlour attendant.

For the past few months I have had a swollen lymph node in my neck that has been hurting. I have seen 2 university affiliated otolaryngologists who have sent me for ultrasounds and they say they are not concerned and the second one said flat out that I do not have cancer. 

I am still really concerned. Could HPV cause a painful swollen lymph node near the submandibular gland? I have two lymph nodes there which a re slightly enlarged as per an ultrasound. (approx 2cm)

I feel like due to a few mistakes made in my teens even though I always used protection fro penetrative sex, I am going to spend the rest of my life worrying about oral cancer from hpv or somehow harming my fiances health. Please doctor tell me what I can do. Is this something that will follow me for the rest of my life? I was 100% single when I acted in this way and now feel guilty to my fiance and my future health. I had no idea it was so serious. Thank you for all that you do. Looking forward to reading your reply. 

Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Welcome to our Forum.  I'll be pleased to comment.  My sense is that your concerns may be in part fueled by recent evidence that there is a link between HPV infection and oral cancer and indeed, rates of oral cancer which have been rising in the past few years.  At the same time, oral cancers due to HPV remain quite rare.  When they do occur, they typically have lesions which are visible to examiners.

In your case, you have been examined and tested by two highly trained professionals.  I really think you should accept the evaluations you have received.  If you have been reading about this on the Internet, my advice is to stop.  The information there, while well intended tends to be overly sensationalistic and is often incorrect.   I hope this comment is helpful to you.  Most people do have a few enlarged lymph nodes which represent non-specific inflammation.  When people become aware of them sometimes worry about them unnecessarily.

I hope,this comment is helpful.  EWH
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34 months ago
Dear Dr Hook,

Thank you so much for your reply. This is slightly off topic of my original questions and if you would like me to purchase a new question i would happily do so. 

I have the swollen lymph node in the groin that I mentioned, I also have what I believe is a swollen lymph node in my lower abdomen/groin. My exposure was having a massage parlour attendant sit on my buttocks with her vaginal fluid coming in contact with potentially open rash/acne on my buttocks. I genuinely believed this was no risk for HIV and was tested at 4 weeks with a duo, at 6 weeks, at 7 weeks and at 8 weeks. 

I had my 8 week test last week, today my groin feels swollen, is there any chance whatsoever (even theoretical) that I could be seroconverting so late? Or are my test results 1000% conclusive. I am just so worried I do not want to get an hiv test every time some new symptoms pops up and I was convinced that I was ok. Can I investigate this symptoms with my doctor without even mentioning the HIV potential? I have also been tested for all other STD's numerous times including herpes. I am in generally good health with normal blood work and only take a protein pump inhibitor for a hiatal hernia and a steroid puffers for a cough and a steroid nasal spray and vitamin d. None of these could have any impact right? I should have sex with my wife unprotected? There is 0 chance of anything right? 
34 months ago
Dear Dr,
Today I feel pain in my armpit and I am worried it is. A lymph node. Is there even a possibility that all the duos up to 8 weeks could be wrong? Do I need to test again to 12 weeks?
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

No need to start a new question.  I'm pleased to answer this additional question as an "extra".   I agree with you that the exposure that you describe was a no risk event and your testing, without a doubt, confirms that you did not get HIV from the exposure that you describe.  There is no reason to worry further about HIV.

As for "late seroconversion", this is an internet-fueled misconception which does not exist, with PERHAPS the exception of persons who have taking anti-HIV medications in an unsuccessful attempt to prevent infection following exposure (i.e. PEP- post-exposure prophylaxis).  It does not exist and your swollen lymph nodes are not a reflection of this.

So, the next logical question is what is causing the discomfort you describe.  Several comments.  First, I would urge you to be sure that what you have noticed are lymph nodes- there are many things that con be confused with swollen lymph nodes, depending on where in the body they occur.  A visit to a health professional should help to determine if what you have noticed is lymph node swelling or something else.  Second, if you are experiencing swollen lymph nodes, you should look for other, non-HIV causes.  Lymph node swelling is a non-specific response to infection and can occur as a result of the sorts of day to day infections that most people get from time to time.  Mononucleosis (not always an STI) is a common cause of such problems.  If you are concerned and the possible lymph node swelling persists for more than a day or two, I would suggest you see your regular doctor.  I would not however worry that it is related to the exposure that you describe. 

I hoe these comments are helpful to you.  EWH

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34 months ago
Doctor thank you so much for your kindness. Just to confirm - there is a 0% chance I have hiv after an 8 week duo? The Ag/Ab test is 100% conclusive after 4 weeks? You are absolutely sure? I just wanted to make sure. I got tested again today with a duo and the results will be available on Wednesday night it will be negative for certain correct? Thank you so much for your time and all the best. 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago
Yes, I as I said, your results are conclusive and do not need to be repeated.  Your repeat test was unnecessary and will show the same result as your earlier test.  It is time for you to stop testing and move forward.  EWH
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34 months ago
Dear Dr Hook,

Thank you so much for replying. I always knew that the window period for fourth generation tests was 4 weeks. The test I took that I mentioned was non reactive for antigen and antibody (4th gen.) I also took an HIV insti test at 9.5 week non reactive. Today I feel some sort of discomfort in my armpit. I went to the doctor who said it was nothing but it is making me worry about lymph nodes again. I just wanted to confirm that I 1000% do not need another test at 12 weeks and 4 weeks was already completely conclusive, and that I can have unprotected sex with my wife with no fear of infecting her with HIV. I just wanted to end off by thanking you so much for answering my questions. The service you provide is invaluable and I appreciate all of your help.

All the best! 
34 months ago
Doctor I am so sorry to bother you again. I am just so worried. I have so much to lose. No matter what the symptoms are I can be 10000% sure? I keep reading about 12 weeks and in Canada the government writes to repeat testing at 3 months as well. Super sorry. I just wanted to confirm that no matter what the symptoms are it can not possibly be what I am worried about. Thanks. 
34 months ago
Here is the truth - my wife and I want to try for our first child and have unprotected sex. I am so scared and I dont know if I should wait another 3 weeks. She is becoming very suspicious. No matter what the symptoms. Thank you so much and my deepest apologies. 
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

Harry:  Our Forum guidelines call for question threads to end after we have provided three responses. This will be the forth.  Thus this will be my final response and the thread will be closed in a few hours.  The results of your 4th generation test proved that you did not get HIV and your 9.5 week test results serves to confirm this. it is now time for you to accept those results. They will not change. There is no reason related to any encounter more than 9 weeks ago to worry that they might.  Thus there is also no reason to worry about unprotected sex with your wife.  No need to wait.


This now ends this thread.  EWH

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