[Question #463] Needless worry?

33 months ago
Hello again Doctors. I previously asked a question about my HIV risk and was assertively reassured that I was not at any risk. And once again I appreciate you all taking the time out of your day to give your expert advice to those out there struggling with the extreme fear and anxiety they are dealing with. Myself included. I don't think you doctor's realize the gratitude people have for you. You are experts, not typical MD's who give advice based on a guideline. Just wanted to note that. I don't want this question to sound repetitive or annoy the experts in any way.

I went for a 4th generation test 28 days after exposure and was negative. For peace of mind I went for another 4th gen duo test 34 days after the virtually no risk exposure (unprotected cunnilingus on an escort) which was negative.

My concern is I now have a yellow coated tongue and my glands on the left side of my neck are tender to the touch. Does constantly feeling your glands actually irritate your lymph nodes?

Can I be rest assured guaranteed that any symptom or new symptom I experience is not due to HIV? There is basically no chance in heck I have HIV and the results will not change?

Is a 6 week duo any more accurate than a 4 or 5 week duo?

Would accepting my 34 day duo results as definitive and moving on with my life be the thing to do here?

Here in Canada most experts say 6 weeks for conclusiveness. In In the UK it's 4 weeks. In France it's 6. I know every place has their own guidelines. But you are the experts who see actual fact and scientific data and do not get enough credit and I wish you had the power to change the guidelines based on your 30 years of experience rather than beauracrats.

Again I appreciate your time.









H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Welcome back, and thanks for the kind words about our services. But I'm sorry you remain fearful despite Dr. Hook's unequivocal, science-based reassurance. I'm afraid we can't help much more; when someone is irrationally worried, simply hearing the facts and probabilities one more time rarely helps much. The simple answer to the question as posed in your title, "Needless worry?" is a definite "Yes, needless."

Because the 4th generation tests are foolproof and error free at 4+ weeks, the results always overrule all other considerations. No matter how high the risk of HIV might have been at the time of exposure (yours was very low) and no matter how typical the symptoms might be for a new HIV infection (yours are not typical, especially in regard to the timing), the test results tell the truth. Your negative tests prove you do not have HIV, assuming no more recent exposure you haven't described. To your specific questions:

Tongue, lymph nodes: See above. Coated tongue is exceedingly common and not in itself necessarily abnormal, and self examination of lymph nodes by medically untrainted persons is highly subjective and usually unreliable. And yes, constant probing node bearing areas can result in swelling, discomfort, and tenderness. Finally, acute HIV symptoms cannot be delayed so long. They start within 1-2 weeks or not at all.

"Can I rest assured...?" Yes. You do not have HIV and your test results will not change.

"Is a 6 week duo...?" and "Here in Canada...." In addition to the institutional conservatism described by Dr. Hook, the data on HIV test performance are not very precise. Few people with HIV know exactly when and where they were exposed, and following such persons with precisely timed tests for several weeks is pretty much impossible. So we're left with biological principles, animal studies, and scant data in exposed or newly infected persons. So there's a lot of room for experts or institutions to consider different intervals as definitive. All I can add is that neither Dr. Hook nor I, nor any HIV experts with whom we have spoken, ever have seen a patient with negative duo testing 4 weeks after exposure who turned out to have been infected. There may be occasional exceptions when persons have received anti-HIV drugs for post-exposure prophylaxis (PEP) that didn't work, but even this appears to be rare.

So do your best to move on without worry. Thanks again for the appreciative comments.

HHH, MD

---
33 months ago
Dear Dr. Handsfield. Thank you for your comforting and reassuring comments. I know you are an HIV expert and not a psychiatrist. However you must find yourself at times acting like the counsellor to everybody who you speak to who has concerns. All I can do is trust you because I know you are assured that I do not have HIV based on my negative results at 34 days. I will try my best to move on from this. I know my anxiety is telling me to go get tested again. That is part of the battle. Knowing I have definitive answers but wanting to keep getting tested. Which would serve no purpose. If I was your patient you would probably tell me to leave your clinic and don't come back. Which is a good thing. I will try to listen to your words and advice. You basically told me I do NOT have HIV. A doctor would not say that unless they were 100 percent confident. I trust you and wish you all the best.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
I'm glad you understand. Best wishes.

---
33 months ago
Hi Doctor Handsfield. I just had one last question to sum up our conversation. 

In regards to lymph nodes and swollen glands. Would they be very clearly visible in a person with acute HIV? Would they be body wide including all lymph areas or just generalized to one area (Neck)? Would they be painful? Also is it normal to feel a lymph node without being swollen?

I went to the dentist and the dentist said there is clear evidence of teeth grinding and he felt my jaw and said it was very tense. Could Bruxism cause tenderness in the neck lymph area?

Once again. My thanks.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Lymph node enlargements due to HIV are generally body wide, painless, and not large enough to be seen, only felt. As for feeling one's own lymph nodes, see my first reply. I suppose a normal, uninflamed lymph node might be something one occasionally could feel. But non-lymph node tissues also can feel lumpy. My advice is to cease further attemtps at self examination. Of course bruxism could cause neck tenderness, but it would be muscular, not lymph node inflammation.

But these questions are irrelevant, since the blood test results prove you do not have HIV. The main point of the replies both now and previously is that the test results overrule examination, risk history, and anything else you can think of. Even if you had typical symptoms of acute HIV and body-wide lymph node enlargements, the clear conclusion would be that something other than HIV is the cause. Do your best to believe it, accept it, and move on. If you cannot, professional counseling might be in order. I suggest it from compassion, not criticism.

That's my last comment. Best wishes.


---