[Question #5540] Need advice on course of action

74 months ago

Possible exposure: 1 year ago, insertive vaginal intercourse with condom with a female csw. Insertive fellatio without condom.

Health problems&duration:

- body wide skin rash 3 months after exposure, ongoing

- yeast infection on penis, 3 months after-cleared with a cream

- headache that started 7 months after, lasted for 5 weeks

- painful spots on head that come and go, 5 months after, ongoing

- 5 months tinnitus and slight loss of hearing on left ear

- white spot on tongue, 10 months after, ongoing. smaller in size now. not thrush because can't be scraped off.

-2 severe throat infections within a month, 10 months after-followed by rhinitis and post nasal drop

- a persistent cough, 10 months after-ongoing for month and a half, getting better but slowly

- 11 months after, a unilateral corrugated patch like thing on tongue, still small, but seems to be getting bigger. does look like hairy leukoplakia, but can't say for sure. ongoing.

- 1 year after, (noticed it yesterday) a big bruise (1,5 inches in diameter) 2 inches above the belly button. Do not remember any trauma and even with a trauma, a very unlikely place to have a bruise. seeing an internal medicine specialist tomorrow, will also mention the tongue.

Negative AB/AG tests up to 8.5 months. I understand that it is enough if not 'over tested'. Also 6, 7.5 and 8.5 month tests were done in 3 different labs.

Questions:

1 - Do you recommend further / a different kind of hiv testing? Especially if what I have is oral hairy leukoplakia.

2 - The list of symptoms make me think they may point to a weakened immune system. Regardless of hiv, would you recommend a CD4 count to see if my immune system is weakened? In light of negative ab/ag tests, would a CD4 count give a meaningful result? Especially, again, if I have OHL, since it is almost exclusively seen in people with considerably weakened immune system?

3 - could this still be hiv?

H. Hunter Handsfield, MD

74 months ago

Welcome to the forum. Thanks for your question.

There are no STDs that cause symptoms like this, including HIV. And you had a low risk exposure, since condoms work well to protect against infections from vaginal sex, and oral sex is inherently low risk -- not risk free, but much safer than unprotected vaginal or anal sex. In addition, although you are obviously focused on the sexual exposure because it preceded your symptoms, I would poitn out that in the 3 months before onset of symptoms you also had innumerable exposures to other people (shaking hands, exchanging money at cash registers, and all the other personal interactions of daily life). You also could have had all kinds of unknown environmental exposures. Don't get me wrong: I don't think you have any infection at all, but some non-infectious cause of your symptoms.

1) The AgAb tests never miss HIV beyond 4-6 weeks. There is no point in any other HIV tests. For sure you don't have it.

2,3) I disagree these symptoms point to any kind of immune deficiency or "weakness". Even if you have something that looks like oral hairy leukopenia -- or if you had other symptoms to suggest HIV -- the test resutls always overrule even the most typical symptoms of HIV, and your test results prove you don't have it.

If your symptoms continue or you otherwise remain concerned, see a doctor for further evaluation. But for sure you do not have HIV or any other apparent infection from the sexual exposure a year ago.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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