After a relatively safe encounter - protected vaginal intercourse and unprotected fellatio with a female CSW- I have had several health issues over a year, the most bothersome being:

-severe body wide kerotasis pilaris & folliculitis (diagnosed by dermatologist)

-small and slow progressing oral hairy leukoplakia (as suspected by GP)

- recent numbness and tingling in both hands and feet (vit B12 deficiency and peripheral neuropathy listed among possible culprits by GP)

- geographic tongue and several oral ulcers (this is gone now)

Recent check-up shows no signs of cancer to explain OHL (if that's what it is). Lym% is slightly high at 43% if those are relevant.

I know a 6 week negative AB/AG test rules out hiv. I have several of those, 1, 2, 3, 6, 9, 12 months, all lab based AB/AG tests. Also a 6 month negative VDRL for syphilis.

1. Am I completely in the clear for hiv? If I really have OHL, would that change your assessment for hiv?

2. Do you think it is just a bad coincidence that I might have 2 problems (OHL and Perp. Neur.)  that are caused by -I think- the same virus almost only when one has immune deficiency?

3. Does a 6 month negative VDRL completely rule out syphilis? How about neuro syphilis? I may have read VDRL may not catch that? Is it warranted to get tested for it? I have not had any chancre sores anywhere.

4. Does the slightly raised lym% raise any concern for std's?

Hearth felt thanks for this wonderful service you provide for troubled people like myself.

The HIV and syphilis blood tests are extremely accurate; if done sufficiently long after the last possible exposure, they are always positive if someone is infected. There are no exceptions. As a reault, the results overrule every other possible consderation:  no matter how high the risk at the time of exposure, and no matter how typical the symptoms or other lab tests, negative results are far more reliable and prove you are not infected.

And in fact, you had an extremely low risk (virtually zero risk) exposure for both infections; and your symptoms don't suggest syphilis or HIV anyway. You're making a basic error in logic:  there are at least a hundred symptoms and medical conditions that are more common in people with HIV than in those without HIV. But still, the vast majority of people with those problems do not have HIV. (And by the way, oral hairy leukoplakia is not caused by HIV, even though it's more common in HIV infected people. In any case, your test results prove that whether or not you have OHL -- probably it's something else -- you don't have HIV.)

Those comments pretty well cover your speciifc questions, but to assure no misunderstanding:

1) Yes, you are completely in the clear for HIV. As you say yourself, it is not possible to become infected with HIV and have a negative AgAb test more than 6 weeks later.

2) Yes, it's a coincidence. These other problems and your symptoms are commonly present in people without HIV.

3) The negative VDRL completely rules out any and all stages of syphilis. Although it is true that rare patients with neurosyphilis have negative VDRLs, that only occurs after many yeaqrs -- usually more than 10 years — in people with late sypyhlis. It is not possible to have syphilis of any stage with negative testing 6 months after exposure.

4) No, such minor variations in lymphocyte counts are normal -- and certainaly do not hint at HIV, syphilis, or any other STD.

Thanks for your kinds words about the forum. I hope this reassurance meets your expectations! Let me know if anything isn't clear.

HHH, MD

I saw my dentist today, who also couldn't tell if it was OHL but also added that he doesn't have much experience in diagnosing it. Chances are he's never seen one.

I will try to control my anxiety and not bother you much so hopefully I will have only this follow up question:

If it turns out that what I have is indeed OHL (and perhaps peripheral neuropathy), and given that I show no signs of cancer, do you think any other kind of testing is required for hiv (like a rna test)?

Thanks a lot for your assistance.

 

The best expertise for undefined lesions in the mouth usually comes from Oral Medicine, a specialty of dentistry. Your dentist may be able to refer you to one; or if you are in or near a medical center or university with a dental school, they probably have an oral medicine department and clinic. Alternatively, an otolaryngologist should be able to sort it out. Or a dermatologist.

In the meantime, I suggest you google lichen planus and look for photos. It's probably the most common oral condition that is likely to mimic OHL.

I have one last follow up question, borne out of curiosity rather than this particular indicent. You and Dr. Hook often say, about a few days to a week after the first ARS symptom shows up, ab/ag tests are always positive. Rare as it may be, does that include hiv 2 as well? Does the AB portion (for hiv2) of the test turn positive  if say 7 to 10 days have passed after the first symptom?

this was my last follow up question. Thank you very much for this priceless service you offer.

The symptoms of acute HIV infection are not due to the virus itself, but to the body's immune response to the virus. That immune response includes the antibody detected with blood tests. This is why everyone with symptoms of HIV must have a positive antibody test -- if not immediatley, certainly within a week of onset of symptoms. This applies equally to HIV2 and HIV1.

Thanks for your kind words about the forum and our services. I'm glad to have helped. Best wishes and stay safe.