[Question #6059] Follow up - test results

19 months ago
Dear doctor ,

This is a follow up question to question #6040. 
I got an hiv CMIA test done today , at 22 days post exposure . It was non reactive .
However the hip pain I complained of has now become inflamed , like a golf ball and swollen since last night . I also have a 100 fever .
My cbc showed lymph count at 10% and neutrophils count at 84 percent .
Do I need further testing ? What would be the accuracy of the test ?
If my nodes were due to hiv would the test pick it up . Considering I did it about three days after noticing the swollen nodes .
Kindly advise 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Sorry to hear of this development. This sounds like some sort of abscess; you need to see a doctor, perhaps for incision and drainage and probably for an antibiotic prescription. However, I can continue to reassure you that this is not HIV, which does not cause a single prominent lymph node or any kind of abscess. Also, it is not possible to have HIV symptoms and have a negative HIV AgAb test.

I am puzzled by the location; "hip" covers a large possible area. In your previous thread, I think you referred to your inguinal area (groin); is that what you mean now? If so, two STDs could explain it:  lymphogranuloma venereum (LGV), which is an aggressive type of chlamydial infection that often causes a highly inflamed lymph node with abscess formation, and in recent years LGV has had a remarkable resurgence in men who have sex with men. The other is chancroid, but that's extremely unlikely in absence of an obvious, painful ulcer nearby (genital, anal, etc). So if this is an STD, I would bet on LGV. That said, an inflamed/abscessed lymph node from LGV usually is in the inguinal area. Also, you refer to "swollen nodes" (plural). Do you have inguinal (groin) swelling(s) in addition to the "hip" lesion?

And this isn't necessarily an STD of any kind -- could be just a garden variety abscess due to staph, strep, etc. Whatever the cause, this definitely needs prompt medical attention. It would be ideal to see a physician or clinic with lots of STD experience. If you see a general surgeon, urgent care clinic, etc make sure the doctor(s) consult with an infectious diseases or genitourinary medicine (GUM) specialist for advice LGV or other STD and test specimens that should be obtained.

I'll be interested to hear how this sorts out. In the meantime, I'd like to hear more detail about exact location(s) of possible enlarged lymph node(s) and the large lump. In the meantime, still there are definitely no concerns about HIV as an explanation of this problem.

HHH, MD
---
19 months ago
Dear dr ,
I showed my physician today he said it’s an abscess . I also showed him the cbc reports.
He had given antibiotics and said it could take a week to settle .
Just wanted to understand if these symptoms were from hiv , it would show up on my test today ?
Any further hiv testing needed ?
I have a lymph node in my groin , a very small one and now this abscess .
Also do you think my cbc readings are fine ? Lymph being 10%
The hip means the layers part of the hip . It’s quite painful 
Yes I have two small nodes in the groin . The doc says it’s coz of the abscess . What is your opinion ? 
Also request you to let me know if I need further hiv testing and the accuracy of this test today . Thanks a lot doc 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
I have said repeatedly that if this problem were due to HIV, your HIV test would have been positive. In other words, this result is conclusive that HIV isn't hte cause of the abscess or lymph node enlargments. Another AgAb test 6 weeks after exposure would be required to be 100% certain about asymptomatic HIV. However, I stand by my judgment that the exposure described was risk free in regard to HIV. Also, I have never seen any patient with negative AgAb test at 3 weeks who later turned positive.

Your CBC result, with 84% neutrophils, goes along with an abscess, not HIV.

I still don't know the location of the abscess. What does "layers part of the hip" mean?

Any MSM with an abscess like this needs testing and evaluation for LGV. Discuss it with your doctor.

What antibiotic was prescribed?
---
19 months ago
Dear doc ,
Just to confirm there is one small node in the left groin and one on the right tip besides the abscess that is on the extreme left of the upper hip .
We don’t have GUM clinics in India . 
Awaiting your vavauabkr feedback. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Sorry, somehow I thought you were in the UK. There may not be GUM clinics in India, but there certainly are GUM/STD experts in major urban areas.

Most likely this is not an STD of any kind and is unrelated to your recent sexual activities and exposures. But I'm still interested to know what antibiotic you were prescribed.
---
19 months ago
Dear doc Handsfield ,

Thank you for your response . I have been prescribed cepodem , twice a day for three days .
My physician has asked me to apply ice as well. Also just curious to know what in your view could be the cause of the small nodes in the groin once on the left and one on top right ? Today’s test has given me some relief but I’m still not totally over my stress . Just to clarify , I have NEVER had anal sex . Whenever I have oral sex( which is very rare ) I use a condom . 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
19 months ago
Entirely healthy people often have easily felt lymph nodes in the groin. But if your doctor believes they are in reaction to the abscess, I can't argue -- although not on the other side of the body. That is, right hip abscess might cause reactive lymphadenopathy in the right groin, but not the left.

That completes this thread. This forum deals strictly with STDs. Now that it is apparent no STD is involved in your current problem, and that there is no realistic chance you have HIV, this will have to be the last of this issue. Please see the disclamer at the end of our previous discussion about repetative questions. It also applies to non-STD issues. In the extremely unlikely event that a future HIV test is positive, of course return with a new question to let us know. Otherwise, any new questions along these lines will be deleted without reply.

I do hope this additional discussion has been helpful.
---