[Question #713] dr HH

55 months ago
dear dr HH  25 days before 2sex encounters with afr. csw from Ugh in Dubai,protected sex with fingering with new cut but not bleeding. 
symptoms: 8-11 days post exposure ( sore throat&fever - tonsillitis swollen - neck lymph nodes swollen-daehera)had a combo test elisa at 12 days (negative)combo test ECLIA at 20 days and 12 hours (negative)
new symptoms: 22 days till now 25 days post exposure i have swollen lymph nodes again in neck specially left side , also at my right armpit i have a small round ball but nothing under my left armpit, i also have a little swollen lymphs at my groin ( but for groin i'm sure i have it a long time ago , may be before the exposure and the tests)all lymphs without pain.i also need to mention that i had a little fever yesterday (24 days) for little hours 37.2 
csw hiv status(unknown) i asked here many times and everytime she have different reply between (no-yes and i don't know ) but i also mention that we had a small spat at the end of the night and she left angry so she may want to play  with my feelings but i am still not sure about her status.i need your help sir to estimate the worst scenario that i am scared about as below :i was at alcohol effect and although i'm sure that i used condoms my symptoms made me doubt about that so may be i missed a minutes unprotected so plz let me assume that it happend . i also forgot to tell dr hook that 10 days before encounter i had laser cautrize for a little wart on my penil near to the top of penis in a place that was covered by the condom , let me assume also that it was not completely healed .1-could my neck lymphs be real symptoms at this time (4th week)?2-do my 20 days test have any assurance?3-a combo test at 27 days will be reliable becuz i only can have the test in this day? can't find the words and the questions sir because of anxiety but i think i told you everything. i need to have the honor of asking both of you doctors so plz if possible i need your answer
55 months ago
one last mention sir : i used to have big size tonsillitis for 1year now and i was planning to remove them but i never used to have these lymph nodes in my neck before.
great thanks for your efforts and for this great forum.
forgive my weak english
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
55 months ago
Welcome back. But I am sorry your anxieties are still having their effect despite all the effort Dr. Hook put in to relieving them. And FYI, it is only by chance I am replying this time. As stated clearly on the pages you read before posting, we do not respond to requests for one of us or the other. And it doesn't matter; our opinions and advice are never significantly different.

As for your current questions, all the description of the exposure, your partner's infection status, and your symptoms make no difference at all. Your 27 day combo tst will prove you do not have HIV. The negative tests you have had already are almost 99% reliable. There is no difference in combo test performance at 27 vs 28 days. Testing ALWAYS overrules all other considerations. Even with your worst case scenario -- if your partner had HIV, if you had a definite high risk exposure without a condom, and if you had typical typical symptoms of HIV -- your test results so far show that almost certainly you do not have HIV. Something else is causing your symptoms. You can expect the 27 day combo test to confirm it.

I understand you are very anxious. But you are asking too much of a forum like this. We cannot relieve your anxiety, except to tell you the facts and probabilities. Dr. Hook already did this and now I have done so as well. The rest is up to you.

Feel free to return with a follow-up comment to report your combo test result. But there is nothing more I can say until then, so I won't have any further comments until that time.

Best regards--  HHH, MD

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55 months ago
Dear Dr hh .first thank you . Just to be sure that I don't miss understand your recommendations.  
*I didn't have my 27 days combo test yet. I will
* ". The negative tests you have had already are almost 99% reliable" You mean by this my 12 & 20 days test?
I asked you before to excuse me weak English and I do again .
Please don't count this as my first follow up question I just want to be sure I really understand you sir 
55 months ago
Dear Dr . I had my 27 days combo test negative result as Dr Hook and you predicted sir. Although my neck lymph nodes and sore throat still there but this is not worrying me anymore as my HIV concerns is over . 
I will use my next follow up sir to ask about my genital wart if you don't mind. Because I had a small things ( small dots ) on my penile appeared 21 days after a previous old  exposure . 1st doctor saw them and said it is warts and removed them by laser . But around 3 weeks later it appeared again in same places so I visited different doc and he said it is not warts . It is molluscum and advice me to remove them by laser also . So I went back to my 1st doctor and removed them again . The problem is that only 2 weeks later it start to appear again . 
1-Is that normal sir that it appears so soon after removing ?
2- do this means that I have a weak immune system (because of anxiety about HIV may be) ? If yes . What test can I do to examin my immune system 
3- what can I do to help my self get red of these things ?
4- in your opinion sir which doc is right . I mean it could be warts or molluscum ? Depending on time frame of appearance .
I just need to mention the absence of experts here where I live and my story is an exemple.  That is why I visit your forum to take a main guidelines .

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
55 months ago
Glad to hear about the negative HIV test. But of course I'm not surprised.

Interesting to hear of your diagnosis of molluscum contagiosum. The penile bumps could not have been warts from the exposure a few weeks ago; it takes at least 2 months and for warts to show up after being infected with HPV. Therefore, I'm sure your second doctor is correct. Any doctor with laser treatment is obivously a dermatologist, and all dermatologists (no matter where you live) are highly expert in recognizing warts, MC, and other skin problems. You can rely on his expertise.

1) Molluscum can reappear promptly. It was too fast for warts.

2) There is nothing to suggest you have a weak immune system. MC occurs all the time in entirely healthy persons.

3) Each new lesion needs to be treated or removed as it appears. Your doctor can give treatment advice. There are less expensive methods available -- in fact, the doctor can teach you how to easily treat them by poking the top of the bump with a needle and then squeezing out the white core. It will then heal. Or a prescription treatment called imiquimod (trade names Aldara and Zyclara). You shouldn't need to return for laser treatment every time. Within a few weeks, your immune system will kick in and new bumps will stop appearing.

4) Answered above; I'm sure the diagnsosis of molluscum contagiosum is correct.

Although MC can be sexually acquired, it's generally not considered an STD. You can google it for lots of information, including photos of typical lesions. It is a very minor infection, with no complications. After a few weeks, new bumps will stop appearing, then it will be gone forever. It is not dangerous in any way.

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55 months ago
hi doctor , this is my last follow up question so i need to ask about my 2 issues (HIV & wart)
HIV: i had my 12 & 20 & 27days combo tests all negative, 2 days after the last test i had some new symptoms that worried me again( strong sore throat-headach - body aches - lymph nodes on both sides of the neck and under my jaw - tonsillitis big size again - face pain - cough from time to time - phelgm - busy nose from time to time) with mild fever
- my question here doctor is can ARS happen after 4 weeks? and if i have now or later a typical symptoms to ars , could this change the face of reliability of my tests ? i mean shall i repeat the test ?
you reply on my HIV concerns sir will be a reference that i will keep in mind to deal with any present or future symptoms because in just 5 weeks i had many symptoms for 3 repetitive times .
2-HPV: i had a visit to a good dermatology expert and for sorry he confirmed what i have on my penis as WARTS
so sir i need to repeat my last questions with changing the fact that i have warts , not MC
-Is that normal sir that it appears so soon after removing ?
- do this means that I have a weak immune system (because of anxiety about HIV may be) ? If yes . What test can I do to examin my immune system 
- what can I do to help my self get red of these things ?
- my wife is 35 years old and i know that there is a vaccine for HPV virus , but for this age will it be effective ? 
- how effective is condoms against Warts ?
as this is my last follow up i don't want to miss thanking you and Dr Hook for what you are doing here, you may listen to many thanking words from alot of users , but realy sir you can't imagine how this forum is helpful and in my opinion 25 $ is nothing when comparing it with having your case being offered & judged by an expert like you, Dr Hook or Terry. To have an advice from best of the best experts is an experience i will never forget specially when your concerns is something like HIV. thanks sir
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
55 months ago
ARS cannot happen later than 2-3 weeks after catching HIV. And even if you had ARS symptoms, it wouldn't matter. Your blood tests show you don't have HIV and any symptoms cannot be from HIV. Whatever symptoms you develop in the future cannot possibly be from HIV, if you are not reexposed. Please stop worrying about it and asking about it. The answers will never change!

If you indeed have genital warts, they were developing before the sexual exposure described above. As I said previously, warts cannot show up sooner than 2 months after exposure. Maybe sometimes as soon as 6 weeks, but never sooner. However, warts indeed can grow back and become visible 2-3 weeks after treatment.

There is no reason to suspect anything wrong with your immune system. The frequency of genital warts, or how quicly they reappear after treatment, are the same in people with strong or weak immunity. You should not have any testing of your immune system.

The HPV vaccine would not protect your wife from your HPV infection. As just noted, you must have had the HPV causing your warts for at least 2 months and maybe for years. Therefore, your wife has been repeatedly exposed. You need not stop having unprotected sex with her; that won't prevent her from being infected. Condoms are not very effective in preventing warts anyway. They're up to 90% effective for any single exposure, but with multiple exposure over time, most partners get infected anyway. But as I said, it doesn't matter in this case. Your wife probably has been exposed and/or infected for a long time, maybe years, and no prevention is going to be effective at this point. Most likely she is now immune to that HPV strain and will never have a problem with it. Of course if she develops warts, she should be examined and treated by her doctor -- but it won't do her any harm. Warts are a very minor health problem.

Thanks for the thanks about our forum services. Do your best to move on without worry. And please no new questions on this forum. We cannot give you any different answers than you have already had.

Best wishes--  HHH, MD


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