[Question #7277] Follow up for Dr. HHH: How conclusive are these results?

6 months ago

Dr. HHH: As background: I masturbated another man, and then used a paper towel to wipe off my hand and then stupidly  reused that towel on my genitals. I also mentioned potential irritation from trimming my scrotum with an electric grooming tool just before the incident. I was unable to get an erection (even in the mornings!) for several weeks and felt a stinging toward the tip of my penis. I read on WebMD that low sex drive and penis pain are early symptoms of HIV. Then the cold night sweats started. They continue to this day, and they are terrifying. I also have diarrhea, dry mouth, a canker sore, and a swollen lymph node behind my left knee. The other guy told me he tested negative in a rapid antibody test, but has not returned my messages about the antigen test, which makes me wonder if he is getting extra HIV confirmation tests before disclosing anything. So now I am limited to my own tests, which include a neg. 4th gen at 26 days, neg 5th gen Elisa at 39 days, and at 46 days: a neg. 4th gen. Alere Determine rapid test and a follow-up blood test using CMIA, which I presume is 4th generation since it's from the same place as the first test. Are these tests conclusive? Does this put me in the 90th percentile? 95th? 99th? What if I wake up tomorrow with a fever or sore throat? Or is it not exact science? Could 46 days be 52 days for someone with a healthy immune system or someone who is slow to develop antibodies? Are there ever positive cases where antigens are not detected until 7, 8 or 9 weeks after? You said last time that HIV-induced night sweats would have created antibodies, so I hope that is true in the case of my body. They have been occurring more than a week, so it presumably would have been picked up in the last test. Thank you again for considering my additional questions. Obviously it has been weighing heavily on me, but I don't want to be overly optimistic about this 46-day test if it's not an exact science.

Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago
Welcome to the forum. Dr. Handsfield and I share the forum and take questions interchangeably. Clients are not permitted to request a specific response from one or the other of us. We have worked together for nearly 40 years and while our verbal styles differ, we never differ on the substance of the messages that we transmit to patients. You do not have HIV.

Thanks for sharing the details of your encounter of concern. It was a no risk event. All experts agree entirely that mutual masturbation is a no risk of that, even in those occasions when participants get each other’s genital secretions on one another.  This is the case even in situations where there may be an abrasion, lesion or recent shaving may have occurred. Thus, if you had asked me if you needed testing I would emphatically sayThat there is no need for testing because the event did not put you at risk for infection even if your partner did happen to be infected most persons do not have HIV and when I ask most patients accurately report whether or not they are infected.

Your test results validate the information I have provided above. The Alere test is highly reliable. A fourth generation test taken at any time more than six weeks following an exposure provides entirely reliable results.  There is no need for further testing of any sort.

Now for a few comments regarding your symptoms.  Neither low sex drive nor penile pain are signs of HIV infection. On the other hand, low sex drive and night sweats may well be a manifestation of anxiety and concern. Irrespective of what symptoms you might have, your test results negate the possibility that you have HIV. 

I hope that the information I have provided is useful and will allow you to move forward without continuing concern. If any part of this message is unclear or further clarification is needed, please don’t hesitate to use your up to two follow-up questions for that purpose. Take care. EWH

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6 months ago

Dr. Hook, I am a little surprised to hear you would have advised me not to get tested. Sure, there has never been a documented case involving hand-to-genital contact, but there is still a chance of infection, right? Especially if I wiped the paper towel over the tip of my penis?

 

On that note, does the head of a circumcised penis count as a mucous membrane, or are we only worried about seminal fluid making its way into the urethra (which still has a possibility, right)?

 

This is the WebMD article I mentioned, which is what originally tipped me off to the possibility of HIV. https://wb.md/3cdelnG. Please read it. It's brief. It says that my lack of erection for three weeks could be due to hypogonadism, which could be caused by HIV. The discussion about bacterial prostatitis also explains the stinging in my penis in week 3 and 4, as well as the dull pain in my left testicle, which still somewhat persists even in week 7.

 

As I mentioned earlier, I have also had extreme dry mouth, numbness/tingling in my hands and feet and pain behind my left knee, where there is a lymph node. I also get light-headed easier than normal, and whenever I do any mild amount of exercise, I find the sweat on my forehead is cold and my body feels a mix of hot and cold. I also get hot flashes throughout the day for no reason. The cold night sweats have mostly gone away, but I still sweat more than usual in my sleep.

 

It seems like you are convinced that I do not have HIV. I would love to believe that is true, but then how do I make sense of these unusual symptoms? Anxiety only explains away so much, and the timing is too coincidental, especially since I am unlikely to catch a cold by staying at home and wearing a mask outside of the house. Are there any other STI’s these symptoms could be linked to?  

 

As background, I am 35 years old and I've tested negative for chlamydia, gonorrhea, UTI, trich and syphilis. I went through the usual course of Hepatitis B vaccinations in childhood and adolescence, but aside from my stomach trouble, my symptoms don’t seem to match Hepatitis B.

 

Please feel free to comment on all of my questions, but I will also enumerate some to make sure they did not get lost in the fray.

1)    Is a circumcised penis head a mucous membrane?

2)    Please comment on the WebMD article about hypogonadism/bacterial prostatitis. Would this delay HIV antigens from showing up in an AGAB test if it was sequestered in my prostate/testicles?

3)    What should I make of my other symptoms such as dry mouth, light-headedness, night sweats, cold sweats, hot flashes, pain behind left knee (where there is a lymph node)?

4) Has anyone ever tested positive after the 45-day testing window for AGAB tests, aside from people on PREP or PEP? Is a test on day 46 conclusive?

Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago
If you want to be tested, you should seek testing.  On the other hand, if you want to know if there is a science-based recommendation in the situation you have described, the answer is no, there is no need for testing.  This assessment is based on assessment of thousands, if not millions of persons with similar exposures over the nearly 40 years we have studied HIV.  Your risk of HIV from the exposure is about the same as your risk of being struck by a meteorite falling from space- you’ll be the first.in response to your specific questions:

1.  The head of a circumcised penis is not a mucous membranes.  Surface contact with infectious material continuing HIV will not lead to infection.
2.  The Web MD piece is full of generalizations and really does not provide useful information.  It could list just about anything as being associated with HIV.
3.  These are non-specific symptoms which can be caused by almost anything, including anxiety.  If you accept that you do not have HIV and the symptoms are still troublesome, you should discuss them with your own healthcare provider.
4.  No.  More than 99% of infected persons are positive at 4 weeks.  By 6 weeks, all tests are positive.

I hope that this information is helpful. EWH


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6 months ago
Hi Dr. Hook, I have tried to take your statements to heart, but in the last couple days, I have been concerned by swollen lymph nodes on the left side of my neck (and a tightness feeling on the left side of my neck. I have been telling myself it's due to me checking them too often.  I also have mild body aches and low energy, which as a reminder, comes on top of the dry mouth (and subsequent raw tongue); trouble sleeping; tingling/numbness in extremities, a several week period where I couldn't get erections; and a  dull pain in my left testicle. Despite all these symptoms, would you be willing to say with 100% certainty that this is not due to HIV, considering the negative 4th generation test results at 21, 39 and 46 days? Even if I managed to wipe his sperm directly over my urethra hole with the paper towel after the incident? I've also tested negative for chlamydia, gonorrhea, UTI, syphilis...Are there any other STD's that you think could explain these symptoms, given the incident I experienced? I am particularly curious about the dull pain in my left testicle...could it be herpes or HPV from 5-10 seconds of penis-to-penis frottage? Prostatitis? I don't have any burning during urination, and my urinalysis culture came out normal on three different occasions about a month after the incident, when I had stinging in the tip of my penis in addition to the testicle soreness. I am going to a doctor in two weeks and am wondering what tests I should request. Thank you in advance for your consideration.
6 months ago
I forgot to mention that I am now 8 weeks out from the incident. Other symptoms I have noticed include abnormally cold hands and feet, unusually smelly sweat and a burning feeling in my nose. I have also experienced many nights of cold and hot night sweats, but those have went away very recently. 
6 months ago
For a more detailed accounting of the situation:  I gave a man a handjob, rinsed my hands with water (semen is thick so it remained on my hands, especially between my fingers) and then I wiped my hands with paper towel. Then I think I used that paper towel to wipe my genitals. I believe I at least folded the towel over before touching the tip, but my memory is hazy. The man in question said he tested negative to an antibody test a month later, but he has lied about other things...This is a follow-up to 7262 by the way.
6 months ago
This will be the last addendum: I also am beginning to have a sore throat, which has got me very scared.  Thank you again for your expert insight on these matters.
Edward W. Hook M.D.
Edward W. Hook M.D.
6 months ago
I’m sorry you’re having so much trouble with this. You are repeating yourself And that will not change the answers. I’m well aware of the exposure you described, as well as your test results. Once again the exposure was a no risk event. The use of the paper towel you describe is likewise no risk.  Further even if it had been a risky exposure your test results prove that you were not infected with HIV. I am not doubting your symptoms but I am confident they are not due to HIV.  

At least some of the symptoms you’re describing our manifestation of your anxiety related hyper-awareness. As far as the swollen lymph notes you describe, this is a difficult diagnosis even for trained physicians. Most people have lymph nodes which can be felt.  Whether or not they are abnormal however is another question.  I would suggest that you ask your own physician to verify whether your lymph nodes are swollen abnormally or not. If they are you need to look for a cause but that causes not HIV or any other STD from the exposure you have described.

As you know from your previous posts, we provide up to three responses for each client. This is my third response. Therefore this thread will be closed with no further responses. In addition I must warn you that further repetitive, anxiety – driven questions may be deleted without a response. This is not an STI, and is not HIV. You need to move on.  Take care.  EWH
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