[Question #7630] Follow up to 7587

3 months ago
Hey dr’s.  Trust me I’m not happy to be back so soon. But I’m at a loss in terms of my situation. So today was 22 days post exposure and 18 days dealing with groin pain.  For about 6 days now I am also experiencing pain under my front ribs and back ribs.  As well as pain in my hip joint.  3 days ago I  developed  a rash consisting  of two small circles filled with really  itchy red dots on the top of my left foot. So I’m  kinda freaking out.  Starting to worry about HIV so I might get a RNA early detection  test tomorrow.  Is it correct that at my time frame of 22 days it would be 90-95% accurate.   Still plan to test at six weeks but don’t think I can wait that long.  To update you On my search for answers I had a cat scan of  my chest abdomen and waist.  No nodes were noted to be enlarged and nothing noted except right interpolar  3mm nonobstructing calculus.  So this combined with my blood work my doctor says I’m fine.  Problem is my groin and everything else disagrees.   So Any advise you can offer on helping me discover what’s going on specialist   or thoughts on my testing or anything you think could somehow help or direct me to help would be much appreciated.  Thanks again 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Welcome back, but I'm sorry you found it necessary. I'll be managing things this time, but I reviewed your recent discussion with Dr. Hook. I agree with all he said.

I'm afraid the forum really can't help much at this point, at least not in the way implied by your question. We do not provide direct medical care, and are not a source to discuss the details of ongoing care, especially when the forum user has a physician and is in care. Since your doctor says you are fine, that also is my opinion. And certainly you describe no symptoms or test results that would concern me if I were your physician. As Dr. Hook advised, you had a sexual exposure that was exceedingly unlikely to result in HIV transmission (a partner statistically very unlikely to be infected, and exposures that were essentially risk free even if she did). Your symptoms are less suggestive of HIV than you apparently think. Based on all you say, I'm rather amazed that a chest-abdominal CT was done -- you must have been very persuasive with your doctor. All the available information indicates that you have no infection of any kind from the sexual exposure 3 weeks ago, and you definitely can expect negative results both on your planned RNA test and follow-up HIV blood tests. All I can suggest is that you keep working with your doctor if your symptoms continue or you otherwise remain concerned.

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

HHH, MD
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3 months ago
I guess I’m really worried because I had no issues with my health before this encounter.  I think my blood work indicated I was probably fighting some kind of infection.  Not completely sure.  Like the dr said could have been common viral infection but what is the likelihood it’s mono or cmv.  Are there test for those because at least if it was that I would have some answers.  I mean I’m losing my mind because I’m not making these pains up.  I think I may need a new primary because when I asked him if maybe I have mono he said to me you’re not in your teens or early twenties.   I understand you can’t give medical advice especially since I’m under the care of a dr. It’s just besides him I’m completely alone in this and feel a little uneasy taking one person’s analysis as gospel.  So sorry to be repetitive and I understand you are limited in the advice you can give but 2 things 
I took the rna test today at 22 days.  Is it 90-95% accurate today and 2 if while having sex her vaginal fluids rolled down and then afterwards when  she was masterbating me rigorously could she have massaged any std or hiv being how hard it was done and the fact my penis was somewhat damaged by the swelling which may have opened up some pathways.  Or does it have to enter the through the tip of penis.  Thanks again 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Everybody gets unexplained symptoms of various sorts from time to time. Occurrence after some event doesn't mean that's the cause. If you had an exposure that had any chance of infection, or if you had typical symptoms or lab results consistent wit these things, your concerns would make sense -- but that's not the case. Your blood work definitely did not necessarily indicate you were fighting an infection. It's conceivable you indeed have had some sort of minor viral infection, or maybe nothing at all.

Yes, an HIV RNA test would detect 90-95% of new infections at this time. I would put the chance you caught HIV at no more than 1 in a million. So when you get the negative result, if we assume 90% accuracy, it will drop the odds you have HIV to one chance in 10 million. And indeed, HIV inoculation occurs via the urethra -- although if you are uncircumcised, some infections may be transmitted by contact with the inner surface of the foreskin.

Perhaps you'll also be interested to know that in the 16 years of this and a preceding forum moderated by me and Dr. Hook, with thousands of questions from people concerned about HIV risk, not one turned out to have HIV. If that happens someday, I expect it to be from a truly high risk exposure, like unprotected anal sex with a known infected partner -- and not someone at virtually no risk. So I am very confident you won't be the first. 
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3 months ago
Okay thanks for the feedback dr.  When you say if I had typical symptoms or lab work what exactly are you talking about.  I was reading Dr.Bob on the body give stats on ars.  It listed out of the people who experience ARD 96% have fever don’t have.  74% have adenopathy I have.  Started in groin.  Then around ribs and now today my armpits. I was feeling my left armpit because there was pain when I put my arm down.  Now I am in extreme pain from that.  Like throbbing pain. Pharyngitis 70% don’t have.  Rash 70%. Had on top of foot. Hepatosplenomegaly I did notice and bump where my spleen would be.  Started with dry mouth today. There is more symptoms but im sure you know them and they don’t apply.  All this right in the 1-3 weeks which is when it occurs.  When experiencing Ars you will have a combination of these which I do.  So I don’t know I’m scared, anxious and super depressed.   
1) I know my exposure was low risk but do you still think I will be negative on my rna and 6 week duo.
2) are all these symptoms just coincidence or am I rational to be concerned.  
3) i know this ends my thread but I would appreciate it if you leave it open so I can post results.  Thanks again dr’s I really do appreciate talking with you all it makes me feel somewhat less alone in this and your feedback does calm me until something else springs up.  

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
You are over-interpreting (or entirely misunderstanding) what you're finding on the web. If you list all symptoms of ARS, you'll find that almost all occur with at least 100 other conditions (including trivial viral infections). You simply cannot conclude that because you have symptom X listed as an ARS symptom, you might have ARS. The exposure history and test results are much more reliable -- symptoms are meaningless. I'll say it again:  meaningless -- that is, symptoms almost never are valid indicators of new HIV infedtion.

1) Yes, your results wil be negative.

2) "Rational" to be concerned? Sure, initially. But not after hearing the scientific facts, both here and in your previous discussion with Dr. Hook; and perhaps with your own doctor(s). Normally people receive new information and change their views and fears as a result. Why not you?

3) OK, we'll leave it open. But only for one more comment, and only for conclusive test results. No need to tell me of your negative RNA test. After you have also had a negative AgAb (duo, 4th genertaion) test at 4 weeks or more after exposure, I'll be happy to hear those results. OK?
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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
I didn't mean to be quite that restrictive about timing of one last comment. Feel free to either let me know your RNA test result at ~3 weeks after the event; or to wait until you also have the the AgAb test results. But not both; the thread will be closed after your next comment.---
3 months ago
Hey drs.  I couldn’t wait until 6 weeks to test so like I mentioned I took the hiv rna early detection test at 22 days and that was negative. At 4 weeks I took the remainder of tests even though it was early.  So I’m assuming I have to test again at 6 weeks or 3 months whatever you recommend.  Those were all negative as well so super excited about that. I know this is my last response and was told I can only post the results but if you could please answer one thing for me I would really appreciate it.  I am a little confused about the HSV results.  I’ve never had a sore on my mouth like ever.  Like 100% ever.  My results were hsv-1    .2        
Hsv-2.  <.2. 
So .2 means I’ve have hsv1 or tested to soon.  I’m confused.  Also <.2 for hsv-2 I guess same question.  I thank you thank you in advance for replying.  If you can’t I would be more than happy to purchase another question just let me know in the reply.  Once again thanks for all your advice I just wish I didn’t doubt so much it would have saved me a lot of stress.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
3 months ago
Your results are negative for both HSV1 and HSV2. What's the confusion or uncertainty? You have neither one.

Please do not post another question about any of this. Thanks.
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