[Question #8355] HIV or something else?

45 months ago

Hello, so I have HSV 2 orally and genitally. September 17th I had oral sex (male to male) both give and received. My partner did not finish in my mouth. However, I finished in his. The next day I started to feel a sore throat and started to get swollen lymph nodes in groin and neck. The night after I had also experienced night sweats. I started to freak out and within 56 hours I started PEP. A week after the exposure I had a STD test (4th generation) and tested negative on all STDs (besides HSV 2). I also started to develop benign fasiculations ( which I tend to get after being sick/ or infected with something) full body. 4 weeks from exposure I re-test for all STD’s (4th generation) and tested negative, after finishing PEP. However, my lymph nodes are still very tender to touch in my groin. A doctor proactive gave me Cipro 250mg and a Zpack to fight precautionarily chlamydia or gonoherrea. I tested now 6 weeks again for STD’s and still negative but still have lymph pain. Are there chances that I have acquired HIV ? And the PEP failed? ….. I do not have a fever, rash, body aches, fatigue, headache, or sores.

Edward W. Hook M.D.

45 months ago

Welcome to our forum and thanks for your questions. I’ll be glad to comment. As I read your post, it appears that you both gave and received oral sex. You do not know the HIV status of your partner. Irrespective, the risk that you acquired HIV from this exposure, even if you had not taken PEP, is very, very low. There are no instances in which HIV has been demonstrated to have been acquired through receipt of oral sex. On the other hand, there are a small number of instances in which persons have acquired HIV by performing oral sex on an untreated, HIV infected sexual partner. The CDC estimates that these events occur less than once in more than 10,000 exposures ( I.e. 1/100th of 1%). First, even if your partner was HIV-infected your risk for infection was very, very low.

Now, to address the symptoms you report. From your report that your experienced the onset of symptoms 24 to 36 Following the encounter you described. This is simply too soon for the onset of HIV related symptoms. On the other hand, it’s entirely consistent with the onset of symptoms from a strep throat or an every day viral sore throat Of the sort we acquire on a regular basis. If you had approached me requesting PEP, I would have done my best to talk you out of it. Nothing about the exposure you described, no your symptoms makes me concerned about HIV.

Since then, you have experienced a variety of symptoms. The symptoms are not suggestive of recently acquired HIV and, quite frankly, have occurred too soon to be due to HIV. In addition, if your symptoms had been due to HIV, your HIV test would have been positive. Symptoms do not occur in the absence of a positive test.

Regarding whether or not this could be a failure of your PEP, it is not. If you were symptomatic due to failure of PEP, your test would be positive.

In summary, based on the test reports that you describe, as well yes interpretation of your clinical findings in the context of your test results, I remain confident that you were not infected by that exposure with HIV or other STI’s from the encounter that you described.

I hope this perspective is helpful. If you have additional questions or any part of my reply is unclear, please don’t hesitate to use your up to follow-ups for clarification. Believe your test results. EWH

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45 months ago

I really appreciate the speedy and informative response and thank you. However, since the exposure my lymph nodes in my groin have been very tender to touch. I haven’t felt like this since acquiring HSV2, as well as the fasiculations. What do you suspect it could be? Could there be a virus that does not particularly have to be a HIV, HPV, HSV?

Edward W. Hook M.D.

45 months ago

Lymph node swelling and, particularly tenderness is a nonspecific sign of inflammation which could be due to any number of different types of infection or other non-infectious processes. It warrants investigation by a trainee clinician who can evaluate you for other, more subtle node swelling at other sites and take steps to address the cause. You’ve proven that your swollen, tender nodes are not due to STI. EWH ---