[Question #8559] False positive HIV test but swollen lymph nodes + rashes - more tests?
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42 months ago
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33 months ago I had an unprotected vaginal sex with Japanese woman I met at bar in Japan. 97 days after this encounter I returned to the UK I got a full sexual health screening for gonorrhoea, chlamydia, syphilis and 4th gen HIV test. They came back negative. 18 months later, when I was 23, I got a minor bout of shingles behind my right ear along with a swollen lymph node (SLN) on the right back of my neck. This SLN has been here ever since and I have since developed a minor chronic rash on my scalp and itchy scrotum. Because of these symptoms I got a home self-sampling HIV, syphilis test kit where blood is taken from a finger prick and is put in a mini tube and sent to lab. This was 3 months ago and 30 months from potential exposure. This came back as reactive for HIV. After this I went to get a rapid 4thgen test at a private clinic which came back negative. I then went to an NHS clinic and got another 4thgen rapid test and a venous blood sample 4th gen lab test. Both came back negative. 11 days after I went back and got a full screening with a venous 4th gen lab test. All came back negative. Since then I have had many SLNs on my neck appear, 7 all appearing one after another and 1 right armpit. I have inflammation behind my ear, on my chin and neck. US scan showed that SLNs are swollen but are within normal range. My question is with my symptoms should I get a test from different facility to be sure I dont have it? Get a PCR test done as more accurate?
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Edward W. Hook M.D.
42 months ago
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Welcome to our Forum and thanks for your questions. You've had some bad luck, both in terms of your falsely positive HIV rapid test (false positives are somewhat more common with the rapid tests than with laboratory-based tests) and having acquired shingles (herpes zoster at a relatively young age (about 1/3 of persons will develop zoster at some time in their lifetimes, the frequency increasing with increasing age (persons over 50 are 10 times more likely to develop zoster than persons younger than 50). That said, all of this can readily be attributed to bad luck and I urge you to accept your multiple negative laboratory-based HIV tests.
Having a swollen node following zoster is not uncommon and does not suggest an ongoing pathological process. Should the node begin to increase in size or become more tender (as long as you have not been poking it), further evaluation by a trained clinician is warranted.
Personally I see no medical or scientific need for PCR testing although I know well just how unnerving a false positive test can be. If you choose to have a PCR test done, this is understandable and I am confident it will be negative although I must warn you, falsely positive results are, if anything, more common with PCR tests than with laboratory-based 4th generation combination HIV antigen/antibody tests. EWH.
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42 months ago
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Thank you for your quick and detailed reply.
My reactive test was actually sent to a lab and was not a rapid test. You drew blood into a mini tube and posted it away. I have since read a study conducted in the UK that concluded that mini tube self sampling has a very high false positivity rate in comparison to dried blood spot sampling so that does fill me with some hope.
A worry I have is that I have only had negative lab tests from the same place presumably using the same machine. Would it be worth using a private company that may use a different brand of lab test to fully confirm? For example a PCR would be both a different lab and a different test so would prove for sure I have had a false positive? Also is it possible that I have picked up a strain from Japan that is less likely to be picked up by a test used in the west? Does region affect the accuracy of tests?
Lastly, is the gradual increase the amount of swollen lymph nodes I am getting a concern and indicative of HIV? Especially since I have had shingles which
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Edward W. Hook M.D.
42 months ago
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Sorry for my misunderstanding. Indeed, self tests using capillary blood tubes do have a somewhat higher false positive rate than lab tests. Since then however you’ve had at least three. additional negative tests, two rapid tests at different clinics and one laboratory 4th generation test. The rapid tests and the laboratory test however use different technologies. I would urge you to accept these results. If it does make you better you could do a PCR or seek another laboratory to test, then do so -you surely don’t need my permission- but I am confident the results would remain negative. The paraphrase Albert Einstein “One definition of insanity is to keep doing the same thing again and again and expect different results”. You have a good explanation for your false positive result and I would urge you to it.
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There are Internet myths about so-called undetectable HIV virus variants, particularly arising from the Far East, however these are myths and have no scientific basis. There is no regional variation in test accuracy.
Again, you have a logical explanation for the lymph node that you can feel. The more you prod it, the more likely it is to become tender or enlarge. The lymph node swelling which is associated with HIV is not isolated to one area but it’s a generalized phenomenon best detected by a train clinician.
I truly understand your concern over the false positive result. I urge you however to accept the science and explanations you have for your bad luck and figure out a way to move forward. EWH
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42 months ago
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Thank you for your reply. I know what you have said is conclusive but I would like to use my last reply to ask some questions as it's rare I can talk to a health care professional
While the test I had was not a home test, it was sent to a lab who performed a 4thgen lab combo test, I get your point that I have had numerous negatives since then. I've had 4 subsequent negatives overall, two additional lab tests and two rapid.
I do have a swollen lymph node in my armpit, cheeks and near my ear as well and some have raised in the last few weeks, long after my shingles infection. Does that indicate an on going infection?
Another thing is that I have lots of symptoms that when I look online relate to hiv. Eg I wake up with a dry mouth daily, I've developed several rashes like on my scalp, one on my knees and inflammation behind my ears, I had none before this along with general itchiness and muscle aches in my arms and neck. Sometimes skin above swollen lymph nodes seems to itch. Even shingles itself can be a presenting symptoms of hiv. Is it common for someone to have so many symptoms that relate to hiv, a reactive test and not have hiv? Is it too much of a coincidence that would warrant further tests, as protocols I read online about what to do after a reactive test seem to say a pcr should be done as a decider.
For context, I have a partner so I want to be sure I haven't given hiv to her. From what I have told you, can I be sure i dont have it and haven't given it to her?
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Edward W. Hook M.D.
42 months ago
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1. The problem with tests performed on specimens collected in the home setting has less to do with the laboratory processing of the specimen and more to do with the collection process and device is used for collection. Further, false positives do occur from time to time without an obvious exclamation.
2. If a person pokes and prods himself enough, they can often detect the presence of lymph nodes. This is not at all unusual. These detectable lymph nodes, which are not necessarily representative of an ongoing pathologic process, are most easily detected under the armpit, in the groin, and below the jar and in the neck. Clearly, the combination of your false positive test, your shingles, and the lymph nodes that you have been able to feel are causing you concern. That being the case, while you have proven that these are not due to HIV, I would urge you to discuss them with your regular healthcare provider.
3. When persons begin to look for signs and symptoms, they often detect or become increasingly aware of normal sensations which would in at other times be ignored or overlooked. I suspect this may be happening in your case. Once again, the way to address your list of symptoms and concerns is to discuss them with your own healthcare provider who can look at these issues more comprehensively. I remain confident that you have already proven that they are not due to HIV.
Hope this perspective helps. EWH
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42 months ago
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Thank you doctor. I'll take what you've said and try and move forward.
The difficulty is that HIV has such broad effects on your body that any illness could be a symptoms of HIV. For example, I've had two separate severe coughs over the past month and my partner has another which makes me think maybe we have a weak immune system. But then it also could just be put down to us all isolating for so long that it's 18 months worth of colds and flus hitting us at once. Likewise I find myself sleeping very long hours and napping a lot during the day but that could be put down to recreational weed use and stress from the false positive. HoV really is one of the worst conditions to wrongly think you have as everything can be evidence of it.
I think I should trust the tests and maybe get another test in a few months just to be safe. Thanks for the help.
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Edward W. Hook M.D.
42 months ago
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I appreciate your concerns but can assure you, if your symptoms had been related to HIV, your tests would have been positive. I wish you the best in your efforts to put this behind you. One additional suggestion. Please avoid the internet, much of what you will find there is incorrect and misleading.
This completes this thread. EWH
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