[Question #8870] Scared of infection

38 months ago

Hello sorry to be back. 4/29-4/30 pick up girl at a bar we will say high risk, went back with me pretty easily. performed both oral and vaginal sex twice.. NO condom. Stupid, and alcohol.. 3 days later, I know early, started having muscle and joint aches, and been a downward spiral since. Stress level thru the roof almost debilitating because added in over the next several weeks medium sore throat,altered taste, terrible dry mouth which remains. mouth sores on the inner gums by roof of mouth on one side, nausea, complete loss of appetite, have lost 15 lbs. stomach constantly making noises. Itchy forehead and scalp.Tested 4th gen from vein 26 days negative. I hr after blood draw ate dinner and then right side of face swells so off to the ER I go and am diagnosed with Parotitis. antibiotics given and swelling went down by next day, this was accompanied by bad diarrhea for 2 days, before the antibiotics. now very wet loose stools. Feel fatigued and just generally not well. Had one small rash week 2 on front of shoulder 1 inch by 1 inch several raised red bumps which has since cleared, NO fever at all. Lymph nodes at both outer sides of hips are felt if i move certain ways. I know 28 days was threshold but has since been moved up to 42. My question is my test although 2 days early from 28 and then the gland swelling and diarrhea, if this is seroconversion wouldn't the test have picked up on the antigen side and in theory antibody should have started to be made. Can I put any kind of reassurance in a 26 day negative 4th gen test. I do plan to test again Could massive stress cause my salivary gland to back up like that? Also for what its worth I did a 10 panel test,,I do have HSV 1 but thats it and cant remember last time i had a cold sore. Had Covid 2yrs ago, not vaxed,, and did have on and off runny nose and cough thruout , so maybe round 2 for Covid?.Smoking ciggs again which may not help things either.Sorry to bother you on a holiday weekend. Thank you Drs.

H. Hunter Handsfield, MD

38 months ago

Welcome back to the forum, several years later. I'm happy to address this question.

Neither HIV nor any other STI typically causes most of the symptoms you describe. Perhaps more important in addressing your worries, your negative HIV antigen-antibody test (AgAb, the proper terminology for what used to be called "4th generation" blood tests) shows HIV isn't the cause of your symptoms. The symptoms of a new HIV infection (acute retroviral syndrome, or ARS) are caused by the immune response to the virus. Therefore, everybody with ARS symptoms more than a few days in duration has positive AgAb test results. In theory, you could still have asymptomatic HIV -- it take up to 6 weeks for conclusively negative AgAb test results -- but it does prove HIV is not the cause of any of your symptoms. And effectively it rules out HIV entirely: when you add up the odds any particular sexually active woman in the US has HIV (under one in a thousand), the low risk of transmission for any single exposure if she does (average once for every 2,500 episodes of unprotected vaginal sex) and the negative AgAb test at almost 4 weeks, the chance you have HIV is no more than one in a billion. The chance you'll someday be struck by a meterorite probably is higher!

As to what IS causing your symptoms, I think you're on the right track to ask about COVID, which sometimes is associated with salivary gland inflammation, including the parotid bland (parotitis). You definitely should be tested for it -- indeed I'm a bit surprised you weren't tested for it during your ER visit (although I can forgive some ER docs for not knowing about the association of parotitis with COVID). In any case, certainly most of your other symptoms also are consistent with COVID -- although some of them may indeed be anxiety magnifying minor symptoms or even normal body sensations that you otherwise wouldn't notice (but not parotid gland inflammation or diarrhea).

So the bottom lines are 1) yes, you can put very strong reassurance about HIV from your negative AgAb test at 26 days and 2) yes, for sure get tested for COVID. And 3) although you don't mention other STIs, given the sexual exposure described, it might make sense to have urine or urethral swab testing for gonorrhea and chlamydia, and a syphilis blood test. However, this depends in part on what antibiotic(s) were prescribed in the ER. If you'd like to tell me which drugs they were, I can be more specific.

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

Oh, and by the way: whether or not you test positive for coronavirus, get your COVID vaccine! (I know, I know -- the media attention to COVID vaccine denial is unavoidable. But not being immunized is not only dumb from a personal health standpoint, it is flatly irresponsible. You have a duty to your fellow citizens to not be a potential transmitter. Sheesh!)

HHH, MD

---
---
---
---

38 months ago

Thank you for the speedy reply Dr Handsfield! The antibiotics perscribed is ammoxicillin and Clavulanate potassium together in one pill,875/125mg.. I did mention that I did take a 10 panel std test which cked for Gon, cly, Hep b,c, Hiv, 4th gen, syphillis, and herpes 1 and 2.. Herpes 1 did light up but I have had that for years. Cant remember last time I had a cold sore..The rest were all negative. These tests were done before the antibiotics were perscribed. I may have to do another because I think its still early for Syp and Herpes. 2.. Your reassurance is very much appreciated and highly valued by me! I feel i can relax a bit at this point!

H. Hunter Handsfield, MD

38 months ago

Thanks. You've had all the STD testing you need. Amox/clav will have aborted incubating syphilis if you had acquired it, so no point in testing; and herpes testing for sure doesn't need repeating and the tests aren't all that accurate: you would be taking a risk of a false positive (and highly confusing) HSV2 test result, which probably is the last thing you need at this point. If you would like a 100% conclusive HIV test, do that again at 6 weeks. Otherwise your smartest course is to do nothing. (Except get that COVID vaccination!) (This may be an HIV/STD forum, but we are also general infectious diseases and public health experts, and I have no patience for head-in-the-sand stupidity about COVID and other immunizations.)---
---

38 months ago

Good evening Dr Handsfield, as you predicted your 18 year streak continues as I tested for Hiv at 45 days Ag/Ab lab drawn blood test and it was negative. Can I now consider this fully conclusive and no further testing needed? Another question, Could HSV2 infection have caused the flu like symptoms i experienced? I know you said that I should be good in that area, but I still wonder if I should wait the 8-12 weeks and have a blood test for that as well. Thank you so much for the service both you and Dr Hook provide.

H. Hunter Handsfield, MD

38 months ago

Yes, conclusive for HIV; no more testing needed.

Initial HSV2 infection certainly can cause systemic ("flu like") symptoms, but almost never without also more typical herpes symptoms, i.e. blisters, sores, etc at the exposed site(s). I don't see a need for repeat HSV2 testing. If you do it out of curiosity or over-caution, I would wait until 12 weeks after the exposure.

That will end this thread, but I'll make a deal with you: If you go ahead with HSV2 testing, and if positive (I'm sure it will not be), post a follow-up comment and we'll waive the posting fee.

Thanks for the thanks. Best wishes. Oh and by the way: since you're happy with the forum and, by extension, our parent organization, consider making a tax-deductible donation to ASHA at www.ashasexualhealth.org

---
---