[Question #931] Herpes, HIV, or Anxiety?

52 months ago
Hello Doctors, 

Thanks for taking the time to answer my question. 3 weeks ago I had protected sex with a csw.  The condom remained on and intact through the entire episode. The past weeks following the incident I have been living in hell. I have no symptoms of herpes, but my only symptom of HIV is a burning sensation in my feet at night and it's disrupting my sleep. Every doctor I have talked to has written it off as anxiety. In fact, one doctor prescribed me klonopin which made the burning feet go away. Here are my questions: 

Is it possible that I could've contracted HIV from the csw and am already experiencing peripheral neuralpathy?

Is it likely that I contracted herpes after no symptoms in 3 weeks?

Can anxiety really cause burning sensation in the feet?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
Welcome to the forum. Thanks for your question. I think I can help.

You describe a very low risk exposure with regard to HIV. Condoms work very well; in 30 years I've never had a patient who acquired HIV after a single condom protected exposure if the condom didn't break wide open. Second, most CSWs in the US do not have HIV (average 1% or less). Third, even if she had HIV, the average transmission risk from UNprotected vaginal sex is only once for ever 2,000 exposures. Finally, your foot tingling is definitely not an HIV symptom. That's a symptom of neuropathy, and although HIV can be associated with neuropathy, that only happens with overt AIDS, i.e. typically several years after catching HIV. It cannot occur within 3 weeks. Also, tingling would never be the only symptom of an HIV infection.

Those comments answer your first question. There is virtually no chance you caught HIV; and absolutely no chance new HIV infection is the cause of the sensations in your feet.

You also misunderstand herpes symptoms. This also is not a possible cause of symptoms that mimic peripheral neuropathy, especially given that it is apparently symmetrical (involving both feet, right)? Neuropathy with herpes is always localzed, and occurs only with recurrent outbreaks, not the first infection.

I would not have thought anxiety a likely explanation for burning in the feet. OTOH, clonazepam (Klonopin) is an anti-anxiety drug, so maybe that's the best bet. Common causes of peripheral neuropathy include diabetes, alcohol abuse, nutritional problems, and as a side effect of certain drugs. So be sure and follow up if the symptoms continue or recur. But I remain confident it isn't either HIV or herpes.

Your risk for HIV was low enough that testing for HIV is optional. However, I assume you'll want to get tested for reassurance. You can have a standard antigen-antibody blood test for HIV (also called a 4th generation, duo, or combo test) in about a week; this test is conclusive any time 4 weeks or more after the last possible exposure to HIV. I do not recommend herpes testing.

I hope this has helped. Best wishes and stay safe--  HHH, MD
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52 months ago
Thanks for your insight, doctor. I love the service you provide. I just have a couple of more questions to follow up with you on. I have a longtime girlfriend (I know, I am awful) and we frequently have unprotected sex, based on your recommendations, do you think it's safe to continue to have unprotected sex with her? We have not done so since the possible exposure. I should note that I have a canker sore on my bottom lip but I am very prone to those. 

Also, on the herpes front, I have experienced no bumps, lesions, or blisters since the event (believe me I have checked myself everyday since the possible exposure), is it safe to say I'm out of the woods on that one as well? 
52 months ago
Oh and I've already taken the step towards testing. There is a local state-run clinic here that does the HIV RNA test for the 12 day exposure. Is that something you would have recommended?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
I cannot guarantee you didn't acquire an STD. However, it is extremely unlikely. If I were in your situation, I would have continued unprotected sex with my wife immediately after the other exposure, with no worried about infecting her.  The canker sore doesn't concern me either.

Lack of painful genital blisters and sores within 10 days of the exposure is strong evidence you didn't catch herpes. Some genital herpes is entirely without symptoms, so here too, there are no guarantees. 

Instead of worrying so much you might have an STD, it would be more appropriate for you to congratulate yourself on the wisdom of using a condom during the event! That's what they are for, and there is no reason to suppose you were so unlucky as to be infected despite the condom.

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52 months ago
Thanks Doctor. I hate to do this but I have to ask while I have you on the forum as your insight is much appreciated. What do you think of the HIV RNA test? It is already under way and I've read that it can produce false positives so I'd like to be ready if that were the case. 

Also I've had a couple of night sweats, nothing drenching but damp. I know I always sweat when I sleep but is it possible to chalk this one up to anxiety? I've really had no other symptoms. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
False positives are very rare with the RNA test these days -- more of a problem several years ago, not now. It's a waste of money, since you could have an antibody or antigen-antibody test at 3 weeks,, which would be just as accurate and about one tenth the cost. (I hope you're paying yourself, not asking insurance to cover an unnecessary test no knowledgeable doctor would order!) After you get the negative RNA result, you'll still need an antibody (or antigen-antibody) test at 4+ weeks to prove with certainty you didn't catch HIV.

True night sweats only occur when there is high fever. The reason for sweating is the break in fever during the night. Without fever, you don't have true night sweats. Even for true night sweats, HIV is one of the least common causes.

You need to stop searching the web for HIV symptoms. All symptoms of HIV occur in a hundred other conditions, most of which are far more common. And even when symptoms are typical, a single symptom by itself is never due to HIV. New HIV infections cause multiple symptoms or none, but never just one or two.

As described on the forum introductory pages, each question comes with two follow-up comments and replies -- so that ends this thread. Stay mellow as you wait for your test results. There's no chance you caught HIV.

Best wishes.

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