[Question #9811] HIV

28 months ago

I am feeling very anxious and could really use your help. I am a 22-year-old male who had a promiscuous year, having had sex with between 10 and 20 sex workers in the UK and China. I engaged in vaginal sex using condoms and received oral sex, sometimes with a condom but not always. I also performed oral sex on a few of them. I don't know why I chose to live this kind of lifestyle, perhaps it's because I started living alone last year. The last time I had sex was 10 days ago. However, I suddenly became very anxious about contracting HIV. I don't recall any condom failures, but on some occasions, I think the condom did not cover my entire penis. However, I believe my penis head was covered. I am uncircumcised.

I have been experiencing some symptoms, such as a sore throat. I have had a chronic sore throat from time to time. I suspect I might have silent reflux, but I am not sure. Now, my sore throat has returned. It's mild, but my anxiety is extreme. I'm also experiencing pain throughout my body. I have pain in my legs, feet, arms, shoulders, and back, but the pain is not severe and doesn't affect my daily life. However, I am scared. Some people say that prolonged sitting can cause this kind of pain. In the last few days, I've been sitting at my desk for several hours per day. I have also noticed lumps when I try to find my lymph nodes. They do not seem to be painful, but I'm not entirely sure what they are. I can't stop searching on the internet.

My questions are:

Are my symptoms typical of HIV? Do I have ARS?

Can a healthy person palpate lymph nodes? I have seen different answers online.

Can anxiety cause pain in the body, like foot pain or leg pain? Can sitting cause this type of pain? What are the characteristics of the muscle and joint pain caused by HIV?

What are my chances of survival? I am very scared.

28 months ago

I also have mild armpit pain. Is this a typical symptom of ARS? Can anxiety cause armpit pain? I'm scared to death. Please help me.

28 months ago

During the time I was waiting for your response, I developed mild hip and groin pain. Could this be a result of sitting at my desk? Is hip and groin pain a typical symptom of HIV? I feel like I experience a dozen symptoms every day, and I don't know how to calm down.

H. Hunter Handsfield, MD

28 months ago

Welcome to the forum. Thanks for your confidence in our services.

I entirely understand your concern about having HIV. However, I can assure you that almost certainly you do not. There are several reasons. First, it is statistically unlikely that any of your 10-20 partners had HIV: in the UK (and according to my admittedly limited understanding) most of China, under 1% of female sex workers is infected; in UK it's more like one in a thousand. Second, when a female has untreated HIV, the average transmission risk by unprotected vaginal sex is around one chance in 2,500; and condoms work well to reduce that risk by 100-fold. (Condom protection against HIV is considered complete as long as the head of the penis and urethral opening are covered.) And oral sex is very low risk: there has never been a reported, scientifically documented case of HIV being transmitted mouth to penis or by cunnilingus (oral-vaginal).

Finally, your symptoms are not at all typical of acute retroviral syndrome (ARS, i.e. initial HIV infection). You don't mention any of the most typical symptoms. On and off ("chronic") sore throat doesn't qualify, and you say nothing about fever, skin rash, or diarrhea. Whether or not a healthy person can feel lymph nodes depends on how hard they look, whether medically trained, and the like; and anyone trying hard enough can feel irregularities under the skin that might be considered "lumps". The lymph node enlargements of ARS are not so subtle.

Can anxiety cause these symptoms? Yes. In particular, anxiety or stress can greatly magnify minor symptoms that otherwise might be ignored or not worrisome, or even expand normal body sensations that otherwise wouldn't be bothersome and maybe not even noticed.

Does all this prove you do not have HIV? No; your risk is low but not zero, and symptoms and exposure history alone never tell the story. Testing is required. Presumably you're planning on having an HIV test, right? Do it soon. For all your sexual exposures more than 6 weeks ago, a negative standard AgAb ("4th generation", "du", "combo") HIV blood test will be conclusive, proving you were not infected. A negative result also will show your symptoms are not due to HIV or ARS. (The symptoms of ARS are caused by the immune response to the virus, which is indicated by antibody. It is not possible to have HIV symptoms with a negative HIV antibody test.) After your expected negative test result, you can test once 6 weeks after your last sexual exposure to make sure you didn't have HIV infection (that caused no symptoms).

Finally, you also should have a urine test for gonorrhea and chlamydia; absence of symptoms like urethral discharge and painful urination indicate these are unlikely, but asymptomatic infection can occur. Finally, include a syphilis blood test. It's probably best to delay that one until you have a follow-up HIV test 6 weeks after your last exposure. Don't be tempted to have a "comprehensive" STD test panel. Many tests on these panels are unnecessary or unreliable.

If you still have symptoms that concern you after your negative HIV and STD tests, see a doctor. But stay relaxed in the meantime: almost certainly aal test results will be negative.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

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28 months ago

Thank you very much for your reply! Yes, I will have an HIV test. I am trying to book a proper (not rapid) test via the NHS. I don't want to use a private clinic. I am so anxious, so I just want to test once at 6 weeks. I am trying to minimize anxiety while I wait for my test results. I don't want to have to do it twice. I really hope I am negative. Do you think this is an acceptable plan? I will certainly test for the other STIs you mentioned at 6 weeks.

Forgive me if I am being too rambling. I just need a bit more reassurance to stay calm. I do have diarrhea, but I eat spicy food frequently, and I get diarrhea from time to time. So this didn't worry me so much. I am not sure if my throat is "on and off," but sometimes I can only feel it if I pay attention to it, and it's mild. I always have phlegm in my throat, and I occasionally get a cough. I always think my symptoms fit into the symptoms of silent reflux, but I have never visited a doctor. I don't have a fever or an obvious skin rash, as far as I know. However, as I mentioned in the first reply, I have various mild pains in many parts of my body. I don't think the pain is the same as the pain I had when I had the flu or a cold in the past, as the pain is mild. Do you have any comments on my body pain? Do the above details change your opinion? Did my symptoms make you very alert and suspect HIV?

I have one more question if you don't mind. Based on your personal experience, how many of your patients who have a similar sexual history as me turned out to be HIV positive in the end?

Thank you again for your invaluable help.

H. Hunter Handsfield, MD

28 months ago

Thanks for your words of appreciation.

The additional informtion does not alter my opinions or advice. These details of your symptoms -- cough, occasional diarrhea, and various aches and pains -- do not raise my suspicion of HIV. (Acute HIV doesn't cause most of these things, such as phlegm or cough.) The chance you have HIV is near zero.

As for your closing question, the answer is zero: personally I have never had a patient with a history like yours who tested positive for HIV. That includes our forum experience: in the nearly 19 years of this and our preceding forum on another website, with thousands of questions from people worried about HIV, nobody has yet reported testing positive. You will not be our first. If and when it finally happens, surely it will be from a genuinely high risk exposure (think unprotected anal sex with another male) and not the low risk situation you have described.

My advice is that you not wait another 4 weeks for an HIV test just to reach 6 weeks since your recent exposure. When people avoid or delay testing for fear of the result, it is always a mistake. When people do that for any test for a potentially life threatening problem -- whether it's HIV testing, colonoscopy for colon cancer, mastectomy for breast cancer and so on -- anxiety declines when the test has been done, even if the result is the one feared. Worry about the result always is overruled by the clarity that results from knowing the answer. And because delayed testing also means a delay in starting treatment, it often is harmful; and HIV treatment is most effective the earlier it is started.It isn't the test that gives someone HIV: you have it or you don't! The result will be negative -- and the next and final result even more assuredly negative, since it will reflect only one or two low risk exposures.

Threads are closed after two follow-up exchanges, so you have one coming. I suggest you get tested as soon as you can (NHS is great, especially a GUM clinic) and let me know the result. But there is little point in further discussion until then. You can be sure I will have no different advice on account of your symptoms or exposure history.

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