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HIV or not?
Oct 3, 2006

Hello I guess it would sound strange but I'm a 5th year medical student from Europe.. I know it's a long post.. but I hope u read it so u could help me..

About 3 months ago- 10th july.. a sex worker gave me oral sex. Please don't lecture me.. I was really depressed (my gf in the last 3 years had left me) and very very drunk.. I don't remember much.. I remember we didn't kiss.. I used a condom.. However.. it's a condom that she gave me.. I don't know if she was with others before me that night (I guess she was).. Her hands touched my genitals and the groin area.. I don't remember having any wounds.. I know the odds for hiv are not high.. However..

7-10 days later.. I begun to have burning sensation in my right groin near the ASIS.. especially at night when cold.. 2 days later.. I began to feel the same pain also in the center of my abdomen (just right to the umbilicus) and in my right upper abdomen. Sometimes I also felt it in the same areas of my back.. the pain wasn't so bad (about 3/10).. and I decided to ignore it.. I didn't notice any ulcer or rash.. no urgency, frequency or dysuria.. no discharge.. no fever.. no lymphadenopathy..

4 weeks later.. I went to my doctor.. CBC, chemistry, hepatitis serology and urine stick were all normal.. The pain continued..

at 6 weeks I begun to have a low grade fever, malaise, anorexia, and mild diarrhea.. I went to std clinic- hiv serology, hepatitis, VDRL and urine Chlamydia were all negative.. The symptoms continued..

At 7 weeks I went back to my doctor: CBC, chemistry, hepatitis serology, VDRL, Chlamydia serology, EBV, CMV were all normal HIV abs + P24 were negative HCV PCR- negative However- I had IgM normal but at the highest limit Mild decrease in my lymphocyte counts Other results were more or less the same as the previous test.

After 10 days of mild fever it disappeared However the pain was getting more severe.. especially at nights or when cold.. and all the time I had the feeling the pain was ascending along my back..

10 weeks- I had flulike symptoms for 3-4 days.. mild fever, mild nasal congestion.. pain in my right scapula and at the right side of the base of my neck.. I was shocked to find enlarged supraclavicular lymph node there.. a little less than 1 cm, firm, not fixed and not tender to palpation.. however it hurts really bad when cold.. couldn't find other lymph nodes enlarged.. I went back to my doctor- hiv antibodies- negative

12 weeks- now I had sore throat for the last 2 weeks.. I had burning sensation in my eyes for the last few weeks.. Sometimes moderate frontal headaches that comes with retroocular pain which worsens when I move my eyes.. Rt SC lymph node is still enlarged.. same size.. more or less.. I have 3 enlarged lymph nodes in my left groin.. When it's cold.. I have severe pain in: groins, back (just right to the vertebrae), right upper chest, right scapula, my neck n just below my ears..

My doctor wants to repeat my CBC, chemistry, hepatits sorolgy, VDRL and HIV tests this week..

By the way.. no change in bowel habits.. no testicular masses.. I lost about 3-4 kgs in the early weeks.. and gained them back since then..

What do u think? Should I get tested for other diseases? What's your DD? (please dont tell me it's all anxiety because it's not). (can gonorrhea, Chlamydia, syphilis migrate through the lymph drainage??) Could it be HIV? Am I late seroconverter? According to these 2 articles it can be!! I 'm sure u must have read them.. but I let myself write them again for you (: By the way.. I can't get tested with PCR for HIV in my country..

Please HELP ME.. I'm not looking for someone to calm me down..

Am J Med, 1997 May 19;102(5B):117-24; discussion 125-6 "Time course of viremia and antibody seroconversion following human immunodeficiency virus exposure" Busch MP

".. Although the majority of infected HCWs seroconvert within 2 months of exposure, the possibility of delayed seroconversion is well established, with approximately 5% of infected HCWs estimated to seroconvert >6 months after exposure.." ".. Animal inoculation studies indicate that a variable period of localized viral replication in lymphoid tissue draining inoculation sites exists prior to systemic viremia and subsequent seroconversion"

J Virol. 1998 October; 72(10): 78227829. Dendritic Cells Route Human Immunodeficiency Virus to Lymph Nodes after Vaginal or Intravenous Administration to Mice Carole Masurier

".. DC migrate to the draining LN within 24 h after subcutaneous injection. After incubation of these cells with HIV type 1, HIV RNA sequences were detected in the draining LN only.. "

Response from Dr. Frascino

Hello,

Your post was long, but my reply will be brief.

1. Your HIV risk is essentially nonexistent if the latex condom was used properly and did not fail.

2. Your symptoms are not consistent with HIV ARS.

3. You've had an excessive amount of HIV testing and STD screening already. A single HIV-antibody test at the three-month mark and limited STD screen is all that was required.

4. You are not a late seroconverter.

5. You may not be looking for someone to calm you down, but that's exactly what you need.

6. My differential diagnosis is short and the top 10 conditions all relate to stress, anxiety and irrational fears. Sorry, I know you didn't want me to tell you that, but you asked for my opinion.

I urge you to stop chasing an illness you do not have. If you are to become a competent physician you need to rationally evaluate medical situations and separate fact from fears and fantasy.

HIV is not your problem. No way. No how.

Good luck.

Dr. Bob



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