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a nuts medical student...please humor me.
Jun 10, 2008

Dr. Bob,

I have written you a few times before. I am really hoping you give me a little insight. My situation is this: I had an exposure consisting of unprotected vaginal intercourse (against my will..currently pressing charges..but not the point). After the exposure, I was tested at baseline in the ER, had a 3 week undetectable RNA PCR, and a 10 week negative rapid antibody test. I should be encouraged, right? Well, I am not really. This is because I am currently studying for my boards (USMLE 1). I am memorizing way too much without having any practical experience. I have had no symptoms except for tons of small lymph nodes in my groin. I am convinced that the virus entered the cells of the vaginal mucosa, infected dendritic cells, and finally made its way to the inguinal nodes. Now, I think the virus is replicating there because those are the lymphatics closest to the site of innoculation. I am trying to study, but end up looking at nothing except the mechanism of HIV infection. Could my lymph node thoughts be correct? Are several <1cm inguinal nodes ever non-pathologic?

I know you must think I am out of my mind for thinking this far into it. However, I also know that at some point you MAY have been a hypochondriacal medical student, and therefore might sympathize with my sad state. Thanks for all you do.

Response from Dr. Frascino

Hello Nuts Medical Student,

Your negative 10-week HIV-antibody test is extremely encouraging, although not conclusive. You'll have to wait for the three-month mark for that. I strongly anticipate you are HIV negative. I don't recommend PCR RNA for routine HIV screening, due to the rate of false-positives, other technical concern and cost. However, your negative three-week test corroborates my very strong suspicion that HIV is not your problem.

To answer your specific questions:

1. Could your lymph node therapy be correct? No, HIV is a systemic disease and the lymph adenopathy is generalized, not localized as it would be with a localized infection.

2. Are several <1 cm inguinal nodes ever non-pathologic? Yes, in fact several <1 cm inguinal nodes would routinely be considered nonpathological.

Personally I didn't have too much difficulty with the "hypochondriacal medical student syndrome," but I did have a number of close friends who experienced it. I had to keep reminding them that if indeed they did have all the diseases they thought they did from the previous week's coursework, they'd be dead already, so why even worry about the disease we were learning about that day? Don't worry too much. Medical students do grow up to become interns and then residents and then post-doctoral fellows and finally "real doctors." Along the way the "hypochondriacal medical student syndrome" usually fades away (as a result of shear exhaustion from being on call). So don't fret. I'm confident all, including you, will turn out well.

Study hard!

Dr. Bob



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