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Seroconversion after PEP
Jul 29, 2008

First and foremost doctor I would like to thank you for the work you do on this site.

Approximately 2 months ago I engaged in an act of unprotected vaginal sex with a female of unknown status. A few days later I felt that I had a tingling sensation within my urethra. After testing negative for Gonorrhea, Chlamydia, and Syphilis, however, I no longer noticed this feeling. I then assumed that the former tingling had simply come from anxiety or guilt. Two weeks ago I took a shower using only Head n' Shoulders shampoo. At this time I noticed that some had entered into my urethra and caused a slight burning sensation. The following morning I had swollen genitals; slight irritation around my eyes, and my scrotum had become much smaller and spongy. At the fear of NGU or syphilis I began inspecting the lymph nodes in my groin. I will admit that I had pressed firmly on them and even squeezed them several times. I am quite thin. Is it normal to be able to feel lymph nodes at all? For the last few days I have noticed that my left node has become approximately 2 times the size of the one on the right. I have also been having a mild case of diarrhea for the last 5 days. As I was placed on a PEP (12 hours after exposure) could these be symptoms of delayed seroconversion? I will be moving relatively soon and prefer to test before leaving. Following a PEP regime would testing now have any form of validity?

Thank you so much

Response from Dr. Frascino

Hello,

The published guidelines for post-PEP HIV testing recommend testing at three and six months from the date of exposure. Testing negative out to six months is not only valid, it's definitive and conclusive. Delayed seroconversion is not an issue if you follow these guidelines. I agree your symptoms may well be related to "anxiety and guilt."

As for "Head 'n' Shoulders," Please note the "head" in the title refers to the one on your shoulders, not the one topping your Mr. Happy. "Swollen genitals" and your "scrotum had become much smaller and spongy"????? Spongy? Hmm . . . OK, that settles it. I'm never ever using Head 'n' Shoulders! I'm assuming your home entertainment center has returned to normal by now. As for trying to feel your own lymph nodes, I'd advise against it. You have no idea what you're feeling for, let alone the expertise to determine what is normal and what is not. Besides you look ridiculous poking at your nether regions

My advice is simple:

1. Take your post-PEP HIV tests per the recommendations.

2. Never risk the potentially catastrophic consequences of unprotected sex ever again.

3. Stop poking yourself in the groin searching for lymph nodes.

4. Keep the Head 'n' Shoulders on the head above your shoulders.

Good luck.

Dr. Bob



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