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Still Worried
Oct 26, 2008

Hello,

Let me first write that I am a huge admirer of what it is you folks do for people and I hope you all recognize and are commended on the fact that you are providing a tremendous service and helping people live better lives.

I had a vaginal sexual contact in June and six weeks later developed a white coating on my tongue, the coating is still there. One doctor diagnosed it as thrush and gave me mediacation, another doctor took a culture and the results came back negative. I also feel my lymph nodes pulsating and at times have pain in my groin and towards the bottom of my throat. I also have had a few evenings when I had night sweats. I just had a rapid HIV test 4 months and one week after the contact in question. The results were negative, I was expecting the result to come back positive. Should I be worried at this point, could it have been a false negative? Can one exhibit signs of HIV (other than the intial flu-like illness) and still test negative even if that person has HIV? Are the rapid test reliable? Are they reliable at four months? Is there a chance that the testing facility (a NYC STD clinic)folks messed up the results somehow? I seem to be driving myself crazy, but nothing like this has ever happened to me before.

Thank in you very much in advance for any light you may be able to shine on my particular situation.

Response from Dr. Frascino

Hello,

Thanks for your kind comments.

I'm assuming your "vaginal sexual contact" was unprotected. Unprotected sex does indeed place you at some degree of risk for STDs, including HIV. Consequently, HIV testing at three months or longer after the last potential exposure is warranted. Your negative rapid test at four months is considered definitive.

A "white coating" on the tongue can be caused by many conditions other than thrush. Even if it was thrush, the vast majority of cases of oral candidiasis (thrush) have nothing to do with HIV/AIDS. Thrush is an often misdiagnosed condition. It's difficult to say whether you had it, because medication was given. If the symptoms remained essentially unchanged after treatment and your second doctor took a culture that did not reveal Candida, the chances are excellent that you never had thrush to begin with!

For the most part, rapid tests are indeed reliable and a negative test outside the window period is considered to be a true negative. There have been some recent reports questioning the exact level of accuracy of certain rapid tests. These issues are being investigated. I do not believe you have any cause for concern. However, if my reassurance is not enough for you to shake your worries, get an ELISA test. The results will undoubtedly be negative.

Finally, if your white tongue continues to be problematic, see an ENT physician. Chances are it's easily fixable!

Stop driving yourself nuts. We have enough crazies in the world already. For instance, who the hell is that mad woman with the up-do dressed to the nines in haute couture shooting at me with a moose gun from a helicopter every time I step out my front door?

Dr. Bob



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