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Occupational exposure? An anxious med student! Please, please answer.
Jun 13, 2011

Dear Dr. Frascino,

I've tried putting forth my situation to you before, but could not get an answer. Please do help me.

I am a pre-final year medical student from India. On 11 May, a retropositive patient was admitted to the labour room in our hospital. (She underwent a CS an hour later). I accidentally placed my hand on a plastic sheet that had been spread over the bed used by the patient. There was no visible blood or fluid on the sheet, but it might have been just a little wet at that spot. I got extremely worried, especially so since i had a four-day old small (less than 1 cm long) cut on my index finger. I washed my hands with soap and water and spirit. I explained the situation to two of my professors in Medicine, but they were of the opinion that the cut had probably healed, and post-exposure prophylaxis was not warranted.

Three days later, (after having gone through a considerable volume of information on HIV) I noted that I had mild irritation of the pharynx. On palpating my neck, I was also able to feel two non-tender submandibular nodes, one on each side. The one on the left was about 1.5 cm long, rounded, soft, and mobile.The node on the right side was about 1 cm, somewhat flat, soft, and mobile. I met a senior professor of Medicine once more but he said I was just anxious, and my throat seemed clear on examination.

Over the last 25 days (unto today), I have had intermittent mild irritation in my throat, and occasional mild odynophagia. I've also had minimal post-nasal discharge and throat discharge. The lymph nodes have become progressively smaller. The one the left side is now less than 1 cm, and the one on the right is barely palpable.

I have had no fever, rash, lymphadenopathy of other regions, myalgia, arthralgia, oral ulcers, weight loss, night sweats, which form part of the so-called 'acute retroviral syndrome'.

Over the last 11 days, I've had one episode of loose stools that followed abdominal discomfort on 2nd June, but it could have been because of some cheese I had taken the previous day. Also, on 1st and 4th June, I had mild throat pain. Been asymptomatic for the last 4 days, but I can still palpate the lymph nodes on my neck.

Do my symptoms suggest primary HIV infection? Or should I be consulting an ENT specialist?

Today marks 4 weeks following my suspected exposure. I have been extremely worried. Please do offer me some advice.

Response from Dr. Frascino

Hello.

Your HIV-acquisition risk is nonexistent. I absolutely agree with your professors. Your problem is irrational fear of HIV, not HIV itself!

I would recommend you follow up with a general internist to evaluate and manage your various physical complaints. You may well also benefit from anti-anxiety mediation and psychotherapy to help you confront and conquer your irrational fears.

Good luck.

Dr. Bob



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