Confused about neuropathy and ARS

Question

Dr. Bob,

Hope this message finds you well. I am writing in hopes that you can provide some clarification/information regarding the presentation of PN in ARS/seroconversion.

About 3-4 weeks post-encounter (unprotected with a woman of unknown status around June 10) I developed PN symptoms. I didn't think much of it as I have genital herpes and experience such tingling sensations from time to time, usually signalling an imminent outbreak. Over the years I have felt the PN tingling in my feet, legs, thighs, butt, hands, and forearms....but mostly in feet and back of legs.

Well, this PN episode came and has never left...very strange...that was 3-4 weeks ago now (am now about 8-9 weeks post encounter). It is also quite pronounced in terms of areas affected (the tingling itself has actually been relatively mild). The tingling is symmetrical, but not just distal...rather I can feel it in my calves (back of my leg), back of my thighs, on the underside of my forearms, up to around my elbows. Ironically, while I can occasionally feel it in my feet, it isn't as pronounced there as in these other spots and hasn't been a constant feeling in my tootsies. To top it all off I have been having very frequent herpes outbreaks during this period.

I have read your previous responses and have done a little reading on PN and HIV. Some say that PN is rare in ARS/early stages, but some of the research literature I have come across references AIDP/CIDP/GBS forms of PN as often the first symptom an individual experiences during the early stages of infection.

Between my generalized (kind of all over my body) PN symptoms and my frequent herpes outbreaks (I should mention I do take one a day valacyclovir...but that hasn't been as effective as it normally is for me lately) during the past 8-9 weeks, does this sound like seroconversion/ARS? I don't think I have had any other symptoms during this period, and I should note that my last negative test was about 10 months ago and this was my first unprotected encounter since then.

I'll be headed next week to get tested as I can't take the stress and anxiety that has literally debilitated me over the past 6 or so weeks. In the meantime, if you could be so kind as to respond to my inquiry, I'll send good karma and a donation your way.

All the best,

Mr. Tingles

Answer

Hello, Mr. Tingles.

You do not have PN! PN stands for peripheral neuropathy. Peripheral by definition involves only the periphery and that means hands and feet. Your symptoms are "generalized (kind of all over my body)." Your symptoms are much more consistent with anxiety.

Unprotected sex does place you at some degree of risk for STDs, including HIV. Consequently HIV-antibody testing outside the window period is warranted.

My advice is simple: stop having "unprotected encounters"!

Regarding neurological conditions occurring during HIV acute retroviral syndrome (ARS), these include aseptic meningitis, meningoencephalitis, peripheral neuropathy, facial palsy, Guillain-Barre syndrome, brachial neuritis, cognitive impairment and/or psychosis. Neurological symptoms occur in approximately 12% of cases of ARS.

Thanks for your support of The Robert James Frascino AIDS Foundation (www.concertedeffort.org). It's warmly appreciated.

Be well.

Dr. Bob