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Had protected sex and performed clitoris licking. Had mild fever, weakness and dry mouth. Cervical lymph swollen. Have redness. Advise?

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Infectious Diseases Specialist
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I has condom protected sex with csw but for three seconds I performed clitoris licking. On the ninth day i had fever mild but have chillness, weakness with it. Fever lasted for three days and then intermittent temp. for five more days . I also developed dry mouth and white tongue though i was on ciprafloxacin and then on levofloxacin. My lymph nodes of neck are swollen I happened to notice it after almost twentieth day and have sonography for that . It was in the report that cervical lymph are especially swollen two on each side. Even after 30 days i still feel weakness , dry mouth. I am also having skin sensitivity and it turns red on slight pressing. on 19 day i had antigen duo fourth generation test and it came back negative. On 27 day i had RNA, DNA PCR along with fourth generation duo test. My value was 0.05 for duo test which had index value 1.0 as border line. Rna detection has 20 copy/ml sensitivity. How sure i must be from these results. I happened to talk to csw and she said she never had any fever in last two years and she is getting regularly checked for hiv at 3 months interval. after 30 days i am having little abdomen pain also. Still i have tiredness and feel pain in muscle it do activity for long. Please suggest .
Posted Sat, 7 Sep 2013 in HIV and AIDS
 
 
Answered by Dr. Binod Kumar Pati 26 minutes later
Hi XXXXXXX
Thanks for your querry.
I don't think you should be worry about HIV. Your partner is negative. You are also tested negative on 27 th day. However get a antibody test done after 6 - 8 weeks of exposure to reassure.
If you can attach the scanned reports and send it , I hope I can evaluate better.
Hope it's helpful.
Wishing you good health.
Above answer was peer-reviewed by
 
Follow-up: Had protected sex and performed clitoris licking. Had mild fever, weakness and dry mouth. Cervical lymph swollen. Have redness. Advise? 22 minutes later
Doctor my concern is this that just after nine days i had fever , weakness which is still here, muscle tiredness, white tongue , dry mouth , rapid heartbeat, now after 30 days i have very mild abdominal pain like. i have lymphadenopathy , sonography report stated "multiple enlarged bilateral cervical node with central fattly hilium largest measuring 20x8 in right submandibular region level IB more likely inflammatory or infective cervical adenopathy. On right level two largest measuring 20x8 mm in size at IB at II few largest 9x4 mm III 6x2 mm
on left levels 13x5 mm lart flat node measure 20x4 mm at II and at III 6x3 mm"

I am really scared since such level of infection is very uncommon and doctor suggested pharyngitis which is also known symptoms of acute infection. I have had sinus infection before and before fever there is rainy season so i was giving little hope to myself because this was the first time I made this disgusting mistake and really cant stand to live with it. I have almost killed my reputation and parents hope. I have stiff neck also and sensation in head very minute headache.

Since after 9 day of exposure i am having symptoms and every symptoms of acute infection like. I read some forum and according to some doc. like Dr. Hansfield and Dr. hook that symptoms are due to antibodies response or viremia replication and our body when fights with infection these occur. My symptoms have continued for one months almost so should not any test that i had 1. fourth generation duo test at 19 days or RNA , DNA PCR with fourth generation duo at 27 day have shown any infection if present. I also have read that in European countries now duo at 4 week is considered to have accuracy of more than 99 percent and pcr tests are also considered to have excellent accuracy after third week close to99 percent. so since i am having symptoms still so what are my chances. Some doctors have also said that it is almost impossible to have symptoms and having negative test after three to fourth weeks of symptoms while some may contradict. I am not able to sleep for last one months and have lost body weight due to anxiety or infection i dont know. Please please give me your opinion as it has been like hell since last 5 july. The only hope is negative results at 27 days and statement of that csw that is not infected and didn't get sick in last months and she was last time tested 17 days before my encounter but again when i look at symptoms i just lose hope and I am still crying while writing so please forgive me for any wrong english.

 
 
Answered by Dr. Binod Kumar Pati 5 days later
Hi

As far as diagnosis of HIV is concerned, unless you are tested positive, no body in the world can ascertain a diagnosis of HIV based on symptoms only. This is because so many other infections can result in similar presentation. You are probably more concerned about HIV because of an associated positive exposure history. And because of the stigma associated with sexual exposure and HIV, you are correlating every other symptoms to be due to the same.

I understand acute HIV syndrome also present similarly. This syndrome is due to a burst release of HIV virus to the circulation at this time. But all the tests are negative for presence of HIV virus. However for your satisfaction kindly go for the most appropriate test for HIV i.e HIV antibody test at 6-8 weeks post-exposure.

Your situation can be explained by presence of a different infection (May not be sexually transmitted). Infectious mononucleosis and similar infections also present in a similar way. so my advice at this time for you will be to visit your infectious disease specialist or a XXXXXXX medicine specialist and discuss in detail along with all your investigations results. He may require some other investigations.

Hope I could provide a rationale for why I think you should not worry.
Go to your physician and follow his instruction.
All the best.
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Follow-up: Had protected sex and performed clitoris licking. Had mild fever, weakness and dry mouth. Cervical lymph swollen. Have redness. Advise? 2 minutes later
Just after one month I had a cd4 report which is as follows

cd3(T cells absolute) Result 3150 reference range 723-2737
CD4 % 16.82 33-58%
CD4 absolute 530 404-1612

Doc. I am totally in shock. What to follow negative DNA RNA AND fourth Gen Duo test are negative at 26 days , csw is also saying that she is negative and in fact got tested 17 days before incident but she may be in window period. Or this cd4 report because it is uncommon to have such low cd4 except hiv. Plz plz give me detailed advice.
 
 
Answered by Dr. Binod Kumar Pati 39 minutes later
Hi
Just cool down.
The CD4+ T cell count is the laboratory test generally accepted as the best indicator of the immediate state of immunologic competence of the patient with HIV infection. But until and unless one is infected with HIV, no conclusion can be drawn from cd4 T cell count only.
Do you have any earlier cd4 count result with which you can compare your current count to know actual decrease or is it just a low value but within normal range?
If not, don't consider it to be a low count.

There are so many people with cd4 count around 500 without evidence of HIV/AIDS. Because they are not infected.
At last my sincere advice, 'Don't go for unnecessary investigation. It will keep you stay puzzled.'

Hope you understood everything.
If there is no more querry, you can close the discussion and rate it.
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Follow-up: Had protected sex and performed clitoris licking. Had mild fever, weakness and dry mouth. Cervical lymph swollen. Have redness. Advise? 44 hours later
Sir
As you said that there are many people who may have low cd4 values but sir my cd4/cd8 ratio is only 0.2 , my cd4 % is only16.8 . Sir i read through many pages on internet and there is only one reason for that, in acute hiv infection cd4/cd8 ratio get inverted. Almost on every page on internet there is only one explanation for low cd4/cd8 ratio. I am on sleep tablet but not able to sleep cause i am so terrified.

Sir is it possible to have cd4/cd8 very low with other viral illness or bacterial infection ? Have you seen such case before?

Since i had pcr test also so it is possible to have undetectable viral load with so many symptoms and negative antibodies also. I read on many sites and explanation of Dr HH Huntsfield and Dr HOOK and they said that if people are symptomatic than antibodies test must be positive in 1-2 week. Is is possible to have all symptoms and negative test for all? I took test on 19 day p24 antigen and rapid test and on 26 day DNA AND RNA PCR and 4 th gen. DUO test.

I am asking you because i couldn't find good doctor here in city. I am still having fatigue and new symptoms like burning tongue (I am on fluconazole) little diarrhea now after 38 days. Can symptoms last such long?



Sir what is your candid suggestion for all three question. Please reply all there question. Thanks
 
 
Answered by Dr. Binod Kumar Pati 3 days later
Brief Answer:
Possibility of HIV is least likely.

Detailed Answer:
Answers to your individual questions are as follows:

1. CD4 count and CD4/CD8 ratio is a test used to determine the immunological status of the individual and to predict the chances of opportunistic infection. And as I do not order these test for regular HIV detection we do not usually come across cases with abnormal CD count reports.

2. That being said, abnormal CD count and ratio is not due to HIV, if HIV tests are negative. Moreover, CD count abnormality in case of HIV is a late occurrence; not something that is expected in few days following suspected exposure.

3. As HIV symptoms are almost similar to any flu symptoms, it is very common to see patient’s misinterpretating usual flu symptoms to HIV though HIV tests are negative. So the answer to your second question is you could be experiencing symptoms similar to those seen in HIV and have negative HIV results; off course this doesn't mean you suffer from HIV.

3. Fatigue and burning tongue unless thoroughly evaluated and treated can last for a while. Besides, since mental and psychological factors contribute to such symptoms, it is important that you rest your thoughts about HIV.

Regards
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Follow-up: Had protected sex and performed clitoris licking. Had mild fever, weakness and dry mouth. Cervical lymph swollen. Have redness. Advise? 20 hours later
Thanks doctor but i still have a feeling of being unluckiest. I read that there are very few documented cases of hiv through female to male cunnilingus and in my case it was only three sec. clit. licking but I just know I am doomed because csw said she is getting regularly tested and never had unprotected sex but again she might be in window period. So means all odd were against me.
I just want you to look at these address.
1. WWW.WWWW.WW 2. WWW.WWWW.WW 3. WWW.WWWW.WW
sir there are numerous examples which are citing inverted ration only in infected in acute infection and in other cases which can cause inverted ratio does not fit in my case. I know I am causing you trouble over silly questions but I am in dire need of mental peace and praying to god.
Even after taking 8 fluconazole my white tongue is continue after one month and have slight burning . My biggest worry is my 0.2 ratio and only 16.8 % cd4 since i read when its below 14 % it is confirmed AIDS means I am totally doomed. I talked to my doctor here and he is not ready to listen and saying pcr is conclusive and since no virus so no hiv. I am very perplexed thats why asking so much question. Hope you wont mind.
 
 
Answered by Dr. Binod Kumar Pati 3 days later
Brief Answer:
Be rest assured that you are HIV negative

Detailed Answer:
Hi XXXXXXX

Please relax; you do not have HIV as of now.

I have read all the links that you sent me. What is written is true. However, we always have to take the actual patient scenario to come to any conclusion. in my view, you are negative for HIV.

PCR is conclusive as said by your doctor. Please trust the doctor and move on in life.

I hope you understand. Unnecessary worries are not going to solve any problem. Please rest well and relax.

Wish you good health.
Above answer was peer-reviewed by
 
Follow-up: Had protected sex and performed clitoris licking. Had mild fever, weakness and dry mouth. Cervical lymph swollen. Have redness. Advise? 10 hours later
Sir sorry i am troubling you last time. My parents are planning my marriage and this again is major worry. I recently after 41 days again had RNA DNA PCR with 4 gen antigen/antibody Duo test. Result came nagative which is after 41 days or almost 6 week. But last time my antibody index on duo test was only 0.05 and after 17 days now in last time it came as 0.57. Is it increasing and matter of worry?

Sir i am already on antidepressant so plz forgive me for continue annoyance. Sir what is your experience with pcr test. How conclusive are they? have you seen anyone who had negative pcr at my time interval and turning positive later on?

With latest test should i move on despite having inverted cd4 ratio. Plz suggest.

Sir these are my last three questions plz answer all three.
 
 
Answered by Dr. Binod Kumar Pati 2 days later
Brief Answer:
I would not be worried...

Detailed Answer:
Antibody titres are not absolutely sensitive. There are other antibodies which can cross react with antigens during testing to produce false positive results. In order to screen out those false positive results, all antibody tests have marked a titre value beyond which the results are considered true. In your case, the rise in titre only mean more antibodies have reacted this time; but we cannot be absolutely sure those are from HIV antibodies. So you shouldn't be worried with rise in titre since both PCR are negative. And stop testing further.

PCR test turning positive in future is highly unlikely. There are no reports of such cases.

You should move on from this incident. Practice safe sex and lead a normal life.

Thanks and take care...
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