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Had unprotected oral sex. Having sore throat and swollen lymph nodes. Hep B,Hep C and HIV tests were normal

DOCTOR OF THE MONTH - Dec 2013
Dec 2013
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Hello I live in Egypt if that matters for your diagnosis . I am also a software programmer , i do not work in the medical field . So the classic story . On 1 XXXXXXX 2013 i had sex with a girl ( this is the first time i had sex ) .She is not a sex worker but you can say she plays around a lot . It was protected but we had a sort of unprotected contact plus oral sex . I also took Viagra . On the second day my throat felt very sore . I was stressed about this issue. I also got from her a UTI and went to see a doctor . I took antibiotics and the UTI was clear . During the UTI i did not see pus yellow or green , just clear discharge some times after urination . I did urine analysis after that and also a urine culture and every thing seemed perfect in both . Even before the antibiotics the WBC in urine seemed a bit elevated , that doctor did not want to give me antibiotics but i insisted on taking them . I took an injection and 2 pills . The doctor told me i have prostatitis though cause i had waist pain and testicle pain that persisted until now . My sore throat never went away , so i visited ENT . The ENT told me your throat is perfect i dont see any problems but your acid reflux is bad . your nose is also affected by the acid , ( he used some endoscope to check my throat and nose ) About 4 weeks later i notice my tonsilar lymph nodes swollen . At that point i was so scared of HIV . I never got fever , rash , sweats , cough , running nose , or flu like symptoms ( classic HIV i assume ) , just the lymph nodes .I dont get flu since years thanks to the vaccination . I was scared that i got a strain of HIV that did not show the normal HIV symptoms but enlarged my lymph nodes . I can feel something in my neck when i look to the right or left but no one can see it . I can feel it with my finger when i look to the right or left . Also small one on the side of my neck maybe lentil sized . but the tonsilar ones are kinda big , but not seen at all . I went to see another ENT and he said do not worry about the lymph nodes . He searched with his hands and said i cannot find them even the one on the side of my neck . He also checked my throat and told me it seems perfect , he said i will not prescribe any medicine to you cause you do not suffer from any thing except acid reflux . I went back to my urologist , cause of the prostatitis issues , he didnt want to do further tests , but i insisted . I did semen culture and the WBC was very high . 1.2 million . I went back to him and he put me on Cypro for 1 month . I dont see much improvment with that antibiotic , still pain in my groin area and the lymph in my groin is felt . I can feel them . I also wonder why i never got fever for the prostate infection ? My temp is 36.5 which is way below normal throughout this entire time . I measure my temp maybe 5 times daily . I was stressed about HIV and thought about it a lot . I hate to stress about something so i decided to be sure i dont have HIV to put my mind to rest . I waited 4 month and 20 days and did the following tests . Did the test on 20 October for Hep B Hep C HIV All came negative . This put my mind at ease a lot , cause those diseases are the big deal as far as i know . I thought if i dont have one of those then i am ok , any thing else is curable . Is the 4 month 20 days period good to be sure 100% that i didnt catch HIV ? I heard some people say 3 month and some say 4 weeks and some say 6 months . Knowing that i did not get any rash in my body or genitals , i assume i dont have syphilis or HSV . I am right in this ? Can someone have syphillis but not show the classic rash on the phase 1 and 2 of the disease ? Is it possible that i have some other STD like chlamydia in my throat that causes the lymph nodes to enlarge ? But is it possible that the ENT cannot see a chlamydia throat infection ? Do you suggest i do chlamydia or gnorhea throat culture ? Is it possible that i have another STD that is in the blood only but not showing any symptoms except the lymph nodes in the neck ? Could the bacteria in the prostate be wondering in the blood or something and proceeding towards a Sepsis and that causes the lymph in my neck ? I also want to know what are the risks of prostatitis since i know i have this now ? Can this hurt my body in some other way or it will be always contained in the prostate ? Can there be complications from it ? Can the infection in the prostate cause lymph nodes in other places of the body to enlarge ? What are other STDS out there that could enlarge my neck lymph nodes ? OR the lymph nodes are not related to an STD at all and its all about the throat inflammation from Acid , which i can feel every day in the morning . I wake up with burning feeling in my throat that goes away after i drink and so . Do you think i might have Mono , that did not show flu symptoms but enlarged my lymph nodes? Also can a mono infection cause my lymph nodes to remain swollen like this for several months while not showing flu like symptoms ? Another thing worth mentioning i get tingling feelings near my colar bone , and pins and needles in my neck , behind the ears , back of the neck , front of the neck , the feeling of insects walking on my neck ( but without the insects ) . Is there any STD that can cause such symptoms ? I know i am straining my muscles from the anxiety a lot . I took my anxiety to a new level really during the last few months . I will never have sex again and i wont get married even . Peace of mind is a great thing . I am sorry i am flooding you with questions but really i am stressed about having something that no one can find . I also want to let you that i was being treated from anxiety , my condition was up and down last years . I been on seroxat for sometime , but i read that is a bad medicine and decided to stop it . I went through hell to clear it from my body , i do not want to tell you this long story . My heart the left shoulder always hurt and i checked for all heart issues and they found nothing . I am also talking to another doctor on your site that might help me find another drug to help with the anxiety issues , maybe long term anti depressant or something . Thank you for reading all this , i know it sounds complicated , but this is what happened .
Posted Sat, 30 Nov 2013 in Sexually Transmitted Diseases
 
 
Answered by Dr. Sanjay Kumar Kanodia 1 hour later
Brief Answer: Kindly see the details below Detailed Answer: Hi, Welcome and thanks for posting your query to healthcare magic. I have gone through your complete query with diligence. I can read out the complete sequence of the problem and can very well make out that your are quite stressed regarding possibility of sexually transmitted disease. SO to guide you best let me first reassure you that you do not have nay major sexually transmitted disease or infection. This I can tell you on the basis of the tests done at the period of 4 months and 20 days, all of which came negative. 4 months and 20 days is one of the adequate period when we can very confirmly tell the patient regarding the status of any of major sexually transmitted diseases including HIV. We take 3 months as the base line period to declare that whether or not a person is suffering form HIV or any other major STD like Hepatitis or anything. Now to tell you regarding other of STDs which are very well treatable- syphilis is one which can show its symptoms at the maximum of 90 days. Rest of all the other STDs shows its effect in few days of period. SO your things are beyond 4 months of time making you clear of all the type of STDs enumerated by you or known by you. So just relax yourself and do not worry about anything related to STDs. IF you have any further queries I will be glad to help. With regards, Dr Sanjay Kumar Kanodia MD ( Dermatology & Sexually Transmitted Diseases)
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Follow-up: Had unprotected oral sex. Having sore throat and swollen lymph nodes. Hep B,Hep C and HIV tests were normal 9 minutes later
Thank you so much for the answer . So if i never had that strange rash in body or so i would never be sick with syphilis right ? What about the lymph nodes in my neck , i have like 3 of them now . What could they be ? I also forgot to mention that i have some strange pins and needles feeling in my chin and front of the neck, the back of my ears . Is that a symptom of any viral infection you know of ? Can i have a throat chlamydia infection that the ENT cant see by the diagnosis ? or something like this will be very visible to him ? One last thing , can the Acid reflux infalmation cause those lymph nodes , some days they are felt and big , some days i cant find them . Can the acid reflux be a a reason for those nodes ? Is there any STD you know of that will just cause lymph nodes in the neck without fevers or any thing ? Thank you very much .
Follow-up: Had unprotected oral sex. Having sore throat and swollen lymph nodes. Hep B,Hep C and HIV tests were normal 47 minutes later
Also i had some questions about prostatitis . I didnt read any where that this condition causes the lymph nodes in the groin to enlarge . Does prostatitis cause enlarging of the the groin lymph nodes ? Can it affect the armpit lymph node or the neck lymph node ? Also my WBC count in semen was 1.2 million the doctor said it was so high . Why is my temperature normal if i have such bad infection in the prostate ? My temp is like 36.5 most of the time . Is that normal ?
 
 
Answered by Dr. Sanjay Kumar Kanodia 2 hours later
Brief Answer: Kindly see the details below Detailed Answer: Hi young fellow, Welcome again to the forum. Before I further answer any of your queries let me first of all reassure you again that you do not have any type of major sexually transmitted infection in yourself. So kindly do not think in that direction. I have provided the scientific medical reasons for the same. So there is no chance of syphilis or HIV. Now for the part of lymph nodes- I very frequently see young men and women like you, who after your type of sexual encounter always think of one or the other type of symptoms of either fever or rash or most frequently lymph nodes. Even after thorough examination I barely find any palpable lymph node in them. Young men like yourself are quite tensed about the possibility sexually transmitted infection and especially HIV and therefore tires to palpate or find the lymph nodes which are not actually significant clinically. So if the ENT doctor (who are really quite good in finding palpable lymph nodes) himself has reassured you for the non palpable lymph nodes, then you should not be concerned of the same. SO neither of the Chlamydia infection and nor the acid reflux can cause lymph node enlargement. The same is true for the pins and needle sensation. This is one of the very common symptoms in anxiety states. SO reduce your stress level and your sensation would totally vanish off. Now regarding your prostatitis- I am afraid to tell you that there is misinterpretation of the reports as you are mentioning. Having 1.2 million WBCs do not always mean infection. We go for further aerobic and anaerobic culture of semen for certain micro-organisms and if anything is present then it specifies an infection. In around 5-10 percent of population we find raised values like yourself without any infection. Your kind of prostatitis is quite benign type which we call as leukocytospermia and because it is not due to any infection that is why you do not have fever or any other symptoms of XXXXXXX pus discharge or any related thing. This type of prostatitis can never cause any lymph node enlargement. SO do not misinterpret your report. I suggest you to take a second opinion form a different urologist and go for culture of the semen for aerobes and anaerobe bacteria. If at all anything is present then would come out. But overall in my experience your tests should come negative for any type of infectious pathology. I finally reassure you for your normal things. It is quite common thing to experience your kind of problem after such a sexual exposure. I will be glad to help for any further queries. With regards, Dr Sanjay Kumar Kanodia MD ( Dermatology & Sexually Transmitted Diseases)
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Follow-up: Had unprotected oral sex. Having sore throat and swollen lymph nodes. Hep B,Hep C and HIV tests were normal 22 minutes later
Hello The thing is i am sure my prostatitis happened after the sexual encounter . I never had testicle pain in my life before that day . Also i never felt the the lymph nodes in this area , now i feel them itchy , at exactly the same spot where they are enlarged . Some times i feel heat sensation in that area also . So i am pretty sure that i got the prostatitis from a bacterial infection . I dont know how can i send you the pdf of my test reports , can we use email ? The urologist assured me that 1.2 million is a bad infection and he gave me a Cypro for one month . He told me we might go on for 3 month on Cypro to clear this infection . The problem is i still get waist pain and testicle pain on some days . I stopped the antibiotic cause i think this is not the right antibiotic for me . Now i am going to repeat the semen test again i will get the second result tomorrow after a month and half of antibiotics . I dont think we can assume the urolgist is wrong about this ? I feel he was wrong about the medication though . Maybe Cypro is not the correct choice for the kind of bacteria i have . Did the urologist make a mistake to prescribe a certain antibiotic without asking for the culture ? It is possible that i caught Chlamydia or something that caused the chronic bacterial infection . And if i do not have bacteria , why is my groin lymph nodes enlarged ? Please give me a way of uploading the pdf of my report to you . Thanks
 
 
Answered by Dr. Sanjay Kumar Kanodia 23 minutes later
Brief Answer: You can upload the reports Detailed Answer: Hello young fellow, You can upload your complete reports. For that you have a feature to upload images by yourself at the right side of the query page. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia. Hope to hear soon from your side to help and guide you best. With best health wishes, Dr Sanjay MD Dermatology
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Follow-up: Had unprotected oral sex. Having sore throat and swollen lymph nodes. Hep B,Hep C and HIV tests were normal 5 minutes later
Hello dr XXXXXXX I uploaded my first analysis report . Please let me know what you think .
 
 
Answered by Dr. Sanjay Kumar Kanodia 27 minutes later
Brief Answer: upload all the reports Detailed Answer: Dear young man, I have gone through your semen report. There is nothing abnormal in this report. Every of the parameter is in normal range. I suggest you to upload all the reports done till now of anything and everything. I will talk to my urologist colleague along with all the reports and also will take care of the matter of prostatitis. I will suggest the best outcome of it. Dr Sanjay
Above answer was peer-reviewed by
 
Follow-up: Had unprotected oral sex. Having sore throat and swollen lymph nodes. Hep B,Hep C and HIV tests were normal 9 minutes later
Hello I will upload my second semen analysis tomorrow when i get it from the lab . This will be after one month and half of Cypro antibiotics . The thing i notice in the report is the 1.2 million WBC , isnt the normal less than one million ? Also the urolgist i saw in Egypt told me the normal range is 200,000 and that 1.2 million is way beyond normal . I felt he made sense cause i really had symptoms like waist pain , sometimes a bit burning sensation , and testicle pain was so real. Also the itchyness in the groin is so real this part cannot be anxiety . And there is also the lymph nodes . I just do not trust his choice in antibiotics and i feel that the antibiotic should be based on culture results not just analysis . My urine tests were all normal even the urine culture was normal . I do not have Pdf formats of them but i am sure they are ok . I can repeat my urine test if you want , the tests here do not cost me much and i want to come up with the best diagnosis . I feel that you are really an expert in this and i am very confident in you addressing my concerns . Thank you for your patience and your prompt replies . Oh and also i test blood test twice and it had absolute lymphopenia reported . There was a period of time between them . So i am sure there is an infection going on . Total Leucocytic count 8100 ref 4000-10500 segmented 74.6 % 6043 ref 2000-6500 Lymphocytes 18.2 % 1475 ref 1500- 3500 Monocytes 2.3 % 187 ref 300 - 1000 Count is within normal limits for age and sex except for absolute lymphopenia . Platelets are normal . I dont know why my monocytes are so low , this is what scared me of HIV at the first place . But for sure there is an infection going on cause the differential seems messed up
 
 
Answered by Dr. Sanjay Kumar Kanodia 12 hours later
Brief Answer: Kinldy follow the suggetions below Detailed Answer: Hello young fellow, Welcome to the forum again and thanks for your prompt reply. I took the time to discuss your problem with my urologist colleague as the problem of prostatitis is better understood by these specialists. Now after through discussion of your problem the crux of things came out are: The types of symptoms you have enumerated are frequently possible in stress and anxiety states. But even then as you have got raised WBCs in the semen examination so you need to be investigated properly for the problem of prostatitis. First and foremost thing is proper staining of semen, because many times the immature form of sperms are interpreted as WBCs and that is why previously I had given the possibility of normal thing in your case. If at all the staining shows physical appearance of WBCs after staining then follow the regimen below - A proper base line ultrasonography is a must in this situation. An edema in the prostate can be easily find out by the sonograpphy. If the sonongraphy reveals the prostate higher than 30gm then it indicates some infection or inflammation. - The next step is to go for culture and sensitivity of the semen. The sample should be taken after proper prostatic massage. A mid sample (meaning middle of the secretion) is best sample. A proper of test will delineate the exact cause and the sensitive antibiotics so that it can be followed properly for adequate period of time. - There is another way out that an empirical course of combination therapy of antibiotic is best in this situation. For this tablet Levofloxacin 500 mg daily and Nitrofurantoin 100mg can be taken for a period of 21 days under medical supervision. A repeat test can be done after 1 month. Nitrofurantoin can be extended for another one month of period as maintenance therapy. - Tablet alfuzosin 10 mg can be added up once daily to relieve the symptoms of pain, irritation and swelling and other of the symptoms which you are feeling in the groin area and prostatic area. So this is one of the regimens which you can discuss with your treating urologist. Now for the part of the blood investigations- I have very frequently seen derangement of differential leukocyte count in absolute stress state. The only part of confusion remains when there is some type of infection or frankly speaking HIV which can cause lymphopenia. But as I already said your period of time of testing is way beyond our baseline range of 3 months to declare your negative status of the same. DO not think anything form your side. DO not search so many things and possibility on net as these itself produces a severe anxiety. “Fear of some disease is more XXXXXXX than disease itself”. So I personally suggest you to lose all your fears regarding HIV. Rest even if in future some other infection comes out ( which I don’t think would be coming out) then all other infections are very well treatable. With regards, Dr Sanjay Kumar Kanodia MD ( Dermatology & Sexually Transmitted Diseases)
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Follow-up: Had unprotected oral sex. Having sore throat and swollen lymph nodes. Hep B,Hep C and HIV tests were normal 4 hours later
Hello dr XXXXXXX Thank you for reply . I did doppler scrotal as per my urologist request , i assume this is ultrasound ? Any way the result is 100% normal . Is it ok that i do a semen culture using masturbation , i dont feel good doing the massage and i do not think the urologist will do it anyways . Is the culture from normal ejaculation inaccurate ? Thank you again .
 
 
Answered by Dr. Sanjay Kumar Kanodia 2 hours later
Brief Answer: Kinldy follow the suggetions below Detailed Answer: Dear young man, This is a good indication that your doppler study was normal. If that is so then there is less chances of edema or inflammation in the prostate. Doppler picks up edema in the prostate very easily. Now for the part of semen culture- as per the urologist the best of prostatic secretions comes after prostatic massage, but it is a cumbersome and difficult process for both patient as well as doctor. So you can go for semen culture using masturbation. This can also pick the infection if present in the prostate. If the culture comes negative then also you can take a course of antibiotic tablet Levofloxacin 500 mg daily and Nitrofurantoin 100mg can be taken for a period of 21 days and further accordingly under medical supervision. With regards, Dr Sanjay Kumar Kanodia MD ( Dermatology & Sexually Transmitted Diseases)
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Follow-up: Had unprotected oral sex. Having sore throat and swollen lymph nodes. Hep B,Hep C and HIV tests were normal 1 hour later
Thank you again dr XXXXXXX I am attaching to you now the second semen analysis , i just got the results now . I see a big reduction in the WBC , and i think this is good news . Tell me your recommendation based on this result ? Do i need one month of the medication you wrote of period as maintenance therapy ? Or get back to my urologist and see what he says ? Or continue on the same antibiotic that he gave me for another month which was Cypro 750 twice daily . Thanks i dont really understand what is the Total Abnormal Forms , it seems to be incresed from 30 to 50 . but i dont worry about that i am just curious what it means . the same thing about the Spermatogenic Cells decreased from a million to 100K , i dont know what it means , but i dont worry about it a lot . I am very pleased with the decrease of pus cells from 1.2m to 200k , i think 200k is kinda healthy limit ?
 
 
Answered by Dr. Sanjay Kumar Kanodia 2 hours later
Brief Answer: Pretty good report- marvelous Detailed Answer: Hi young fellow, Thanks for your further queries. Regarding the issue of total abnormal forms and the spermatogenic cells- these are basically important in deciding the fertility issues of man. These things basically comes under sperm morphology. Each sperm has a head, body and tail. If there is any abnormality in any of the part then accordingly the abnormal forms of sperm are designated. Even if a sample contains upto 85% of abnormal forms in the sperm architecture even then it is considered to be normal and the person is considered to be adequately fertile. So as you have around 50% abnormal forms makes you potentially fertile in all issues!!! Any how this is not our concern as the fertility issue is not our concern so this is beyond our point of discussion. For pus cells if these are less than 1 million then is always normal. Yours is now way below that making us quite relaxed about everything. I am really happy to know the report. I hope your all the queries are fully justified. If you have any further queries I will be gald to help or if do not then can close the query and rate the answer. With regards, Dr Sanjay
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Follow-up: Had unprotected oral sex. Having sore throat and swollen lymph nodes. Hep B,Hep C and HIV tests were normal 9 minutes later
Hello Final question :) Can you tell me your recommendation based on this result ? Do i need one month of the medication you wrote of period as maintenance therapy ? Or get back to my urologist and see what he says ? Or continue on the same antibiotic that he gave me for another month which was Cypro 750 twice daily . Thanks
 
 
Answered by Dr. Sanjay Kumar Kanodia 15 minutes later
Brief Answer: Kinldy see the details below Detailed Answer: Hi dear young man, I am really happy to know that you understood the whole series of facts provided by me. Now at this juncture you should inform your main treating urologist. He had tried his best in treating your problem. This will also be beneficial to you for any future reference. If you see my previous mail then to take the medication is the third step and not the first one. In my opinion you do not require any medication. If at all in the dire of the need if you require in future then better one would be the regimen I have provided. Levofloxacin is obviously the higher and better counterpart of ciprofloxacin. So you must relax now and have sweetest of the dreams!!! I hope your all the queries are fully justified. If you have any further queries I will be gald to help or if do not then can close the query and rate the answer. With regards, Dr Sanjay
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