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What causes persistent sore throat, dry cough and pain in right testicles?

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Posted on Fri, 6 May 2016
Question: Hi doc,

I had a protected sex with a csw in mid of oct'15. After the activity some semen came out after ejaculation(as she was on top) as my penis became flaccid and I suspect fluid exchange.
I had got flu - fever & sore throat from 25- 30 th day post exosure and burning sensation on my penis. Had duo test on 30th day post exposure and result came negative. Took medication for flu and for penis skin (doc said it was just allergy since i had shaved two days prior)and was fine next day.
I was relieved with the result but got white tongue and dry mouth at around 8 weeks. I again had the duo test( with p24 and for 1 & 2) at 8 weeks and result came negative. Since then I had shown to five docs and all said that my tongue is fine. I had test for all std 11 weeks post exposure and I got negative for duo test as well ( cmia method). Finally I had pcr test for HIV 1 and 2, hep c and duo test on 87th day post exposure and all were negative pcr tested undetectable levels. The HIV specialist I met considered my 8 week result conclusive and advised no more tests.however I persistently had sore throat and dry cough 2-3 times in a very short interval in the 3rd month. Also I have very gentle pain in my right testicle which occurs often,what might be the reason for this? I had full cbc done and results were normal with neutrophils slightly higher(71%). Please suggest if I should have any more tests? Is pcr and duo test (1&2& p24) together after 12 weeks conclusive? Can I go through late seroconversion.? I had easinophilia in childhood. Also is elfa & cmia methods as accurate as Elisa? Now I am on close to 100 days
doctor
Answered by Dr. S. Murugan (4 hours later)
Brief Answer:
You are free from HIV infection. Symptoms are not related to HIV.

Detailed Answer:
Hi,
Welcome to HCM.
Thanks for posting your query.
Even if semen dribles after ejaculation during a protected intercourse (girl above position), your penis was still protected from the contact of her vaginal fluid. So you need not worry about these odd possibilities.
You had both PCR for HIV 1 and 2 and also 4th generation COMBO test after 8 weeks. Negative results of these tests assure that you are free from HIV infection. Only for antibody detection tests, the reliability would be likely to get delayed sometimes up to 12 weeks, not for the antigen detecting test. PCR and P24 antigen part of 4th generation tests are detecting the direct presence of HIV particles and they would be conclusive and highly reliable by 4 weeks itself. So no more tests for HIV is necessary for you. You are free from HIV infection.
All your symptoms are vague and not specific to HIV and can occur to anybody. Your observation of white coating of tongue would not necessarily be due to oral thrush. Only Physician will able to tell better due to their experience. For persistent sore throat you consult an ent Specialist. Culture and sensitivity test from a throat swab abd appropriate antibiotics as per the outcome of the result would relieve your problem.
Dr S.Murguan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan (4 hours later)
Hi Doc,

Thanks for your prompt reply. I wasn't worried about this act till I started getting the symptoms exactly within a month ( fever, sore throat,cough etc.). As i was drunk i wasnt very sure if the condom broke or not and after the act she asked me if it broke and I wasnt sure neither bothered to check. Considering that acy was of high risk will you suggestion change? I have done pcr test for 1&2 and HIV duo test (with p24 for 1&2)after 12 weeks and all came negative(87th day).

Would request you to answer below ques please
1. What is the accuracy of pcr after 12 weeks for both 1&2?

2. What might cause delay in antibody production after 12 weeks? How about possibilities of HIV 2? Would you consider that also conclusive by pcr and duo after 12 weeks?
3. I feel I have a very weak immune system and I often catch cold and cough. Is there any chance that I might get late seroconversion?

4.Please also suggest a test for my pain in the right testicle. Could it be some STD? I was negative for herpes,hep c, syphilles.

5 can stress also cause white tongue and dry mouth?

Thanks a lot!
doctor
Answered by Dr. S. Murugan (4 hours later)
Brief Answer:
Your test results are highly reliable and you are free from HIV

Detailed Answer:
Hi,
Welcome back.
1. HIV PCR is highly reliable 4 weeks after the exposure on wards.
2. HIV 2 infection is rare. Less than 1% throughout the world except in certain parts of XXXXXXX Negative HIV DUO test done after 12 weeks ruled out the possibility of HIV 1 and 2 infection and it is a 4th generation test, highly reliable.
3. If you are on immunosuppressive drugs like steroids or had PEP, HIV antibody test may be delayed after 12 weeks.
4. It is unlikely to be delayed in your case.
5. For the scrotal pain, you have to get examined by a surgeon and have the investigations under his guidance.
6. Any fever or mild illness will lead to dry and coated tongue.
Nothing to worry.
Dr S Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan (3 hours later)
Dear doc,

Hopefully this will be my last question.

Thanks a lot for your kind guidance. I have not taken any immunosuppressive drugs but still feel that my immunity is very weak as I often get flu easily.

If in case my body would not have been able to produce antibodies for either HIV 1&2 after 12 weeks(I took all these tests after 12 weeks) , then antigen or pcr test should have been positive if I was infected right ? If antibody wasn't produced by the body would the viral load be very high after 12 weeks or still antigen would have been detected?

I do believe that I haven't caught any infection but I am getting married next month and that is causing the worry for me. Do you think I should go ahead without any hesitation?

Looking forward for your reply to my above questions.
doctor
Answered by Dr. S. Murugan (4 hours later)
Brief Answer:
You are free from HIV infection. You can get married.

Detailed Answer:
Hi,
Welcome back.
As you rightly pointed out, immunosuppression or immunosuppressive drugs can affect only the production of antibodies against HIV and the tests those detecting the antibodies. PCR test detects the antigens which would not get affected by the immunosuppressive drugs. So your negative PCR test results are absolute. You can proceed with your marriage without any hesitation.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan (9 hours later)
Dear doc,

My last question:

I have tested negative for syphilles, chlamydia and herpes after 11 weeks std test and negative for hep c after 12 week test.

Is there any more std test I should go through?

The mild pain in right testicle is bothering me. I hope that should not be a worry for my decision to get married next month?

All these symptoms in the last two months have put me in too much stress and anxiety.

Thanks
doctor
Answered by Dr. S. Murugan (1 hour later)
Brief Answer:
You are free from HIV, Syphilis, HepatitisC and Chlamydia

Detailed Answer:
Hi,
Welcome back.
So you are free from HIV as well as STDs like Syphilis, Chlamydia,Hepatitis C and genital Herpes.
STDs are more than 30 in numbers. Tests for all STDs either not available freely or not indicated always.
If you have symptoms Test for Gonorrhea and Trichomonas is necessary (not after 8 weeks- gonorrhea will manifest within a week). You had tested for Hepatitis C. Rule out Hepatitis B also with appropriate test. Other tests only if there is any symptoms.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan (18 days later)
Hi Doc,

I tested for hep b and HIV (rapid) 1&2 at 100 days and both were negative. But offlate I have developed lot of rashes on my chest,stomach and underarms. I am close to 4 months since exposure. Is it possible to develop HIV rashes so late? Also I had done urine test recently and had RBC shown as occasional. Have you seen anybody negative after 3 months converting to positive later? Can rashes be a sign of some other std ?
doctor
Answered by Dr. S. Murugan (24 minutes later)
Brief Answer:
You are HIV free. rashes are unlikely be due to HIV.

Detailed Answer:
Hi,
Welcome back.
I had not come across any case so far in my career of 25 years in the field of HIV turned to be reactive after 4 months and found to be non reactive by 3 months.
As you had tested HIV negative more than once after 12 weeks. It confirms that you are HIV free, almost 100% sure. Your rashes could be due to something else other than HIV. Not to worry and consult a dermatologist and get well soon.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan (4 hours later)
Thanks for your advice doc and I had definitely moved on after your last advice. It is just that these symptoms keep on persisting one by one.
My scrotum pain also appears more often now and inhave lost around 6 kgs in two months withiut any workout. Can this rash,weight loss and scrotum pain be due to some other std ?
What does RBC ( occasional) in urine test suggests?
I haven't tested for gonorrea and trichomoniasis yet.
doctor
Answered by Dr. S. Murugan (5 hours later)
Brief Answer:
Symptoms can occur conditions other than STDs also.

Detailed Answer:
Hi,
Welcome back.
Skin rash can occur with other STDs like Syphilis (Serological test will be positive), very rarely in other STDs.
Pain over scrotum also can be caused by Gonorrhea and Chlamydial infections. RBCs in urine can be due to infections or injury of reprodutive at any point (urethritis, seminal vesiculitis etc.)
At the sametime skin rashes, loss of weight, scrotal pain, Presence of RBC in urine can occur conditions other than STD also. Without the support of investigations we can not diagnosis most of the STDs.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan (30 hours later)
Hi Doc,

Thanks for your advice. I will get it investigated and revert you with the outcome. But can I be assured that I can rule out HIV in my case? I don't have nerves now to get tested for it after undergoing so many tests or should I go for another pcr or ab test ?
doctor
Answered by Dr. S. Murugan (20 minutes later)
Brief Answer:
HIV had been ruled out beyond any doubt.

Detailed Answer:
Hi,
Welcome back.
Negative Rapid HIV Antibody test done 100 dyas after the risky contact (?) ruled out HIV totally. Forget about HIV and about that incident. No more test for HIV is necessary for you as far as the last contact you had 100 days back.
Have a nice time.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan (3 days later)
Hi doc,

This would be my last question. Does HIV rash itch? My rashes are increasing and i am unable to consult a doc since I am on vacation outside.

Does late seroconversion really occur these days? I was also negative for syphilles tests at 77 days. I am very tense
doctor
Answered by Dr. S. Murugan (22 minutes later)
Brief Answer:
Seroconversion in HIV not go beyond 12 weeks.

Detailed Answer:
Hi,
Welcome back
Rashes of different types can occur in HIV disease at different stages. Both itching and nonetheless rashes can occur. Rashes during acute infection would be nonitchy or mildly itching. With Normal individuals seroconversion would not be delayed beyond 12 weeks.
Dr S Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan (6 days later)
Hi doc and thanks for reverting to my queries.
I showed my rashes yesterday to my dermatologist and HIV physician and both were concerned.

Dermatologist: he asked me to have vdrl & HIV 1-2 test ( both came negative) and called it pityriasiform papules and plaques on trunk and proximal part of thighs. When he saw the results today he was relieved and said he was not concerned with HIV but vdrl since HIV doesn't cause skin changes. He gave me medication( limcast and some gel) and asked me to relax and HIV is not my problem.

HIV physician: He was very confident after my 11 week duo negative result and asked me to get married without any hesitation. Yesterday on seeing the rashes he was concerned and asked me to have HIV viral load test. The result will come on Monday.

Doc I am so much under depression now and can't wait till Monday for my outcome.I never thought I have such depleted immune that I will seroconvert after 4 months(18weeks).

Please let me have your thoughts on the above and can I test positive on viral load after 3 month undetectable pcr test for HIV 1 & 2 and 18 week antibody negative test?

Can HIV rashes come so late after 3.5 months?

Have you seen a case like this before?

Please help me!!
doctor
Answered by Dr. S. Murugan (3 hours later)
Brief Answer:
Not come across any case sero-converted for HIV so late after 18 weeks.

Detailed Answer:
Hi,
Welcome back.
I already extended my opinion that HIV Sero-conversion is unlikely after 18 weeks. Your HIV RNA PCR result will likely be to come as undectable viral laod only. As your Dermatologist told is not related to HIV and likely to be due to Pityriasis Rosea.
Not to get anxious about the same.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan (21 hours later)
Hello doc and thanks again for your response. I can't tell you how much relived I am when I hear you haven't seen 18 week negative seroconvert later.
It is just that too many coincidence on symptoms are happening to me. I was always confident of negative status since I had not developed any rash in the first three months but that symptom also occurred.

I have left everything in God's hand and waiting for my viral load result on Monday.

I have updated my rash photos with you. Can you please check and let me know your feedback?

Also can viral load remain low after 90 days and yet no antibodies are produced? Is antibody production the reason for viral load and antigen decrease ? Are they related ?

Have you heard of HIV rash appearing after 3 months?

Thanks for support !!!
doctor
Answered by Dr. S. Murugan (2 hours later)
Brief Answer:
Rashes are likely due to Pityriasis Rosea. Not related to HIV.

Detailed Answer:
Hi,
Welcome back again.
I saw the pictures sent by you. Your rashes are looking like Pityriasis Rosea only. It is a self limiting skin condition (within 3-4 months). Follow the advice of your Dermatologist. These rashes have no relation to HIV.
Rashes can occur anytime during the course of HIV due to various reasons, due to co-morbidities, viral fever, drug rashes and various skin conditions , pruritic papules etc as with a normal individuals. No specific characters for HIV rashes. HIV acute infection is unlikely to occur after 3 months.
A high viral load is a rule in the first few weeks of the HIV disease. Body will recognize these virus swiftly and produce antibodies maximum within 12 weeks. It will not be missed.
Don't imagine odd things.
Dr S.Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S. Murugan (2 days later)
Hi doc,

I got my HIV 1 viral load result yesterday and it was below 40 copies/ml (not detectable) from srl diagnostic.my rashes have also almost disappeared.

Should I do pcr for HIV 2 also ?

Can viral load and antibody test together be negative after 18 weeks if HIV is there ? If HIV was there either of them should have been positive right ?

I just want to put this behind me. Thanks very very much for your support so far !!!!
doctor
Answered by Dr. S. Murugan (4 hours later)
Brief Answer:
You are free from HIV 1 and 2 infection beyond any doubt

Detailed Answer:
Hi,
Welcome back
I already assured you that you are free from HIV 1 and 2 infection. No further test is necessary for you. 4th generation Combo test cannot be non-reactive 12 weeks after the exposure in the presence of HIV infection. Relax and forget that incident.
Dr S Murugan
Above answer was peer-reviewed by : Dr. Deepak
doctor
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Follow up: Dr. S. Murugan (2 days later)
Thanks doctor. You have been of immense help to me.
Had it not been advices from you I might have taken a drastic step with my life. I had done a pcr blood test two days prior for HIV 2 to put an end to this trauma and I know I will receive a negative report today.

Wish you all the best and hopefully I will not bother you again with this topic.

Best regards,
doctor
Answered by Dr. S. Murugan (6 minutes later)
Brief Answer:
You will get a non-reactive report for HIV 2 infection also

Detailed Answer:
Hi,
Welcome back
Best wishes. I am sure that you will get a non-reactive report for HIV 2 infection also.
Dr S Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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What causes persistent sore throat, dry cough and pain in right testicles?

Brief Answer: You are free from HIV infection. Symptoms are not related to HIV. Detailed Answer: Hi, Welcome to HCM. Thanks for posting your query. Even if semen dribles after ejaculation during a protected intercourse (girl above position), your penis was still protected from the contact of her vaginal fluid. So you need not worry about these odd possibilities. You had both PCR for HIV 1 and 2 and also 4th generation COMBO test after 8 weeks. Negative results of these tests assure that you are free from HIV infection. Only for antibody detection tests, the reliability would be likely to get delayed sometimes up to 12 weeks, not for the antigen detecting test. PCR and P24 antigen part of 4th generation tests are detecting the direct presence of HIV particles and they would be conclusive and highly reliable by 4 weeks itself. So no more tests for HIV is necessary for you. You are free from HIV infection. All your symptoms are vague and not specific to HIV and can occur to anybody. Your observation of white coating of tongue would not necessarily be due to oral thrush. Only Physician will able to tell better due to their experience. For persistent sore throat you consult an ent Specialist. Culture and sensitivity test from a throat swab abd appropriate antibiotics as per the outcome of the result would relieve your problem. Dr S.Murguan