Pcr Test

[Jalpcr]

Hello. I had sex with a CSW on Nov. 16th. Protected oral and vaginal (condom did not break or come off). (I have been under enormous stress, anxiety and depressed over this.) This was in an urban area with a Hispanic girl. I started to have symptoms 4 weeks later. Low grade fever, sore throat ( GP did a culture came back viral) Pain in my right bicep, pain in my right knee, tingling / numbness in my left chin facial area and then in my left leg and foot also in my left hand. Joints in both hands were stiff and fingers felt like they were "locking " in the morning after I woke up then only stiff, no rash. These lasted for about a week to week and a half. GP did HIV and std panel at 4 weeks all negative. Went to an infectious disease specialist last week. He found no swollen lymph nodes. He did an RNA PCR Quantitative which was negative at week 7. He said I do not have HIV. I am concerned since I am married and have a 3 1/2 year old son. I had unprotected sex with my wife after the PCR test but remain worried because still have some tingling in my face. I need you to clarify a few points for me please.
1. What was my risk low? or non-existent?
2. You have said in previous posts that a combination of PCR and antibody at 4 weeks in 100% but I am worried that the antibody at 4 weeks is too soon.
3. What do you mean in the following post: http://www.medhelp.org/posts/HIV---Prevention/False-Negative-Test/show/1459490 when you said that a PCR can be negative but antibody test positive? Why would this be the case? I am worried now that the PCR test being negative may not mean I don't have HIV. Is it possible then that I need another antibody test? I read you saying in that post that if the virus is present the PCR will pick it up since there cannot be a "little of the virus" that is not detected.
4. Can I still get ARS symptoms at this point or beyond? Have you seen that with your patients? ( I am at week 8 now)
Thank you for your time.

[Edward W Hook, MD]

This is an unrelated question.  I will provide a single answer.  The bumps you describe do not sound like HSV-2 which only very, very rarely infects the mouth.  The only way to be sure however is with a PCR or culture for HSV performed on a swab specimen from the lesion.  

This is not a sign of HSV either.  

End of thread. EWH

[Jalpcr]

Dear Dr. Hook, Could you please tell me if little white bumps on my upper outer lip could be Herpes 2? I also have them on both sides of the inside part of the lips. I also had two canker sores/ mouth ulcers back to back in the last few weeks. Aren't these mouth issues HIV problems usually? I am very worried about these.... I have some tingling on the mouth/ chin area. Could this be because herpes hides in the nerves and is causing these symptoms? Thank you very much for your time.

[Edward W Hook, MD]

Thank you. I'm pleased I could help. Take care.  EWH

[Jalpcr]

Dear Dr. Hook, thank you for your fast and informative reply. You have indeed done a great deal to ease my mind about this situation. I feel much relieved by your definitive answers and  I can now more easily move on. You and Dr. Handsfield are a credit to your profession. I wish you both all the best in the New year! Thank you and take care.
JAL

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help and relieve your stress.  I suspect that what I am about to say will primarily serve to confirm what you have already heard.  There is no realistic risk for HIV or other STIs from protected sex as long as the condom was worn throughout sex and did not break.  Even contact with small amounts of genital secretions during sex would not pose a risk.  Thus, had you asked me, I would have told you that you did not need testing at all. Further, you now have a negative PCR test which serves to prove that your symptoms were not due to HIV and that you did not get HIV form the exposure you have described.  There is no reason to worry further.

In answer to your specific questions:
1. What was my risk low? or non-existent?
See above. This was a no risk encounter.

2. You have said in previous posts that a combination of PCR and antibody at 4 weeks in 100% but I am worried that the antibody at 4 weeks is too soon.
All I can do is repeat what I have said before. The combination of a negative PCR test and a negative antibody test are definitive at four weeks- You do not have HIV.  Believe the results.  

3. What do you mean in the following post: http://www.medhelp.org/posts/HIV---Prevention/False-Negative-Test/show/1459490 when you said that a PCR can be negative but antibody test positive? Why would this be the case? I am worried now that the PCR test being negative may not mean I don't have HIV. Is it possible then that I need another antibody test? I read you saying in that post that if the virus is present the PCR will pick it up since there cannot be a "little of the virus" that is not detected.
When a person has HIV and has been infected for four or more weeks one of the two tests (PCR or antibody) will ALWAYS be positive. The reasons for this are too complex to go into on this forum but this is the case.

4. Can I still get ARS symptoms at this point or beyond? Have you seen that with your patients? ( I am at week 8 now)
No, you are well beyond the time when ARS would occur and you have been proven to not have HIV.  Believe it.


I hope these comments are helpful. Take care. EWH