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Suggest Treatment For Dry Mouth And Swollen Lymph Nodes On Either Side Of Neck
Question: sir
I had vaginal intercourse with sex worker on july 18 and condom burst and I took penis within 5-7 sec. I have taken PEP (TENOFOVIR with EMTRICITABINE once daily) on 60 hours of exposure. I completed PEP on 16.8.16 (13 days ago). After starting PEP I have developed rash (after first dose) which was on & off on chest, shoulder. For this I took fexofenadine 800 for a week. On fourth week of PEP I developed sore throat and small lymph node on either side of upper neck and at same time I had severe dry mouth. Now all these symptoms subsided, however, now I am having few white areas on posterior pharyngeal wall and on tongue. On completing PEP (next day after end of PEP) I have done HIV combo test which was negative.
a) I am infected with HIV?
b) why I am having these symptoms. whether these symptoms are due to HIV?
c) white areas in throat and tongue are oral thrush? and is it specific for HIV?
d) whether this combo test is conclusive on immediately completion of PEP?
I am totally stressed out and depressed.
Kindly give suggestion sir
Thank you
I had vaginal intercourse with sex worker on july 18 and condom burst and I took penis within 5-7 sec. I have taken PEP (TENOFOVIR with EMTRICITABINE once daily) on 60 hours of exposure. I completed PEP on 16.8.16 (13 days ago). After starting PEP I have developed rash (after first dose) which was on & off on chest, shoulder. For this I took fexofenadine 800 for a week. On fourth week of PEP I developed sore throat and small lymph node on either side of upper neck and at same time I had severe dry mouth. Now all these symptoms subsided, however, now I am having few white areas on posterior pharyngeal wall and on tongue. On completing PEP (next day after end of PEP) I have done HIV combo test which was negative.
a) I am infected with HIV?
b) why I am having these symptoms. whether these symptoms are due to HIV?
c) white areas in throat and tongue are oral thrush? and is it specific for HIV?
d) whether this combo test is conclusive on immediately completion of PEP?
I am totally stressed out and depressed.
Kindly give suggestion sir
Thank you
Brief Answer:
Your symptoms are unlikely to be due to HIV.
Detailed Answer:
Hi,
Welcome to HCM.
Thanks for posting your query.
The sex workers are not always HIV positive. Even if considered her HIV positive, as you had taken PEP (started before 60 hours), you are almost safe.
1. You are unlikely to have HIV.
2. Skin rashes could be due to pep drugs. Sore throat and Whitish tongue and pharynx can occur to anybody. Such a common problems that any body can have.
3. Unlikely be oral thrush,
4.Your HIV combo test one month after the exposure almost ruled out HIV 1 infection.
Not to worry.
Dr S.Murugan
Your symptoms are unlikely to be due to HIV.
Detailed Answer:
Hi,
Welcome to HCM.
Thanks for posting your query.
The sex workers are not always HIV positive. Even if considered her HIV positive, as you had taken PEP (started before 60 hours), you are almost safe.
1. You are unlikely to have HIV.
2. Skin rashes could be due to pep drugs. Sore throat and Whitish tongue and pharynx can occur to anybody. Such a common problems that any body can have.
3. Unlikely be oral thrush,
4.Your HIV combo test one month after the exposure almost ruled out HIV 1 infection.
Not to worry.
Dr S.Murugan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you sir
A) almost ruled out mean is there chance to developing HIV 1 within 3 months?
B) can I have physical relationship with my wife as this test excluded HIV 1
C) is there any chance to develop hiv2 eventhough it is rare?
D) is there any test can be done before 3 months?
thank you sir
A) almost ruled out mean is there chance to developing HIV 1 within 3 months?
B) can I have physical relationship with my wife as this test excluded HIV 1
C) is there any chance to develop hiv2 eventhough it is rare?
D) is there any test can be done before 3 months?
thank you sir
Brief Answer:
HIV risk is negligible only.
Detailed Answer:
Hi,
Welcome back.
HIV COMBO test has two parts. Antigen detecting part can detect the HIV as early as 1 week and more conclusive by 3-4 weeks after the exposure. Antibody part of the test is reliable only after 8-12 weeks after the window period. Antigen part can detect only HIV 1 infection whereas the antibody part can detect both HIV 1 and 2 infection.
HIV 2 infection is a rare possibility (less than 0.5%),throughout the world except in certain parts of XXXXXXX So your negative HIV COMBO test ruled out HIV 1 infection. Moreover you were on PEP. That will delay the appearance of antibody formation if there is an infection.
Earlier the PEP, the effectiveness of removal of HIV is better than starting late. But your Chances of getting HIV is remote with PEP started by 60 hours after the exposure.
Dr S Murugan
HIV risk is negligible only.
Detailed Answer:
Hi,
Welcome back.
HIV COMBO test has two parts. Antigen detecting part can detect the HIV as early as 1 week and more conclusive by 3-4 weeks after the exposure. Antibody part of the test is reliable only after 8-12 weeks after the window period. Antigen part can detect only HIV 1 infection whereas the antibody part can detect both HIV 1 and 2 infection.
HIV 2 infection is a rare possibility (less than 0.5%),throughout the world except in certain parts of XXXXXXX So your negative HIV COMBO test ruled out HIV 1 infection. Moreover you were on PEP. That will delay the appearance of antibody formation if there is an infection.
Earlier the PEP, the effectiveness of removal of HIV is better than starting late. But your Chances of getting HIV is remote with PEP started by 60 hours after the exposure.
Dr S Murugan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you sir
Today I have done combo test again (43 days after exposure) and it was negative.
a) negligible risk for only HIV 2 or both HIV 1 & HIV 2?
a) Is there any chance of antibody test for HIV 1 positive after window period, even though antigen test negative on two occasions? (since I was on PEP)
b) Is there any chance of negative combo test at 43 days becoming positive within 3 months without any further exposure?
b) do you ever seen any negative combo at 43 days turned out to be positive later?
thank you sir.
Thank you sir.
Today I have done combo test again (43 days after exposure) and it was negative.
a) negligible risk for only HIV 2 or both HIV 1 & HIV 2?
a) Is there any chance of antibody test for HIV 1 positive after window period, even though antigen test negative on two occasions? (since I was on PEP)
b) Is there any chance of negative combo test at 43 days becoming positive within 3 months without any further exposure?
b) do you ever seen any negative combo at 43 days turned out to be positive later?
thank you sir.
Thank you sir.
Brief Answer:
Your HIV risk is negligible only.
Detailed Answer:
Hi,
Welcome back.
Medicine is not mathematics to get constant answers. Any odd combination or reaction can occur inside the body. We can not predict each and every individual.
a) If PEP started within 24 hours you risk is almost nil.As you started by 60 hours your risk can be predicted as negligible. After 72 hours PEP has no value.
b) As PEP was started within 60 hours after exposure, seroconversion is unlikely. Antigen detection usually not interfered with PEP. So your results are reliable to the maximum extent.
c) It is possible if the individual has HIV 2 infection.
d) Combo test is a 4th generation test. It is available in the market just a year or more. My experience with 4th generation combo test is very minimal. I had not come across any such case, negative before 50 days and became positive with antibody test afterwards, as my cases of HIV 2 were diagnosed only by antibody detecting test alone, not with 4th generation test.
Dr S.Murugan
Your HIV risk is negligible only.
Detailed Answer:
Hi,
Welcome back.
Medicine is not mathematics to get constant answers. Any odd combination or reaction can occur inside the body. We can not predict each and every individual.
a) If PEP started within 24 hours you risk is almost nil.As you started by 60 hours your risk can be predicted as negligible. After 72 hours PEP has no value.
b) As PEP was started within 60 hours after exposure, seroconversion is unlikely. Antigen detection usually not interfered with PEP. So your results are reliable to the maximum extent.
c) It is possible if the individual has HIV 2 infection.
d) Combo test is a 4th generation test. It is available in the market just a year or more. My experience with 4th generation combo test is very minimal. I had not come across any such case, negative before 50 days and became positive with antibody test afterwards, as my cases of HIV 2 were diagnosed only by antibody detecting test alone, not with 4th generation test.
Dr S.Murugan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks sir
I would like to ask follow up question sir.
8 weeks after exposure (4 weeks after PEP) I have done DUO test and became NEGATIVE.
I also done HIV 1 RNA PCR qualitative test 25 days after PEP & HIV 2 RNA PCR qualitative test 21 after PEP (almost 8 weeks and 7 weeks after exposure respectively) and interpretation were NOT DETECTED. PCR test were done at Metropolis healthcare.
Rashes are still persisting (on and off, disappears if I take fexofenadine 180), few ulcers on either side of tongue with small submandibular lymph nodes on either side without increase in size still there from 4 week of exposure and a new submental lymph node noted 2 days back. I used Betadine mouth gargling for 1 week.
(I have done VDRL after 3 weeks of exposure)
My questions are
a) Is these results (duo, HIV 1 & 2 RNA PCR qualitative test) are conclusive and reliable?
b) Why there is rash on an off ? (rash-red mildly elevated, non-itchy and non scaly)
c) What could be the reason for painless ulcers on either side of tongue with LN in neck?
Thank you sir
I would like to ask follow up question sir.
8 weeks after exposure (4 weeks after PEP) I have done DUO test and became NEGATIVE.
I also done HIV 1 RNA PCR qualitative test 25 days after PEP & HIV 2 RNA PCR qualitative test 21 after PEP (almost 8 weeks and 7 weeks after exposure respectively) and interpretation were NOT DETECTED. PCR test were done at Metropolis healthcare.
Rashes are still persisting (on and off, disappears if I take fexofenadine 180), few ulcers on either side of tongue with small submandibular lymph nodes on either side without increase in size still there from 4 week of exposure and a new submental lymph node noted 2 days back. I used Betadine mouth gargling for 1 week.
(I have done VDRL after 3 weeks of exposure)
My questions are
a) Is these results (duo, HIV 1 & 2 RNA PCR qualitative test) are conclusive and reliable?
b) Why there is rash on an off ? (rash-red mildly elevated, non-itchy and non scaly)
c) What could be the reason for painless ulcers on either side of tongue with LN in neck?
Thank you sir
Brief Answer:
Qulaitative RNA PCR 1 and 2 tests ruled out HIV infection.
Detailed Answer:
Hi,
Welcome back.
a).HIV 1 and 2 RNA PCR are reliable and confirmed that you are free from HIV. HIV DUO test has to be repeated after 6 months as you had taken PEP. In this negative DUO test also P24 Antigen part is reliable and ruled out the possibility of HIV 1 once again. PEP may delay the sero-conversion up to six months. So part of DUO test could be very much relied.
b).Rash could be due to many reason, like allergy, exantheme etc. Consult a dermatologist and get well. Your symptoms are not related to HIV.
c). Mouth ulcers once again could be due to many reasons, like vitamin deficiency, aphthous, traumatic etc. When there is ulcers in mouth, lymph node enlargement is inevitable.
Dr S.Murugan
Qulaitative RNA PCR 1 and 2 tests ruled out HIV infection.
Detailed Answer:
Hi,
Welcome back.
a).HIV 1 and 2 RNA PCR are reliable and confirmed that you are free from HIV. HIV DUO test has to be repeated after 6 months as you had taken PEP. In this negative DUO test also P24 Antigen part is reliable and ruled out the possibility of HIV 1 once again. PEP may delay the sero-conversion up to six months. So part of DUO test could be very much relied.
b).Rash could be due to many reason, like allergy, exantheme etc. Consult a dermatologist and get well. Your symptoms are not related to HIV.
c). Mouth ulcers once again could be due to many reasons, like vitamin deficiency, aphthous, traumatic etc. When there is ulcers in mouth, lymph node enlargement is inevitable.
Dr S.Murugan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you sir
a) If there is infection by hiv2, it would have been picked up my PCR? or is there chance to miss infection sir?
b)Regarding hiv2 pcr report, they mentioned ''Specimen with viral load below 100 IU/ml cannot be detected by this assay''. If there is infection, viruses are in blood would be in thousands, since the exposure was 8 weeks ago. Is am correct sir?
c) HIV DUO test after 6 months is just for protocol? or to detect missed infection? eventhough HIV 1 and 2 RNA PCR detect virus, not antibodies and it is reliable and accurate?
thank you sir
a) If there is infection by hiv2, it would have been picked up my PCR? or is there chance to miss infection sir?
b)Regarding hiv2 pcr report, they mentioned ''Specimen with viral load below 100 IU/ml cannot be detected by this assay''. If there is infection, viruses are in blood would be in thousands, since the exposure was 8 weeks ago. Is am correct sir?
c) HIV DUO test after 6 months is just for protocol? or to detect missed infection? eventhough HIV 1 and 2 RNA PCR detect virus, not antibodies and it is reliable and accurate?
thank you sir
Brief Answer:
Qualitative PCR are more reliable and conclusive.
Detailed Answer:
Hi,
Welcome back.
a and b). PCR Specific for HIV 2 would detect the presence of HIV 2 infection as early as 3 weeks. The viral load would be definitely more high in early infection and there is no reason that it could not be found out by this test in the presence of an infection.
c) HIV DUO as per protocol with PEP. In your case it is not mandatory as it had been already ruled out HIV 1 and 2 infection with the negative PCR. RNA PCR is more reliable.
Dr S.Murugan
Qualitative PCR are more reliable and conclusive.
Detailed Answer:
Hi,
Welcome back.
a and b). PCR Specific for HIV 2 would detect the presence of HIV 2 infection as early as 3 weeks. The viral load would be definitely more high in early infection and there is no reason that it could not be found out by this test in the presence of an infection.
c) HIV DUO as per protocol with PEP. In your case it is not mandatory as it had been already ruled out HIV 1 and 2 infection with the negative PCR. RNA PCR is more reliable.
Dr S.Murugan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much sir
Forgive me asking same question again and again in different format sir.
a) Is there any possibility of getting positive antibody test by duo test after 6 months without further exposure as had some symptoms?. Have you seen any such cases?
b) Can I have normal family life considering these results are conclusive and confirmatory?
I hope you understand my situation sir...
Forgive me asking same question again and again in different format sir.
a) Is there any possibility of getting positive antibody test by duo test after 6 months without further exposure as had some symptoms?. Have you seen any such cases?
b) Can I have normal family life considering these results are conclusive and confirmatory?
I hope you understand my situation sir...
Brief Answer:
You are free from HIV 1 and 2 infection.
Detailed Answer:
Hi,
Welcome back.
It is quite unlikely to have the HIV DUO test become positive 6 months after the exposure when your HIV RNA PCR tests were nonreactive. I don't have come across so far such an incident.
You can have sex with your partner without any hesitation.
Dr S Murugan
You are free from HIV 1 and 2 infection.
Detailed Answer:
Hi,
Welcome back.
It is quite unlikely to have the HIV DUO test become positive 6 months after the exposure when your HIV RNA PCR tests were nonreactive. I don't have come across so far such an incident.
You can have sex with your partner without any hesitation.
Dr S Murugan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you sir
Very happy to hear that I am free of HIV from well experienced specialist. Now I can concentrate on my study as I am giving exam soon.
Thank you for your valuable suggestion at needy time sir.
Very happy to hear that I am free of HIV from well experienced specialist. Now I can concentrate on my study as I am giving exam soon.
Thank you for your valuable suggestion at needy time sir.
Brief Answer:
You are most welcome.
Detailed Answer:
Hi,
Welcome back.
Forget about that incident.
Enjoy your days ahead.
You are welcome at anytime if you have any more queries.
Dr S.Murugan
You are most welcome.
Detailed Answer:
Hi,
Welcome back.
Forget about that incident.
Enjoy your days ahead.
You are welcome at anytime if you have any more queries.
Dr S.Murugan
Note: Get personalized answers to your HIV related queries You can choose to talk face to face with your doctor. Book a Video Call now.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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