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What Is 4th Generation HIV Ab/ag With Reflex Test?
Question: Under Arm Lymph Node
Hi Doctor, this may sound familiar to you, as I have posted the issue before but the dicussion is closed and I dont know who get to answer the query next time, so I have added a summary of last discussions.
Request you to please specifically answer the questions as pointed with (Q#)
The problem started from XXXXXXX 1, had a white soapy tongue, took hexamedine oral spray. XXXXXXX 3, I sampled for a broad STD panel, 4th Gen HIV ab/ag with reflex test, since I had sex with 4 prostitutes in Brazil on May 12,13 and 25, the tests were negative.
(Q#1: What is 4th Gen HIV ab/ag with reflex test?)
(Q#2: What is the test window for the test above to be conclusive? Since I had sex 20 days and 7 days before the test) XXXXXXX 10, the problem aggravated and I got a dry tongue and throat with white hairy tongue texture, went to the doctor he said tonsil abcess, since he spoted white dot on right side tonsil but gave no medicine XXXXXXX 24, I got a painfull swollen lymph node infront of right ear, went to the doctor and he gave an injection of steroid. Tested all STD panel again. All test were negative, HIV ab test, only ab was conducted.
(Q#3: How conclusive are HIV ab test at 6 weeks and 4 weeks mark?)
July 2: Noticed white spot on right side tonsil and a mouth sore(Like a pus filled pimple) very close infront of the right tonsil, when picked with a tooth pick it bled and became normal
(Q#4: How to distinguish mouth sore from any other fungal outbreak?)
July 6: Got another swollen lymph node under right side arm(painless), next to the nipple.
(Q#5: The white spot was on right side tonsil, the face lymph node swoolen was right side, and under arm is also right side, are these issues connected, do they any how relate to any STD/HIV?)
(Q#6: Can tonsil abcess cause lymph nodes to swell under arm pits too?)
NOTE: I never had these issues before, I am living in XXXXXXX now. I dont have any other problems like body ache, muscle ache or fever. Although since XXXXXXX 24 I have noticed little swelling below my ears on saliva glands.
Hi Doctor, this may sound familiar to you, as I have posted the issue before but the dicussion is closed and I dont know who get to answer the query next time, so I have added a summary of last discussions.
Request you to please specifically answer the questions as pointed with (Q#)
The problem started from XXXXXXX 1, had a white soapy tongue, took hexamedine oral spray. XXXXXXX 3, I sampled for a broad STD panel, 4th Gen HIV ab/ag with reflex test, since I had sex with 4 prostitutes in Brazil on May 12,13 and 25, the tests were negative.
(Q#1: What is 4th Gen HIV ab/ag with reflex test?)
(Q#2: What is the test window for the test above to be conclusive? Since I had sex 20 days and 7 days before the test) XXXXXXX 10, the problem aggravated and I got a dry tongue and throat with white hairy tongue texture, went to the doctor he said tonsil abcess, since he spoted white dot on right side tonsil but gave no medicine XXXXXXX 24, I got a painfull swollen lymph node infront of right ear, went to the doctor and he gave an injection of steroid. Tested all STD panel again. All test were negative, HIV ab test, only ab was conducted.
(Q#3: How conclusive are HIV ab test at 6 weeks and 4 weeks mark?)
July 2: Noticed white spot on right side tonsil and a mouth sore(Like a pus filled pimple) very close infront of the right tonsil, when picked with a tooth pick it bled and became normal
(Q#4: How to distinguish mouth sore from any other fungal outbreak?)
July 6: Got another swollen lymph node under right side arm(painless), next to the nipple.
(Q#5: The white spot was on right side tonsil, the face lymph node swoolen was right side, and under arm is also right side, are these issues connected, do they any how relate to any STD/HIV?)
(Q#6: Can tonsil abcess cause lymph nodes to swell under arm pits too?)
NOTE: I never had these issues before, I am living in XXXXXXX now. I dont have any other problems like body ache, muscle ache or fever. Although since XXXXXXX 24 I have noticed little swelling below my ears on saliva glands.
Brief Answer:
About HIV related questions , tests & answers.
Detailed Answer:
Hello XXXXXX
After going through your query I will try to explain about few things and about the tests .
Please note down ( read carefully ) , so you will get your answers.
HIV type 1 & type 2.
Laboratory diagnosis of HIV infection depends on the demonstration of anti_HIV antibodies and/or the detection of HIV or one of its components.
The standard screening test for HIV infection is the detection of anti-HIV ANTIBODIES ( ab as you want to know ) using an ENZYME IMMUNOASSAY( EIA )
This test (EIA ) is highly SENSITIVE ( > 99.5%) and is quite SPECIFIC ( as you asked about this ) .
Western blot is the most commonly used confirmatory test & detects antibodies to HIV ANTIGENS (ag as asked by you) of specific molecular weights.
Antibodies (ab) begins to appear within 2 weeks ( 15 days ) of infection ( as asked by you time for test ) and the period of time between initial infection and the development of detectable antibodies is rarely more than 3 months ( if person got infection antibodies ( ab ) will appear after 2 weeks and not later than 3 months ).
The HIV plasma p24 antigen can be measured using an EIA type capture assay.
Plasma p24 antigen levels rise during the first few weeks following infection , prior to appearance of anti-HIV antibodies.
Now answers of your questions .
Q1 ANS 1 .
4th generation HIV ab/ag with reflex test means .Reflex test means a part of infection caused by HIV due to its early STIMULATION ( as early as possible for detection for HIV ab/ag).
4th generation is a term means latest and ultramodern test as antibodies response to antigen (ab/ag ).
Q 2 and ans .
Conclusive , as I clearly mentioned that after 2 weeks not later than 3 months , if infection will appear in tests.
Western blot ( E I A ) is as mentioned is most decisive and specific and accurate
Q3 and ans How conclusive HIV ab tests at 6 weeks and 4 weeks .
Ans is as mentioned you had sex on 25th May last ( 4 weeks ) May 12 ( 6 weeks )
Ans Yes if infection is there it is decisive and will be positive after 6 weeks and 4 weeks .
Q4 How to distinguish mouth sore with fungus infection .
Ans Fungus infection also causes soapy tongue and on buccal cavity in mouth.
The diagnosis of fungus infection is established by visualization of PSEDOHYPHAE /HYPHAE in the presence of inflammation in the appropriate clinical sample . Physician with physical examination can find out difference between fungus and HIV infection ( sore).
Q5 White spots on tonsils , face swollen , right lymph under arm pits . Are these connectd , do they related to STD/ HIV.
Ans , Yes they may be connected to each other and it depends upon the bacteria or virus which causes infection over tonsils .
Draining lymph nodes are usually enlarged due to infection and so is with HIV / STD .
All depends upon the nature of infection.
However in the absence of positive tests, they are unlikely related to HIV/STD/
Q 6 Can tonsil abscess causes lymph nodes to swells under arm pit too?
Ans , Yes again I would like to say depending upon the type and nature of causative organism that enlargement of lymph node occurs or not in arm pits.
Swelling in salivary region near ear may be due to virus infection or bacterial infection caused by "oral sex"
In my opinion Get in one more all test for confirmation for HIV infection. If any question I will reply in follow up.
Good luck.
About HIV related questions , tests & answers.
Detailed Answer:
Hello XXXXXX
After going through your query I will try to explain about few things and about the tests .
Please note down ( read carefully ) , so you will get your answers.
HIV type 1 & type 2.
Laboratory diagnosis of HIV infection depends on the demonstration of anti_HIV antibodies and/or the detection of HIV or one of its components.
The standard screening test for HIV infection is the detection of anti-HIV ANTIBODIES ( ab as you want to know ) using an ENZYME IMMUNOASSAY( EIA )
This test (EIA ) is highly SENSITIVE ( > 99.5%) and is quite SPECIFIC ( as you asked about this ) .
Western blot is the most commonly used confirmatory test & detects antibodies to HIV ANTIGENS (ag as asked by you) of specific molecular weights.
Antibodies (ab) begins to appear within 2 weeks ( 15 days ) of infection ( as asked by you time for test ) and the period of time between initial infection and the development of detectable antibodies is rarely more than 3 months ( if person got infection antibodies ( ab ) will appear after 2 weeks and not later than 3 months ).
The HIV plasma p24 antigen can be measured using an EIA type capture assay.
Plasma p24 antigen levels rise during the first few weeks following infection , prior to appearance of anti-HIV antibodies.
Now answers of your questions .
Q1 ANS 1 .
4th generation HIV ab/ag with reflex test means .Reflex test means a part of infection caused by HIV due to its early STIMULATION ( as early as possible for detection for HIV ab/ag).
4th generation is a term means latest and ultramodern test as antibodies response to antigen (ab/ag ).
Q 2 and ans .
Conclusive , as I clearly mentioned that after 2 weeks not later than 3 months , if infection will appear in tests.
Western blot ( E I A ) is as mentioned is most decisive and specific and accurate
Q3 and ans How conclusive HIV ab tests at 6 weeks and 4 weeks .
Ans is as mentioned you had sex on 25th May last ( 4 weeks ) May 12 ( 6 weeks )
Ans Yes if infection is there it is decisive and will be positive after 6 weeks and 4 weeks .
Q4 How to distinguish mouth sore with fungus infection .
Ans Fungus infection also causes soapy tongue and on buccal cavity in mouth.
The diagnosis of fungus infection is established by visualization of PSEDOHYPHAE /HYPHAE in the presence of inflammation in the appropriate clinical sample . Physician with physical examination can find out difference between fungus and HIV infection ( sore).
Q5 White spots on tonsils , face swollen , right lymph under arm pits . Are these connectd , do they related to STD/ HIV.
Ans , Yes they may be connected to each other and it depends upon the bacteria or virus which causes infection over tonsils .
Draining lymph nodes are usually enlarged due to infection and so is with HIV / STD .
All depends upon the nature of infection.
However in the absence of positive tests, they are unlikely related to HIV/STD/
Q 6 Can tonsil abscess causes lymph nodes to swells under arm pit too?
Ans , Yes again I would like to say depending upon the type and nature of causative organism that enlargement of lymph node occurs or not in arm pits.
Swelling in salivary region near ear may be due to virus infection or bacterial infection caused by "oral sex"
In my opinion Get in one more all test for confirmation for HIV infection. If any question I will reply in follow up.
Good luck.
Above answer was peer-reviewed by :
Dr. Prasad
Thank you doctor, based on your reply for Q3, the tests are conclusively negative, which is what I was expecting. You still recommend a test, is there something wrong you suspect?
Yesterday(July 8), I had this swollen node again next to right side nipple which is little painful. Went to the doctor again for the white tongue and this swelling.
He prescribed me 1 tab Fluconazole and Flucticasone Propionate nasal spray. He said my inner nose is red and purple which is indication of strong allergy, which are quite famous around Memphis(#2 most allergent city in US, with asthma as #1).
He did examine the node and did an ultrasound, told me the size was 6mm. He said this also could be an allergic reaction, and he will monitor the size in the follow up. I never had such issues ever in life. I am originally from XXXXXXX which is quite un-sanitary. I was wondering how long does swollen nodes last?
What are other symptoms should I keep an eye out for? In your opinion do think this is not any STD.
Yesterday(July 8), I had this swollen node again next to right side nipple which is little painful. Went to the doctor again for the white tongue and this swelling.
He prescribed me 1 tab Fluconazole and Flucticasone Propionate nasal spray. He said my inner nose is red and purple which is indication of strong allergy, which are quite famous around Memphis(#2 most allergent city in US, with asthma as #1).
He did examine the node and did an ultrasound, told me the size was 6mm. He said this also could be an allergic reaction, and he will monitor the size in the follow up. I never had such issues ever in life. I am originally from XXXXXXX which is quite un-sanitary. I was wondering how long does swollen nodes last?
What are other symptoms should I keep an eye out for? In your opinion do think this is not any STD.
Brief Answer:
Follow up for HIV & related question with answer.
Detailed Answer:
Hello XXXXXX
Regarding Q3, at present it is difficult to predict how that swollen lymph node will progress. However I am glad all the tests are negative - and this is a good thing for you. I will not write for any more tests now.
As you mentioned that you are living in an area where allergy is most common.
When such patient visit I prescribe them to take monteleukast+ fexofenadine tablet once or two in day till complete relief.
The cause of concern is enlarged lymph nodes ( on 8th July ) . The most worrisome thing is "oropharyngeal ie. mouth and tongue " and lymphadenopathy . In such cases I emperically start my patients on "doxycyclin 200 mg / day for 7-10 days". You can discuss about it with your treating doctor.
In future keep watch about these symptoms .
Major
-weight loss,
- chronic diarrhea , prolonged fever.
Minor
- Persistent cough for one month.
- Recurrent herpes zoster,
- Generalized pruritis dermatitis,
- OROPHARYNGEAL CANDYDIASIS
- Chronic progressive & disseminated Herpes Simplex infection
- GENERALIZED LYMPHDENOPATHY.
Once again observe these symptoms next 6 months.
Hope this helps.
Follow up for HIV & related question with answer.
Detailed Answer:
Hello XXXXXX
Regarding Q3, at present it is difficult to predict how that swollen lymph node will progress. However I am glad all the tests are negative - and this is a good thing for you. I will not write for any more tests now.
As you mentioned that you are living in an area where allergy is most common.
When such patient visit I prescribe them to take monteleukast+ fexofenadine tablet once or two in day till complete relief.
The cause of concern is enlarged lymph nodes ( on 8th July ) . The most worrisome thing is "oropharyngeal ie. mouth and tongue " and lymphadenopathy . In such cases I emperically start my patients on "doxycyclin 200 mg / day for 7-10 days". You can discuss about it with your treating doctor.
In future keep watch about these symptoms .
Major
-weight loss,
- chronic diarrhea , prolonged fever.
Minor
- Persistent cough for one month.
- Recurrent herpes zoster,
- Generalized pruritis dermatitis,
- OROPHARYNGEAL CANDYDIASIS
- Chronic progressive & disseminated Herpes Simplex infection
- GENERALIZED LYMPHDENOPATHY.
Once again observe these symptoms next 6 months.
Hope this helps.
Above answer was peer-reviewed by :
Dr. Prasad
Hi Doctor, I am sorry, I forgot to mention that my doctor did prescribe me anti-allergic tab, one/day (Loratadine).
Also i did forgot to mention that the swollen node was painful on July 8th, but after the medication i took for 2 days, I would say the swelling is pretty much the same but the pain has gone.
You said the oral and lymphopathy is a worry some issue, in your opinion what are you worried about, what can cause these bodily responses.
Also aside from the comment above, can it be possible that only general lymphopathy may appear without fever/diarrhea/rash or any other symptoms?
Because if that is not the case then this lymph cannot be associated with any STDs, which will give me some peace of mind.
Also i did forgot to mention that the swollen node was painful on July 8th, but after the medication i took for 2 days, I would say the swelling is pretty much the same but the pain has gone.
You said the oral and lymphopathy is a worry some issue, in your opinion what are you worried about, what can cause these bodily responses.
Also aside from the comment above, can it be possible that only general lymphopathy may appear without fever/diarrhea/rash or any other symptoms?
Because if that is not the case then this lymph cannot be associated with any STDs, which will give me some peace of mind.
Brief Answer:
HIV & related question & answer
Detailed Answer:
Hello,
I am pleased to know the pain has subsided, now lets wait for the size to reduce. It may take a few weeks to reduce.
If you develop oropharyngeal candidiasis - which present as milk like coating over tongue and mouth along with lymphadenopathy, I would look for other sexually transmitted infections.
If you do not develop them, you need not worry. That should give you peace of mind.
Good luck.
HIV & related question & answer
Detailed Answer:
Hello,
I am pleased to know the pain has subsided, now lets wait for the size to reduce. It may take a few weeks to reduce.
If you develop oropharyngeal candidiasis - which present as milk like coating over tongue and mouth along with lymphadenopathy, I would look for other sexually transmitted infections.
If you do not develop them, you need not worry. That should give you peace of mind.
Good luck.
Above answer was peer-reviewed by :
Dr. Prasad
Hi doctor, I did get tested for all other STDs along side HIV on XXXXXXX 24 they were all negative. I am not sure of the conclusiveness of other STD tests.
Also as you know that my doctor here suggested its allergies and gave me these tablets, can allergies cause such kind of body response?
And from the timeline stand point its all weird:
May 12,13 and 25: Sex Encounter XXXXXXX 1: Mouth and tongue whitening, no swollen lymphs.
July 8: Swollen lymph.
Lymph problem did not present until after 38 days of oral issue. My doctor's hunch here is its just a coincident that the mouth infection I picked was from Brazil and swollen lymph node was caused by allergies in XXXXXXX What do you think your take on this would be?
Also as you know that my doctor here suggested its allergies and gave me these tablets, can allergies cause such kind of body response?
And from the timeline stand point its all weird:
May 12,13 and 25: Sex Encounter XXXXXXX 1: Mouth and tongue whitening, no swollen lymphs.
July 8: Swollen lymph.
Lymph problem did not present until after 38 days of oral issue. My doctor's hunch here is its just a coincident that the mouth infection I picked was from Brazil and swollen lymph node was caused by allergies in XXXXXXX What do you think your take on this would be?
Brief Answer:
HIV & related questions & answers
Detailed Answer:
Hello XXXXXXX
No doubt that allergy many times causes mouth ulcer ( as may be in your case ) and this ulcer produces enlargement of lymph nodes .
Now your history is encouraging that it seems that are free fro S T D and HIV . But still I like to advise keep watch over any other symptoms in next 6 months , otherwise you are alright . Good luck .
HIV & related questions & answers
Detailed Answer:
Hello XXXXXXX
No doubt that allergy many times causes mouth ulcer ( as may be in your case ) and this ulcer produces enlargement of lymph nodes .
Now your history is encouraging that it seems that are free fro S T D and HIV . But still I like to advise keep watch over any other symptoms in next 6 months , otherwise you are alright . Good luck .
Above answer was peer-reviewed by :
Dr. Prasad
Once again thank you for a prompt response, I will keep the symptoms in check for future.
There is one more question I had, I have another symptoms/maybe just my over suspicion. I got pain when I touch write above my hip bone i.e. on the crest of iliac on the right side of my abdomen. I was wondering are there any lymph nodes there? the pain do seem to extend when I press.
The pain started today morning.
There is one more question I had, I have another symptoms/maybe just my over suspicion. I got pain when I touch write above my hip bone i.e. on the crest of iliac on the right side of my abdomen. I was wondering are there any lymph nodes there? the pain do seem to extend when I press.
The pain started today morning.
Brief Answer:
HIV and related questions & answers.
Detailed Answer:
Hello XXXXXXX
Pain over iliac region or over hip bones crest is not related to HIV or STD as far as known to me . This may be due to any pressure or bone pain or due to over concern . There is no lymph node in these bones.
Good luck.
HIV and related questions & answers.
Detailed Answer:
Hello XXXXXXX
Pain over iliac region or over hip bones crest is not related to HIV or STD as far as known to me . This may be due to any pressure or bone pain or due to over concern . There is no lymph node in these bones.
Good luck.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thank you doctor.
I have been monitoring the swollen node under the armpit, the pain has gone and swelling has reduced probably by 5%, not much of a difference.
The left side abdomen pain may be of some bruising, but lately again I have got a bruise/rash like mark on the left hand arm, about 1" in diameter.
Can you please tell me how would a HIV rash look like?where will it usually appear? why does it appear?will it pain/color?
Hi doctor, I was very concerned, so I got myself a HIV-1 RNA Qualitative test, it is negative (sampled July 10th), how conclusive is this test?
What is HIV 1?
I have been monitoring the swollen node under the armpit, the pain has gone and swelling has reduced probably by 5%, not much of a difference.
The left side abdomen pain may be of some bruising, but lately again I have got a bruise/rash like mark on the left hand arm, about 1" in diameter.
Can you please tell me how would a HIV rash look like?where will it usually appear? why does it appear?will it pain/color?
Hi doctor, I was very concerned, so I got myself a HIV-1 RNA Qualitative test, it is negative (sampled July 10th), how conclusive is this test?
What is HIV 1?
Brief Answer:
HIV , RELATED QUESTIONS & ANSWERS .
Detailed Answer:
Hello XXXXXXX
H I V related rashes are just like pimples (smaller in size), but with pointed head and with slight burning and mild degree pain (rather I should say some anxiety type pain i.e . dull pain ). It can erupt anywhere in body - no fix site for rashes.They don't have typical color; but most of viral rashes are erythematous (red). While lymph nodes also can enlarge anywhere in body but most common site is inguinal lymph nodes area .
Color of lymph nodes ( enlarged lymph nodes are usually skin color type with mild pain ) . These lymph nodes enlarge because of defense system of body . Enlarged lymph nodes try to prevent infection to spread further .
The rate of disease progression is directly correlated with plasma RNA levels. So this test is used to determine the rate of progression. Patients with high levels of HIV RNA progress to symptomatic disease faster than do those with low levels of HIV R N A . This means patients who have HIV1 there levels of R N A is high than those who don't have .
In your case this (HIV1 RNA ) is NEGATIVE and this is very good .
Good luck to you.
HIV , RELATED QUESTIONS & ANSWERS .
Detailed Answer:
Hello XXXXXXX
H I V related rashes are just like pimples (smaller in size), but with pointed head and with slight burning and mild degree pain (rather I should say some anxiety type pain i.e . dull pain ). It can erupt anywhere in body - no fix site for rashes.They don't have typical color; but most of viral rashes are erythematous (red). While lymph nodes also can enlarge anywhere in body but most common site is inguinal lymph nodes area .
Color of lymph nodes ( enlarged lymph nodes are usually skin color type with mild pain ) . These lymph nodes enlarge because of defense system of body . Enlarged lymph nodes try to prevent infection to spread further .
The rate of disease progression is directly correlated with plasma RNA levels. So this test is used to determine the rate of progression. Patients with high levels of HIV RNA progress to symptomatic disease faster than do those with low levels of HIV R N A . This means patients who have HIV1 there levels of R N A is high than those who don't have .
In your case this (HIV1 RNA ) is NEGATIVE and this is very good .
Good luck to you.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Prasad
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