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Hi Sir, I Had An Unprotected Sexual Exposure With A

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Posted on Tue, 14 Feb 2023
Question: Hi sir, i had an unprotected sexual exposure with a CSW 152 days back & took the following HIV tests -
1. HIV RNA VIRAL LOAD at 19, 60 & 130 days.
2. HIV DUO at 19, 43, 60, 76, 100, 120 & 145 days from 4 different labs & all were negative.
Sir, but for the past 10 days I can palpate very small lymph node like structures (small pea size & multiple) in the epitrochlear & popliteal regions.
Sir, in addition to this for the first time in my life I got a toe fungal infection along with a thumb nail excess drying, with striated looks & skin peeling around it..

Sir, my questions are -
1. Are these in anyway related to HIV or shall I forget about it and move on with my marital life.
2. Is there any possibility that I could have acquired HIV 2 as they say its window is quite long sir?!
3. Lastly in your long-standing practice have u seen any genuine person testing positive after a 5 month negative using such advanced antibody tests sir?!
doctor
Answered by Dr. Sankaranantham Murugan (20 hours later)
Brief Answer:
You are free from HIV 1 and 2 infection beyond any doubt.

Detailed Answer:
Hi,
Welcome to ASK A DOCTOR through HCM.
Thanks for posting your query.
HIV DUO test is highly reliable. It is very much conclusive 12 weeks after the exposure. The non reactive HIV DUO test 12 weeks after the exposure ruled out both HIV 1 and 2 beyond any doubt. But you had nonreactive test even after 21 weeks. There is no chance for you to have HIV infection. Moreover, you had HIV RNA PCR test with undetectable viral load even after 4 months. That also ruled out HIV 1 infection.
Your symptoms are not at all related to HIV infection. Multiple palpable node in Epitrochlear and popliteal region. This finding itself is wrong.
Skin and nail symptoms, explained by you, can occur anybody.
You can forget the incident and go ahead with your normal routine.
For your skin and nail problems, consult a Dermatologist and get well.
Dr S. Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sankaranantham Murugan (7 minutes later)
Thank you so much sir for giving ur valued opinion.
Feel psychologically releived.
doctor
Answered by Dr. Sankaranantham Murugan (30 minutes later)
Brief Answer:
You are most welcome

Detailed Answer:
Hi,
Welcome back.
You are very much sure that you are free from HIV 1 and 2. Forget about that incident at all and proceed with your day today activities as usual, including your marital activities.
Here afterwards be careful to have protected sex in future in such situations.
Dr S. Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sankaranantham Murugan (10 minutes later)
Sure sir. Sir, 2 final questions-
1. I took Doxy PEP for syphilis immediately after exposure for 7 days and checked for TPHA & RPR 92 days after exposure. Is this conclusive sir?!
2. Should I test for HTLV & is it prevalent in Tamilnadu sir?!
doctor
Answered by Dr. Sankaranantham Murugan (7 hours later)
Brief Answer:
You are almost free from all STIs /HIV

Detailed Answer:
Hi,
Welcome back.
I guess that you are a medical personnel. Others would not have used the words epitrochlear and popliteal and Doxy PEP. Doxy PEP is being talked only within a year only.
You had taken Doxy PEP and your serological tests (Specific and nonspecific) were nonreactive for syphilis. Then, forget about Syphilis also.
HTLV (Olden term?) - You mean HPV infection? Among the viral STIs, Herpes Simplex and Genital warts are the common STIs prevalent all over the world and also in Tamilnadu also. Serological tests for HPV are available widely. I usually will not recommend tests for HPV infection. I will treat with the appearance of clinical manifestations only. If it is available, there is nothing wrong in testing for the sake of completion. It had been already 5 months past after your unprotected exposure. if you have infection of HPV, by this time it would have appeared and you would have recognized the same by close inspection of your genitals.
Not to worry about all these things. Relax and carry on with your routine.
Dr S. Murugan

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sankaranantham Murugan (2 hours later)
Thank you sir for your detailed reply, yes sir I am a doctor and this first & last mistake of mine is torturing me for the past 5 months with non-specific symptoms like generalised joint pains/muscle pains, sudden Vit D reduction to 5.3 value. Now i am in Vit D supplement for the same sir.

I previously tried to contact you through doctor spring.com but wasn't able to & sir, i have attached an image of a lesion for your valued opinion. Could this be HPV?! This lesion appeared 10 days after the exposure, persisted for months and even now it remains mildly.

And finally sir, I asked for Human T Cell Lymphotrophic Virus 1 & 2 as it is also categorised as an STD. That's all are my doubts & thank you sir..
doctor
Answered by Dr. Sankaranantham Murugan (6 hours later)
Brief Answer:
HTLV 1 and 2 are not categorized under STIs

Detailed Answer:
Hi,
Welcome back.
I can understand your concern. Forget about HIV and syphilis in your case totally.
The lesion does not look like a HPV infection from that picture. It could be taken more focused on the lesion alone apart from your fingers and proximal part of the penis.
HTLV 1 and 2 are not considered as STIs.
Dr S. Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sankaranantham Murugan (44 minutes later)
Thank you sir for the reassurance. Should I check myself for HTLV owing to this exposure?!
Sir, for Chlamydia i took a IgG, IgM on the 135th day, is that enough to rule out or should I go for PCR?!
I have attached the present day lesion in macro mode sir.
doctor
Answered by Dr. Sankaranantham Murugan (5 hours later)
Brief Answer:
No more test is necessary to rule out STI/HIV

Detailed Answer:
Hi,
welcome back.
You need not worry about any STI including Chlamydia. No more test is necessary.
The lesion does not look like Genital warts. It looks some healed lesion.
HTLV 1 and 2 are not related to STI.
Please forget about that incident and move towards your normal routine.
Dr S Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sankaranantham Murugan (15 days later)
Hello sir, hope you are fine.
Today is 170 th day after my exposure and out of anxiety even after you advising me that no more HIV test is required, I took 1 last HIV CMIA lab test at 158 days, which was negative.

1. Sir, Is there any chance for the result to change in the next 20 days?!
2. In your years of experience have you ever come across or heard of any patient in XXXXXXX seroconverting after 5 months?!
3. Sir, shall I take 1 last HIV test at 181 days or shall I forget it once & for all?!
doctor
Answered by Dr. Sankaranantham Murugan (9 hours later)
Brief Answer:
You are free from HIV 1 and 2 infection beyond any doubt.

Detailed Answer:
Hi,
Welcome back.
You are a medical professional. You have to believe medical science. Modern Medicine is evidence based. I have already assured you that you are free from HIV infection.
A congenital immune deficient (CME) individual or a defaulter of PEP or an individual on PEP started after 72 hours can become a sero-converter for HIV even after 3 months. This also is very much unlikely after 180 days after the exposure.
I had not come across any such cases in my practice of HIV Medicine since 1989 onwards.
Dr S. Murugan
Above answer was peer-reviewed by : Dr. Saisudha Kotla
doctor
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Follow up: Dr. Sankaranantham Murugan (3 hours later)

Thank you again sir for your reassurance, but since of my persisting joint aches and mildly swollen lymph nodes (generalised) i had this doubt sir.

And one final question sir, some studies state that the COVID vaccine offers protection against a wide array of flu-like viruses, hence would this by any chance delay the window period of HIV, which too is an RNA virus?!
doctor
Answered by Dr. Sankaranantham Murugan (11 hours later)
Brief Answer:
Your symptoms may be due to some other causes other HIV

Detailed Answer:
Hi,
Welcome back.
Look for various other reasons for your joint aches and lymph node enlargement.
HIV does not come under FLU virus. No such study is available to mark that Covid vaccination delays the sero-conversion of HIV infection. Window period is only for antibody formation and for antibody tests and not for antigen tests. HIV RNA test and HIV DUO test are detecting antigen. So there is no role for Covid vaccination,
Dr S. Murugan

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Sankaranantham Murugan (30 minutes later)
Thankyou sir, just a question out of curiosity-

Blood banks in Western countries accept donor blood just 3 months after doubtful exposure after an ID XXXXXXX sir. Generally in these IDNAT tests do they screen for HIV RNA or DNA or a combination of both?!
Even I took an ID XXXXXXX here in Apollo 19 days after exposure but they never mentioned whether it was a DNA/RNA or a total nucleic acid test sir.
doctor
Answered by Dr. Sankaranantham Murugan (8 hours later)
Brief Answer:
IDNAT is a multiplex test can detect HIV, HBV, HCV.

Detailed Answer:
Hi,
Welcome back.
Really I don't have much idea about this test.
It seems that IDNAT is multiplex test for HIV, HBV and HCV. It can eliminate the chances of transfusing infected blood during the window period and thereby increases the safety of the individual. But it can detect HIV 1 and not HIV 2.
The incidence of HIV 2 is less than 0.5% in the rest of the world except certain parts of XXXXXXX
A microbiologist may be in a better position to answer your question regarding whether it detects HIV RNA or DNA.
Dr S. Murugan
Above answer was peer-reviewed by : Dr. Saisudha Kotla
doctor
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Follow up: Dr. Sankaranantham Murugan (2 hours later)
Thank you very much sir for clearing my doubts patiently..
doctor
Answered by Dr. Sankaranantham Murugan (20 hours later)
Brief Answer:
You are most welcome

Detailed Answer:
Hi,
Welcome back
Forget about that incident and go ahead with your routine.
Have a Great day!
Dr S. Murugan
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Kampana
doctor
Answered by
Dr.
Dr. Sankaranantham Murugan

HIV AIDS Specialist

Practicing since :1974

Answered : 3109 Questions

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Hi Sir, I Had An Unprotected Sexual Exposure With A

Brief Answer: You are free from HIV 1 and 2 infection beyond any doubt. Detailed Answer: Hi, Welcome to ASK A DOCTOR through HCM. Thanks for posting your query. HIV DUO test is highly reliable. It is very much conclusive 12 weeks after the exposure. The non reactive HIV DUO test 12 weeks after the exposure ruled out both HIV 1 and 2 beyond any doubt. But you had nonreactive test even after 21 weeks. There is no chance for you to have HIV infection. Moreover, you had HIV RNA PCR test with undetectable viral load even after 4 months. That also ruled out HIV 1 infection. Your symptoms are not at all related to HIV infection. Multiple palpable node in Epitrochlear and popliteal region. This finding itself is wrong. Skin and nail symptoms, explained by you, can occur anybody. You can forget the incident and go ahead with your normal routine. For your skin and nail problems, consult a Dermatologist and get well. Dr S. Murugan