Dear Doctor,

like many other I foolishly had unprotected sex with a female (I am hetero, the woman was caucasian and encounter was local, Toronto, Canada. Her history, according to her, was that she had protected sex outside her marriage once before me. After our encounter she went to get tested for STI's as well as HIV and the results were, according to her, all negative). It is to be noted that while I have no reason not to believe her I cannot verify any of it either ).
A few days after unprotected sex I noticed my glands in my groin were acting up and then later, my glands in my armpits. The panic set in instantly. I had no fever and no other symptoms other than in the past 51 days maybe 4-5 times a bit of night sweat around my neck (Random nights, not consecutive and I even checked my temperature right after - again no fever or elevated temperature), just my lymph-nodes being painful. I did have dry eyes for a day or two but I think it was because I was severely stressed out about the whole thing.

About 9 days later I went to an anonymous clinic and had a HIV1/2 Rapid test performed, which was negative. My glands, although irritated, were not swollen (the doctor there checked it). Further testing for Chlamydia, Gonorrhea, etc. turned out negative. I was advised by the councillor that I need to retest after 12 weeks as I was within the 'window period' of HIV.

After 32 days I tested negative for HIV1 RNA-PCR (with STDweb) and HIV1 Elisa. After 35 days (this was pre-arranged) I tested negative for HIV1/2 Rapid test. After about 40 days, I went to my doctor, confessed to what happened and he performed a blood test (immunology) and a urine test for a variety of STI's as well as Hep C. Further, the blood was tested for any abnormalities of the immune system. He thought a couple of my glands (one groin, one above my collar bone appeared to be swollen. The good news are that everything appears to be completely normal, with no sign of any irregularities in blood or urine.

The bad news is that my lymph-nodes under my arm and in my groin are still bugging me (painful). Sometimes the whole day, sometimes just a stinging sensation here and there. I told the doctor about it and he said normally a pain in the glands indicates an infection being fought off. However, he said it contradicted itself with the fact that my test results (blood) were not indicating anything. So he said to just come back in a month to run another set of tests.

I know my exposure to HIV is generally considered low risk as it was hetero and vaginal only. However, I have a very sensitive Urethra and I am sure that due to this my exposure was more risky - vaginal fluid could have entered my system.

My question is... how accurate is the HIV1 RNA-PCR test that was performed 32 days after potential exposure? From what I found on the internet it is supposed to be conclusive? I understand the latest Rapid test (35 days after) I took is about 80% accurate. I understand that I will have to retest anyway but I would like to know how much I do have to worry, at this point (I suffer from anxiety and depression from this).

I understand this is all self inflicted and that I am the author of my own misfortune - I certainly learned my lesson and going through this (as you know from all the other cases) is punishment. I just don't know if this will be punishment for life. Your comments on the above would be much appreciated.

Thank you and best regards.

Hi,

Testing and counseling for sexually transmitted disease is an area where emotions, reasoning and scientific data are so intricately entangled that the real issues at stake are sometime more difficult to be distinguished.

THE TESTS:

Testing for anything always presents at least these two components: Interpreting Results on one hand and Issues of Certainty on the other. You had HIV antibodies at 9, 32, 35 days…all negatives. You had a HIV-PCR and 32 days…also negative. In addition Hep C and additional general testing at 40 days…all negative.
You need to remember that the PCR (polymerase chain reaction) test is not FDA approved for diagnostic purposes and is used primarily to follow the efficacy of treatment in HIV positive patients. Given its popularity, however, it has gained attention and demand in an effort to relieve anxieties related to the HIV antibody waiting time of 16 weeks. The PCR test detects the presence of HIV-RNA or DNA in a person's blood and therefore the presence of virus itself and not antibodies. When one is infected by HIV and the immune system is overwhelmed by the viral charge, viral replication can occur within one to two weeks time.
The PCR test has such an exquisite amplification power that can take a short and specific genetic segment of HIV (viral gene) and easily produce millions of copies of that nucleic acid sequence…in vitro.
PCR detects HIV infection one to three weeks earlier than a standard antibody test. It is so sensitive and so complex that it may produce more false positives than the antibody test. That is why the FDA is hesitant in using this test to make a diagnosis and relies more on HIV antibodies testing. Therefore take an antibodies test at 16 weeks from exposure and if negative close your case. Remember that nothing in science is written in stone and that Certainty ultimately never comes from the outside and…needs to be declared by you.

“THE GLANDS ACTING UP”

Discovery of lymph nodes, glands and similar in the groin and armpit is a common finding during a physical exam…they are there to do their job and unless pain, tenderness and unusual sizes are present, they are not given too much attention. The case may be different when normal nodes are palpated, sometime for the first time, by someone whose perceptions are amplified by his/her amplification technology...read this as FEAR. In that case a node becomes THE NODE and that sensation is easily embedded in internal talks of guilt, judgments and things like “something bad might happen”. I hear that conversation in your email. Are you going to continue for the rest of your life or again…you, the author, will choose a different ending!

Thanks and Stay Well

Dr. Gian

Dr Gian , I had a one night stand with a woman I met. I used a condom for the vaginal sex, but no protection was used when I gave her oral cunnilingus and also none when I received oral sex/ fellatio.

About 5 - 6 weeks later I began to notice a thick white coating on my tounge. I read that Candida/ Thrush is a sign of HIV , so I was tested for all STD'S at about 11 weeks after my one night stand and was negative. I also read that you should be tested again at 6 months, which I plan on doing, but basically my question is can thrush / candida show up only after 5 or 6 weeks as a result of being infected with HIV ???

Thanks in advance.

Hi,

This is a situation very similar to another email I received earlier today but it had to do with a man having sex with a man. Same approach applies here.
Oral thrush is a transaction between a fungal infective charge and a decreased body ability to develop an adequate immune response. Candida and company are usually in action. The manifestation of any fungal infection has as components
• the condition of the intestinal tract which is our own personal biosphere and usually indicates a disequilibrium in the quality of the intestinal bacterial flora (“disbiosis”).
• all those conditions which negatively engage our immune system and first of all stressful situations.
• a possible exposure through genital-oral contact with direct exposure to fungi.
• a possible exposure through genital-genital contact and a viral infection with possible immune system engagement
I agree with your in retesting after 6 months.

Stay Well

Dr. Gian

hi I am 15 years old and I am a virgin . I shaved my vagina and then I started to get white itchy bumbs the white stuff went away when I put vasaline on it but then the outside of my vagina is still very itchy and dry . White creamy stinky stuff comes out when I pee. what is going on here ?


I really hope you did not mean “vagina” but pubic and perinea area about the shaving!!!! The "white creamy stuff" is not unusual in teenagers especially in relation to menstrual activity…..take a look here

Be well.

Dr. Gian

Dr. Gian,

I am writing to ask for your help and consel.

I am currently experiencing pain and discomfort from a cluster of whiteheads on my right external labia majora. I will do my best to summarize the events of the past 6 weeks, as I do not know for certain which of the following are contributing factors:
* i had unprotected sex in mid-march with my partner in mid-march, followed by taking plan be 36 hours later
* the plan b was ineffective and i tested positive for pregnancy 10 days later
* i had a surgical abortion four weeks ago tomorrow
* last week, i used a vaginal spermicide supository for the first time as a secondary contraceptive method
* three days after using the supository, i began to experiencing extremely painful and burning urination and noticed at that time a single whitehead postule on my labia majora
* three days after the onset of symptoms, i went to see a general practitioner. i had a urinalysis which showed i had blood (3+) and leuts (1+) in my urine. she also conducted a pelvic exam, noting that my cervix was very aggitated and that i had very heavy, thick white vaginal discharge. upon my request, she also did a swab test of the postule on my labia. she said at the time it did not look like herpes, but i requested a test for herpes anyway. i am still awaiting the test results for the labwork sent out on monday (urine, pelvic swab, and postule swab). she told me the discharge seemed indicative of a yeast infection and prescribed fluconazole. the pain of urination began to substantially subside the next day.
* yesterday, i noted that there were several more whiteheads in the same area on my external labia majora and, while i cannot see to identify the cause, i also have discomfort in my anal area
From everything I have read, the symptoms seem to point to herpes. However, my partner has had no outbreaks, symptoms or history of this or any other std. I have also had a very clean medical billing. I am 35 years old.
I am suffering much anxiety at this point. My primary question is: is it possible these symptoms could be anything other than herpes? I should have the test results in a couple of days, but would very much appreciate if you could provide insight prior to that time. The worst infliction is simply not knowing.

Thanks for your time and consideration.



Hi
It seems to me you have been having some rough times lately…and a fungal infection and a urinary tract infection and... I doubt what you describe as whiteheads are herpetic manifestation and I would instead look into a local staph bacterial activity. Anyway, if Herpes is in your mind, just get tested and find out and if the whiteheads reoccur see your local Physician…

Stay well,

Dr. Gian

Dear Dr Gian

I live in boston, MA area. A year ago, I was in houston, tx for a job interview and called one of this massage girls while I was in my hotel room. Not a smart move I guess. Few weeks later I think I developed what maybe a chancre on my stomach, bcoz I would find blood in my shirt. I m not sure if this is was a chancre or a wound that I scratched. Anyways ab 6 months later I developed a major non itchy rash that originated from genital area then spread to stomach, trunk, back, etc. I also lost weight and had severe malaisyia and tiredness. I was traveling for work purposes outside the country and went to see a doc who said it was syphilis. I did some blood test results (RPR, TPHA), and I got -ve results. Also did ghonorrea, chlamidya, hiv, tests , all of which came -ve. went back to him and he said to repeat the test in different labs, so I did and one lab came out +ve (RPR and TPHA) in one lab while three other labs were -ve for same test... I was treated with penicillin for secondary syphilis and repeated tests came ALL -ve at this point.
I m back in MA and did some tests (RPR, FTA ABS, TPPA) all of which came back -ve.
I still get some rashes that are not same looks at the initial rash.
Now my question is: was this syphilis ? I have seen various physicians and they said its NOT, that I have allergies , hives, etc.
Also are syphilis serology tests reliable and accurate ?
Is there anything such as 'syphilis with -ve serology', I think I read that somewhere online.
What about the recurring rashes , I don t seem find explanations for those.
Could this be something else, if so what would it be ?
Thank you v much for your help

Hi,

I think you used the word Chancre a bit too liberally…and I understand! I also think from your description that you are and were negative for syphilis. In addition I think you should check, if you have not already done so, for Herpes type1&2 IgG (remember that antibodies for herpes may show up form 2 weeks – 4 months). I would not be surprised if ….!

In good health

Dr. Gian

Dear Dr Gian

Thank you for your response. I know I already tested +ve for herpes many years ago. In fact I was prescribed valtrex and was taking that to avoid recurrences. I just was under the impression that HSV virus affect only genitals and mouth but my rash was covering the stomach, back, legs, feets, etc ...also the lesions looked different than those of HSV.
Any feed back ?

Thank you and Best Regards\

Hi, I'm a 22 y.o. and I've been in a relationship with another male for over a year now. We've had unprotected sex. Now I think i have oral thrush. Naturally, I assume the worse each time i get tested. But I don't know anymore. I'm a vegetarian and I eat a lot of starchy foods and I also got sick after coming back from Costa Rica, so who knows. But there's a large possibility I could have HIV. What do you think? It's been a year since I got my last HIV test.

Hi,

Oral thrush is a transaction between a fungal infective charge and a decreased body ability to develop an adequate immune response. Candida and company are usually in action. The manifestation of any fungal infection has as components:

• the condition of the intestinal tract which is our own personal biosphere and usually indicates a disequilibrium in the quality of the intestinal bacterial flora (“disbiosis”).
• all those conditions which negatively engage our immune system and first of all stressful situations.
• a possible exposure through genital-oral contact with direct exposure to fungi.
• a possible exposure through genital-genital contact and a viral infection with possible immune system engagement

If your history suggests exposure to HIV virus it would be advisable to run an HIV antibody test.

Stay Well

Dr. Gian

Hi doc

Well, ... had sex with an ex girlfriend - we both cheated on our spouses. Horrible affair. It was kind of a drunken quicky, vaginal, nothing extraordinary - not even very pleasant. In fact, the self loathing started before the sex...
She of course swears that this event was the only sex she ever had outside her marriage. However, I cannot account for her general faithfulness and I know she was quite experimental when we dated some 15 years back.

I'm avoiding sex with my wife at all costs but have not had the courage to break the news to her.

After the..., you know, event.... I had 5 days of combivir PEP, antibiotic PEP (three white tablets, one of one kind and two of another which was explained to me as the standard prophylaxis) as well as Hep A&B innoculation some 17 hrs (but no immunoglobulin) after the event.

Guilt and anxiety ridden, I then started on a series of tests. Most of these were apparently taken before appropriate elapsing of window periods. Two doctors attended to me during this time, however neither one claims to be an expert in this field. Their general attitude is friendly but dismissive of my overt concerns and due to the "low risk exposure" they are apparently not overly concerned with testing window periods, which in my opinion defeats the purpose of getting peace of mind.

The schedule below sets out the general gist of test, times and results.

I'm going for a final HIV PCR next week - about 6 weeks PE - (and knowing myself, I'll probably find myself taking an Elisa at 3 or 4 months as well...)

Within the first two weeks, I had a lot of discomfort in the perineum and surrounding areas. I eventually developed a dull pain in my testicles (like an unwelcome but gentle squeeze) that radiates up thhrough my pelvis and stomach cramps about 2 weeks+ into this mess. I went to our regualar GP, whom I obviously told nothing about the sexcapades. He treated me for stress induced Colon infection/ IBS with some antispasmodics?, anti anxiety goodies and antibiotics (I think a 1 a day for 3 days regime of Ciprobay XR). Things got better for a while, but I have since developed some musculo-skeletal pains, nausea, dry burning eyes and leg pains that come and go, which I ascribe to anxiety and stress. (I even use some fancy names such as "sciatica", "fibromyalgia", "pelvic floor dysfunction" and such, but I also understand that I don't fit the clinical criteria for most of these) I find however that some excercise works for most of my symptoms. Otherwise I get the odd itch in the crotch and some of those, Oh-no-its-a-burning-sensation!! moments on my penis. Hard to tell what is real, what is different and what is just, well, an itch. Nothing lasts for more than a minute or two, but tomorrow is the same thing...
Still, many of my current symptoms are "flu-like" - and we know what happens if you type "flu-like" and "std" in the Google search engine... Then again I'm better today - and no fever so far! Not that I know of - damnit! Keep on double guessing myself, and well, there is the dull pain on the right of my penis agian like clockwork. I cannot keep this up - if you'll pardon the pun.

Could you please give me some guidance on the following -

1) Does it appear that my antibiotic treatment would prevent most if not all bacterial risks of my exposure?

2) I think the Hep B Surface antigen test at 17 days was a waste of money. However, do I need to do more Hep B testing in view of my innoculation after the event and the 24 day qualitative PCR?

3) Should Hep C be a concern to me at all?

4) I'm happy about the positive HSV1 IgG, as I understand it may provide some limited protection against subsequent HSV2 exposure. I know (was told...) the IgG is prone to "cross-reactions" and false positives, but in view of the negative result I guess I got the better roll of the dice. There is however conflicting reports on the reliability of the HSV2 IgM at 9 days. Some even say a 4-6week window applies (and a 6-8 for the IgG), although my doctors seem quite happy with that result. Dr. Hunter of www.medhelp.org is particularly unhappy with the IgM. I qoute: "You are right about the "suspect nature" of IgM antibody for HSV infection, but the test is even worse than you might know. HSV IgM antibody testing is basically useless, except perhaps in diagnosing HSV in newborns....The basic problems are that for HSV in adults, IgM antibody often doesn't appear earlier than IgG, even with initial herpes"

Am I at the right place, or is it time to move on to a psychiatrist?

Thanking you in advance with much appreciation.

Regards

Hi, I wanted to know if I should get tested. I never had vaginal sex before but I have performed oral sex and I have received oral sex. The last time I was intimate was August 2004. However, in 2006 or 07I learned that my ex (whom I performed oral on) had unprotected sex with a man before he met me and he said he got tested and he was clear or whatever. But I never got my self tested to make sure and I read that you can't always go by somebody else results. I think about it all the time and wonder if I could have contracted a STD from him. I have no symptoms but I rather be safe than sorry. I was thinking about ordering the "STD Panel 4 Remote Exposure" from your website just to clear the air and prevent me from possibly exposing another man in the future, just in case. What's your opinion? Thanks in advance.

Hi,

Action is always betters tha worrying. Since your exposure was in 2004 a negative resulta in tte Complete Remote panel would clear the air.

In good health

Dr. Gian

Hello Dr G,

I couldn't agree more with your statement about despair, anxiety and resentment when it comes to this virus! After much research & consulting with Dr.'s, we're still left with many questions & doubts. Forgive the long email but, we need as much information as possible in order to make informed decisions.

I am 49 yr. old male...(excellent health) dating a 49 yr. old woman(excellent health) for the past 8 mos. A few weeks ago, she noticed a few blemishes in the pelvic area & was dx with Molluscum by her Gyno. Topical treatment resolved them..( I only wish I could say the same for our relationship).. Her gyno feels it was sexually transmitted. I have NEVER been with anyone else during our relationship. She claims the same & I believe her based on what I know of her morals & family values etc.. The Last sexual contact with others was virtually the same for both of us..about 1-2 Mos..prior to us meeting. P.s. I've never had ANY noticeable bumps/pimples in that area ...altho' a week after her diag. my dermatologist removed One, tiny ..flat, red spot from there...which turned out to me the 'M'. Also, about midway thru the relationship I was tested for all STD's with Negative results. Naturally, doubt has crept in to the relationship as we both try to find 'explanations' for other than it being sexually transmitted. Note: we have ALWAYS had protected sex.

As she is an Elementary school teacher (& its prevalence in children) I theorized that she may have touched a contaminated surface and contracted it that way..

Question 1.? If so, would she have had to touch the area (pelvic) the lesions showed up? need clarification as Ive learned that when Adults get it..it tends to settle in that area..but, not sure if it can enter one area...and show up in another WITHOUT touching that area.

Question 2 ? Being familiar with the stated incubation period, Is it possible...lets say, I contracted from my previous partner BUT...it had a long incubation & therefore I wasn't contagious until 4 - 6 mos? THEN, if transmitted to her...it didnt appear for a few months ..thereby explaining the lengthy period for it to appear?

Question 3 ? Do the 'lesions' ALWAYS follow the same development cycle? e.g. Over time do they always grow larger ? OR could they just appear as small ..red blemishes and stay that way for a long period where I may not have noticed? (or her on herself) As I say, Ive never had anything resembling the example photos Ive seen online... but, like most...have had little dots or tiny 'bumps' ( no head) in that area. Ive learned that the lesions can last for 1-2 yrs avg...and wondered if thats a possibility or would they DEFINITELY be noticed.

A few other notes... we've traveled quite a bit...various locales and hotel rooms ...and I've read where items such as clothing, bedding, toys, towels and other surfaces can be contaminated & wondered about that probability. Is there ANY other probable scenario which you can think of that would explain (other than sexual) our situation? I am beside myself & very anxious about the possible damage to our trust & relationship this can cause. I dont' blame her as she was deceived in a past relationship & has to be cautious. Its killing me that Im innocent of any wrong doing & can't seem to come up with info to prove otherwise.

Thank you in advance for any help/ advice you can offer... I know you must be very busy & receive loads of emails... Please answer at your earliest convenience....

Best regards,

Hi,

Molluscum is an innocent virus, easily spread, slightly on the rise in the US, of little health concern and rather than “blamishes” it shows up as small, waxy, round, raised polyp-like growths (often with a tiny depression in the middle) which may be single at first, but can multiply into clusters and contain a firm, waxy, white/yellowish substance. http://dermatlas.med.jhmi.edu/derm/result.cfm?OutputSet=2&BO=AND&Diagnosis=39

The infections source is usually skin to skin contact especially when present in the genital aerea but many other sources of infection are known such as contaminated towels, clothing, toys, benches and exercise equipment and even contaminated bedspread in a hotel. Molluscum spreading is made easier in the presence of stressed out skin areas i.e. sunburn, burns from too much chlorine in a swimming pool, eczema, scrapes, rug and razor burns, etc.

And…like the herpes virus, spreading to different parts of their body may occur due to autoinoculation by touching or scratching a bump and then touching another part of the body.

The manifestation of any infection and also for molluscim is always a transaction between the charge of the infective agent and your immune system modulation. Therefore several scenarios of clinical manifestation are possible within the congruity of certain ranges.

http://www.lib.uiowa.edu/hARDIN/MD/molluscum.html

http://www.cdc.gov/ncidod/dvrd/molluscum/overview.htm

I hope this information help giving an answer to your “questions and doubts” although, it seems to me. that the fundamental questions and doubts have to do with the presence of a breakdown in reciprocal trust rather than a health concern and “informed decisions” in such a situation need to come more from a reciprocal sharing of personal integrity rather than arguments based on statistical or scientific information.

Stay Well

Dr. Gian

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From:
To: Dr.Gian
Subject: Pregnancy

Hi Dr.Gian

Well I have been reading a lot of articles on herpes and pregnancy and genital warts and pregnancy. Well my issue is that I have both. I have only had 1 herpes outbreak, which was my first, and got put on Valtrex. Currently I am taking one pill daily for prevention and have not had any second episodes. As for my warts I had my first out break and got some treatment for them and I really haven’t had any problems since just 1 or to small ones and they disappear. I am now planning to have a baby and I want to know how can that effect me and my baby as well my delivery choices other options I might have or if even I should have a baby.

Thank you I will appreciate your help and honesty!!

Hi,

First let me say that your ultimate reference about how to manage the herpes infection and minimize the risk to your baby is… a talk to your obstetrician or midwife. However, I have good news for you. Having herpes does not mean having hard choices in having a baby.
First element in your favor: You acquired herpes before getting pregnant and not during pregnancy, especially during the last part of pregnancy. Transmission rates are lowest for women who acquire herpes before pregnancy.
Second, herpes of the newborn is remarkably rare and while it is estimated that 20-25% of pregnant women have genital herpes only less than 0.1% of babies contract an infection. Compared to other risk of pregnancy, neonatal herpes is very small especially when the Mom does not have an active outbreak. Neonatal herpes occurs mostly from asymptomatic shedding (when the virus reactivates without causing any symptoms) especially.
Third: herpes antibodies in the mother's blood cross the placenta to the fetus and babies of mothers with long-standing herpes infections have a natural protection against the virus. Even women who acquire genital herpes during the first two trimesters of pregnancy are usually able to supply sufficient antibody to help protect the fetus. The higher rate of asymptomatic shedding, plus the lack of antibodies, create a greater risk for babies whose mothers become infected in the last trimester.
Only if a woman has a herpes lesion at delivery or complaints and symptoms which are called pro-dromal and occur immediately preceding the herpes, the OB-GYN may recommend a cesarean delivery to prevent the baby from coming into contact with active virus. Between 10% and 14% of women with genital herpes have an active lesion during delivery. The odds are higher for women who acquire herpes during pregnancy, and lower for women who have had herpes for more than six years.
Although some mothers, even without herpes lesions at the time of delivery, do request a C-section and put them selves at an higher delivery risk because they want to do everything possible to avoid infecting their babies. the standard of care recommended by the American College of Obstetrics and Gynecology (ACOG) is vaginal delivery. In your case, since you do not seem to have large and vaginal obstructing and/or bleeding vaginal warts, vaginal delivery would be also recommendable for your warts concern.

Stay Well

Dr. Gian

From:
To: Dr. Gian
Subject: Testing procedures

Dear Dr. Gian:

My girlfriend and I will be using on of your test centers for std testing. She insists that the only

conclusive way to properly test males for certain stds is by obtaining a sample from inserting a collection instrument into the urethra in the penis. Do you do this form of sample collection? Is this true, over just blood samples?

Thanks, Chris

Hi Chris,

I believe you are referring as " certain stds" the following : Chlamydia, Gonorrhea and Trichomonas. These are the ones where we use a swab inserted into the urethra. However today we have also a urine test available for Chlamydia and Gonorrhea which is widely used and very accurate. It is called the PCR test and it is done both in males and females. This is what we do. And we also, of course, do many other tests for STD, such as HIV, Syphilis, Herpes, Hepatitis etc. which require instead the taking of blood samples.

Thank for using our testing centers.

Dr. Gian

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