How to detect the cause of my swollen lymph nodes?

Question

Hello doctor,

I had a high-risk sexual exposure about seven months ago. About two months later, I was tested for HIV and other sexually transmitted infections. CMV and HSV-1 were positive; all other results were negative.

Since then, I have continued to have symptoms, including a warm sensation in my stomach, which sometimes seems to move to various parts of my body. I also have a swollen lymph node on my neck that has been there for several months.

I was tested again for HIV, hepatitis A, hepatitis B, hepatitis C, syphilis, gonorrhea, chlamydia, and HPV, and all of these came back negative.

I also had an abnormal Pap smear, but it was negative for HPV, bacterial vaginosis, urinary tract infection, and yeast infection.

Because my symptoms are still present, should I have additional testing for HIV or any other sexually transmitted infections, or do my previous negative test results stand as conclusive now?

Please help me.

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query, and I understand your concern.

You have all of the following symptoms:

Tiredness.
Weight reduction.
Low-grade fever.
Itchy inside.
Urticaria (hives).
Lymph nodes swollen.
Chills.

The timing of symptoms overall is compatible with a primary cytomegalovirus (CMV) infection, i.e., a new CMV infection in adulthood.

CMV can cause prolonged fatigue, swollen lymph nodes that may persist for weeks to months, flu-like symptoms, and sometimes elevated liver enzymes. You may feel warmth or moving sensations due to ongoing inflammation, anxiety (which can really cause physical feelings), or some other condition that has not yet been evaluated.

I would suggest you follow up with your doctor for further evaluation.

If the lymph node has been swollen for months, it needs to be re-evaluated. Your doctor may want to look at it again, see how big it is and what it looks like, and may want to do some imaging studies or refer you to a specialist.

Even if your Human Papillomavirus (HPV) test is negative, your abnormal Pap smear still requires appropriate follow-up.

Your obstetrician-gynecologist should provide you with a clear follow-up plan. Depending on the exact results of your Pap smear, this could mean a repeat Pap smear after the recommended time period or a procedure such as colposcopy.

It would be helpful to clarify the cytomegalovirus (CMV) results.

Ask if your CMV testing was positive for Immunoglobulin M (IgM), Immunoglobulin G (IgG), or both. A positive IgM usually means you have a recent or active infection, whereas a positive IgG means you had an infection in the past.

If the doctor did not do the Epstein-Barr Virus test, it is a good idea to talk about it.

The Epstein-Barr Virus can cause a sickness called mononucleosis, and it can cause symptoms that are very similar to the CMV infection, such as feeling very tired for a long time, swollen lymph nodes, and a low fever that does not go away.

If your symptoms do not go away, the doctor may want to do blood tests.

The doctor may want to do these tests:

Test for the Antinuclear Antibody.
Sedimentation rate of erythrocytes.
C-Reactive Protein.

These tests can help figure out if you have an inflammatory condition that is causing your symptoms to last for a long time.

The tests you had in the past for sexually transmitted infections were negative, and that is good.

However, the fact that your lymph nodes are still swollen and you are still having symptoms means you should go see your healthcare provider again to make sure they are not missing something.

I hope this information helps you.

Thanks.