Seeking your expertise to help me rationalize my irrational thoughts at the moment.

14 days ago I had an encounter with a pre op TS sex worker in London, uk.

We engaged in mutual unprotected oral sex and condom protected anal (I was the receptive partner). I kept a close eye on the condom and didn’t notice any damage or slippage throughout. The sex worker mentioned prep but I didn’t engage them in a more far reaching discussion on their status.

I’be gotten myself quite worked up - around day 8/9 post encounter I started feeling a little sensitivity in my glands under my armpits and on day 12 post encounter hve been experiencing a flu like illness with muscle aches and headache and swollen glands. Mild sore throat and not much fever.

10 days post encounter I had an early screen and HIV1/2 RNA and all others came back negative.

I’m now 13/14 days post encounter and having hoped the blood tests would give me some reassurance, I’m instead catastrophising that my flu like illness is ARS and that the test result is invalid. Seeking your objective input on the situation and wondering should I have another test this week to put my mind at ease.

Many thanks

The encounter you describe was low risk-  It is statistically unlikely that your partner had untreated HIV (did you ask her?), and although receptive rectal intercourse is a high risk exposure, use of a condom which remained visibly intact transforms the encounter into safe sex (when condoms fail, they do not lead a little, they break wide open) .  Further, the risk for acquisition of performing fellatio on an HIV infected, untreated partner is less than 1 infection in 10,000 exposures, and there has never been a proven case of HIV acquired from receipt of oral sex from an infected partner.  Although a little early, your negative HIV RNA PCR is further evidence that you were not infected - most manufactures use 11-13 days as a cut off for conclusively negative PCR tests and 10 days is close but not quite there.  Nonetheless, your negative PCR test is strong evidence that you were not infected.  

Flu-like symptoms of the sort you describe may be caused by many illnesses- most commonly influenza, COVID-19, and other community acquired, non-STI viral infections.  When studies have been performed on at risk persons with symptoms such as yours, less than 1% of them have HIV.  The best thing you might do now is to get an 4th generation, combination HIV antigen/antibody test.  If your symptoms were due to HIV, the test would be positive- when symptoms are due to HIV, tests are always positive.  I anticipate that hat is the result you will get.

I hope this information is helpful.  EWH

Thankyou for your reply, greatly appreciated.

Interestingly all providers here in London were offering the RNA tests at 10 days and citing 98% accuracy at this point, I do wish I’d known that a couple of days more would be more valuable in terms of conclusiveness.

I’ll seek out a duo test asap, many thanks.

Reporting back - I got a duo test yesterday (which would have been at 15.5 days post exposure) and as you predicted it came back negative this morning. 

With the negative PCR at day 10 and the duo negative at day 15, in the name of future paranoia avoidance, which type of test (or combo of tests) at what point in time would allow me to establish conclusivity?

Many thanks 

I hope that this information has been helpful.  I am confident that you will find that you will find that you were not infected.

We provide up to three responses to each clients questions.  This is my 3rd and therefore final response.  The thread will be closed shortly without further responses.  Please don't worry.  EWH