I am very scared that I contracted HIV. I met a guy and had sex 8 days ago. We kissed a lot and he performed oral sex on me.  We also had anal intercourse and I was the insertive person. I wore a condom and I do not think it broke but not absolutely sure. He said he was tested in May and was negative. Of course he could have lied or gotten exposed after his test.  

I now have developed a rash on the middle of my back that goes to the right side. It’s a number of reddish flat and smooth circles that do not itch or hurt. I wouldn’t have know it was there but a friend saw it on it yesterday.  

I know this could be the rash people get when exposed. I have no other symptoms at this moment. I’ve never had a rash like this before and the timing fits with ars.  I’m scared to dearth and need help 

1) should I get a PCR test at 12 days?

2) does the rash start first and then other symptoms follow?

Thanks 

On one hand, this can be considered a high risk exposure in regard to HIV, since anal sex between men is the highest risk of all sexual practices. On the other, congratulations for going about it with maximum safety, both in discussing HIV status with your partner and using a condom for anal sex:  good show! Oral sex carries nearly zero risk for HIV, so that part of the exposure can be disregarded. And it seems you can be confident the condom didn't fail. It's rare to not notice if the condom ruptures; it's generally hard to miss. If the condom was not obviously broken wide open, protection almost certainly was complete. In addition, people rarely lie about HIV status when asked directly, and the chance your partner has HIV acquired in the last 3 months probably is very low.

In contrast to your statements, this rash is not at all suggestive of acute retroviral syndrome (ARS, i.e. acute HIV infection). First, absence of other symptoms (at the same time) -- i.e. sore throat, enlarged lymph nodes, fever -- argues against it. Rash is never the only symptom. Second, the rash of ARS is not limited to one area of the body; it's generally body wide. In reply to question 2, usually it's the opposite:  rash tends to appear a few days after onset of the other symptoms.

You certainly could have an HIV PCR test around 12 days after the event. However, I would prefer you see a provider in person, someone with experience in evaluating HIV infections; it probably would be very reassuring, supporting the comments I just made. It would also include careful physical exam. With or without in person care, you can expect a negative PCR. You should then have an AgAb (4th generation) blood test in a few weeks to make it 100% certain you weren't infected. Alternatively, if you can contact your partner and ask him to be retested, a negative result would confirm you were not exposed.

So stay mellow while you sort all this out. Almost certainly you do not have HIV.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

I was not able to see a specialist but I did take an HIV RNA test on Thursday which was 14 days after I had sex and it was negative.  Unfortunately he lied to me and said he hasn’t been tested for over a year. That has me concerned. He said he would get tested but not sure he will do it.  What should I do now? How should I interpret these results?  Thank you!

"How should I interpret these results?" Like this:  Chance your partner had HIV, let's say it's as high as 10% (it's probably a lot less likely). Chance of infection by receptive anal sex if he has it, around one in a hundred (1%) -- that's without a condom. Add a condom that didn't fail, which is 99% effective, i.e. 1% chance of unrecognized condom failure. Then we'll add a 5% chance you have HIV despite the negative RNA test. Mathematically your risk then is 0.1 x 0.01 x 0.01 x 0.05 = 0.0000005. If I've counted my zeros correctly, that's 5 in 10 million, or one chance in two million you have HIV. Even this probably is too high, since we estimated the individual component risks on the high side. So the odds you have HIV are not quite zero, but they're a whole lot lower than your statistical odds of dying accidentally in the next 12 months, which is one chance in 1,756 for the average American, according to the National Safety Council. (You can easily find that website if you'd like to check me out.) That risk is more than a thousand times higher than the possibility you have HIV.

Have an AgAb (4th generation) HIV blood test at least 4 weeks after the sexual exposure, with another expected negative result. In the meantime, mellow out about HIV -- but don't forget your seatbelt and keep those smoke alarm batteries fresh!

Thank you son much for your help. I took a 4th generation HIV test at 4 weeks post encounter and it came back negative. I had already taken the HIV RNA test at 14 days which was negative. Are my results now fully conclusive or should I take another antibody test once I hit 6 weeks to be absolutely sure? Thanks again for all you do for people!

That completes two follow-up exchanges and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.