Good afternoon and thank you for this forum.

About 10 days ago I had unprotected anal sex with a trans m2f and I was the receiver. I had met up with this person a few times  but never engaged in sex until now. Each meeting she told me she was STI/HIV neg. At this encounter she told me she had tested around 2 mths ago and had no other recent unprotected partners. We talked about the importance of testing and she offered at home HIV test if I wanted. Before I left she said I wouldn’t catch anything from her. She seems to be responsible based on conversations, however, even knowing all of that I regretted the decision I made and I do plan to get tested to ensure I am still STI/HIV free. I have not noticed any symptoms of anything, however, I have felt off this week. 

Tuesday (8 days after) I felt fatigue and “floaty” all day. Yesterday I felt fine outside of over analyzing my body symptoms, and today I still don’t feel 100%. I didn’t sleep well and I can’t tell if my lymph nodes are swollen but I know that’s not always a determining factor. I do not have a fever, have not noticed any discharge/lesions/rash/etc on any part of my body outside of what is normal for me. I believe I may be experiencing anxiety, and reading through other posts, I believe my risk to obviously be higher risk, but still relatively unlikely that I caught anything based on how open the conversation was on sexual health. My questions are as follows:

1 - what do you assess my risk to be as a professional for any STI’s/HIV?

2 - when do you recommend I test for my own wellbeing?

3 - do any of my symptoms sound to you like they may be the beginning of STI/HIV infection?

4 - would you have recommended any specific actions after the encounter? Or am I outside of the window for preemptive treatment? 

Thank you for taking the time to answer my questions.

Welcome to our Forum.  Thanks for your questions.  I'll be glad to comment.  I agree with your assessments regarding your recent partner.  Most trans women do not have HIV.  Her detailed history of testing, as well her offer to do a home test is reassuring.  I'll comment further as I address your questions below:

1 - what do you assess my risk to be as a professional for any STI’s/HIV?

See above.  Everything your partner said suggests that she does not have HIV or other STIs.  Even if she did, even as the receptive partner, less than 1% of episodes of receptive rectal intercourse with untreated HIV infected persons lead to infection.

2 - when do you recommend I test for my own wellbeing?

Testing is always a personal choice however "reading between the lines" of your post suggests to me that a negative test would be reassuring.  When to test would depend on your level of concern.  A negative test at this time would prove that your current symptoms are not due to HIV since when symptoms are due to recently acquired HIV, tests are always positive.  Testing at this time however would not conclusively rule out the possibility of infection.  To do that you would need to test using a 4th generation, combination HIV antigen/antibody test at some point more than 6 weeks after the exposure.

3 - do any of my symptoms sound to you like they may be the beginning of STI/HIV infection?

No, your symptoms really are not suggestive of the ARS due to recent HIV acquistion.  The symptoms of the ARS are high fever, severe sore throat and widespread muscle or join pains.  

4 - would you have recommended any specific actions after the encounter? Or am I outside of the window for preemptive treatment? 

It is too late for you to benefit from post exposure prophylactic (PEP) treatment.  

If I were you I would simply wait to test although if you wish to rule out other STIs such as rectal gonorrhea or chlamydia, you could get a rectal swab test for these bacteria at this time and anticipate conclusive results.  EWH

Just a few follow questions

1) would you expect a test to be negative from this encounter?

2) the timeline for ARS is within 2 weeks correct? Any symptoms I experience after that wouldn’t be due to HIV?

3) today I wouldn’t say I have a sore throat or muscle/join pains but I seem to have some swelling underneath my chin on the right side. I’m assuming that if that was a swollen lymph node due to HIV I would be experiencing much more severe symptoms in addition? 

I know I am probably overthinking everything right now but I am also trying to understand at the same time. I did look up HIV statistics for my area and it looks exactly like you said - less than 200 cases of the 20K diagnosed cases are trans women which seems highly unlikely that I would ever run into an individual with HIV

2.  The symptoms of the ARS typically occur 10-20 days after an exposure.  The ARS virtually never occurs more than 30 days after an exposure.

3.Correct

I agree that your risk for HIV is quite low.  I really would not be worried.  EWH

Last week at 21 days post encounter (12/4), I noticed a swollen area on the right side of my neck along with the potential swollen lymph node under my neck I mentioned before still present. This obviously sent me into a worry. I've been checking that are, and my temperature every day, have never had a fever. I don't have any kind of sore throat or fatigue either (at least nothing that cant be explained by normal work fatigue). However, earlier this week, around 29 days post encounter (12/12), I also began to notice some pain and another potential lymph node just under the front of my neck on my right side collar bone (it feels like it's attached). In addition, yesterday, I noticed a similar pain on my left hip bone, but could not tell if there was any swelling there. All of these are mild symptoms that do not impede my day to day function. I cannot notice any kind of noticeable swelling on the collar bone or hip, but if I feel around those areas I can pinpoint a slight pain.

My question is - would a recent HIV infection cause nodes to swell and become painful gradually over time? And could this be the only symptom or would swollen nodes always be accompanied by more severe sickness?

Thank you again for your time in answering my questions.

As You know, we provide up to 3 responses to each client's questions.  This is my 3rd response. Therefore the thread will be closed shortly.  I hope the information I have provided has been helpful.  EWH