I had unprotected vaginal sex with a woman and later found out her husband is bisexual and they are in open relationship. This made me extremely worried but I tested negative on 4th gen test at 47 days. I got tested for everything at 9 days so thought I was in the clear and resumed sex with partner at 17 day mark. She has since had a rash mostly on wrists and ankles, but it did spread throughout body that lasted about a week and symptoms similar to sinus infection (lost voice, soar throat, congestion) currently going on day 9. Additionally I have a soar throat that feels like strep for 10 days now. No other symptoms but throat has been very soar with ulcers and white spots in back. Culture came back negative and they think it is thrush. Couple questions below. 

1. Is it possible to spread HIV and test negative after? What is the absolute longest this could be? I understand p24 starts shortly after HIV starts. Could I spread before HIV starts and how long is the max for p24 to follow HIV?

2. I had a soar throat at day 44 and tested negative at day 47. Is there even a small chance this could be missed. 

3. I know most places and your site has said conclusive at 42-45 day range but have seen a range of outcomes. I’m just worried there is still a 1 in 10,000 chance this could be something that could completely ruin my life given that it’s odd all these symptoms came on after exposure. Any validity to this or is there literally 0% chance. 

Thank you very much in advance!

I'm not sure I entirely understand the timing. I believe the unprotected vaginal exposure was more than 47 days ago; you had a negative HIV AgAb test (i.e. 4th generation, "combo" test) at 47 days; and also tested negative for HIV and presumably other common STDs 9 days after the exposure. But your rash and sore throat/congestions symptoms are recent -- going on 9 days now, but how long after the sexual event did they begin?

Here's perhaps the main information that should assure you:  First, the AgAb tests always are positive by 45 days after acquiring the virus; there are no exceptions, ever. Second, it is not possible to have symptoms of a new HIV infection (called acute retroviral syndrome, or ARS) and also have a negative AgAb test. That is, once symptoms begin the AbAb (and the standalone antibody tests) always are positive. That means that a negative test result is solid proof that any symptoms at that time are caused by something other than HIV.

I'll also add that your symptoms are not typical for ARS. It doesn't cause nasal congestion; fever usually is present (which you don't mention); onset of ARS always is within 2 weeks of catching the virus; and the rash you describe isn't typical.

Now to your specific questions:

1) Yes, it is possible to have a high viral load and spread HIV to a new partner for a brief time before blood tests become positive. However, that is not possible in your case:  your negative test results at 47 days proves you were not infected and there was no possibility of transmitting HIV to your regular partner at any time.

2) No, there is no realistic chance your 47 days test missed an HIV infection. Something other than HIV is the cause of your sore throat, rash, and all other symptoms.

3) Even one in ten thousand is too high an estimate for false negative HIV test results. There has never been a reported case of HIV in which it took more than 45 days for positive AgAb test results (not counting a few cases in which anti-HIV drugs were taken after exposure, which can delay positive testing).

So you really needn't be worried at all. Keep working with your health care provider if your symptoms continue -- but you can be confident it isn't HIV, or any other infection from your sexual exposure a few weeks ago.

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

HHH, MD

Yes you are correct. Sorry if that was confusing. Symptoms for me only began 9 days ago. My wife’s rash began 4 weeks ago and sinus/headache 10 days ago. Neither of us had fevers. I wasn’t sure if spreading it was possible if testing negative a few weeks after. 

One last follow up. I understand this is definitely not HIV. Is there a possibility it could be any other STD?

That concludes thie thread. I hope the discussion was helpful. I'm glad you didn't start a new one:  the reply would not have been signfiicantly different than these comments.

Best wishes and stay safe.