Dear Dr. Handsfield,

I am a 30 year old healthy male who had unprotected vaginal sex with a female partner on July 13, 2016. She claims to be STD free, however, I am extremely anxious that I may have contracted HIV.

After 20 days of possible exposure I didn’t have any symptoms. However, I took an oral swab OraQuick which was negative.

Around the three week mark, I began to develop some symptoms that have me very scared. I’ve had nausea, feeling of weakness and unwillingness to speak. My tongue has a light white coating more prevalent towards the back. Not thrush. I had swollen lymph nodes in the front right part of my neck. I had a very slight sinus congestion, no real cough or sore throat. I’ve had a very dry mouth especially at night. I’ve woken up with some light sweating, which is atypical for me. I lost about 10 pounds in 2 weeks because I basically lost most of my appetite. I seem to have hot flashes or an increased sensitivity to changing temperatures. Most recently my stool seems to smell more than usual and appears to be discolored (Patches of black/darkgrey). I can also hear what seems to be my spleen making a lot of noise especially at night. Through out all of this I never really had a fever, just have felt hot. I measured my temperature actively and it has been 98.6 orally taken. It read 99.5 rectally taken on occasion.

This has sent me into a panic and made me extremely anxious. I took another oral swab OraQuick 28 days after possible exposure. It was negative. I took another oral swab OraQuick 32 days after exposure, it was negative.

Do I have HIV? Can I trust my test results so far?

I am waiting for the results of an HIV/RNA QL test which I took 33 days after exposure. Please help me Doctor. I am seeking some peace of mind.

Thank you greatly.

Welcome to our Forum.  I will be pleased to comment.  I anticipate that your HIV RNA test will be negative, providing that you do not have HIV (if you had HIV your RNA test would certainly be positive when taken more than 4 weeks after an exposure).

This was a low risk exposure.  Here are some figures to help you see why I say this.  Fewer than 1% and likely far fewer, of U.S. women have HIV.  Further, this person has told you that she does not have HIV and most people do tell the truth.  Even in the unlikely circumstance that she had HIV, the risk of infection from a single episode of unprotected sex is less than 1 infection per 1000-2000 acts of intercourse.  Thus on the basis of statistics alone your risk for infection is less than 1 in 100,000.  Finally, while not definitive as your RNA test will be when you get the results, at 4 weeks (28 days) an Oraqiick test would be expected to detect about 90% of recent infections, thus providing still more evidence that you are not infected. 

Your symptoms are non-specific and are not particularly suggestive of recent HIV infection but are more consistent with the sort of summer cold that some people do get from time to time.  Dry mouth, sinus congestion and coating of the tongue are not part of the syndrome described for persons with recent HIV.   

I am confident that your test for HIV will be negative.  In the interim, please do not worry,.  EWH

thanks for your follow-up. As I said in my original response (" I anticipate that your HIV RNA test will be negative, providing that you do not have HIV (if you had HIV your RNA test would certainly be positive when taken more than 4 weeks after an exposure)."), your negative HIV RNA test is definitive evidence that you do not have HIV.

I am not sure what you mean by "an abnormality in my Herpes 1 test" but the symptoms you describe are not symptoms typical of HSV-1.  I would mention however that over 60% of adults have HSV-1 and most infected persons do not know it.  If your test was a blood test, I suspect that your result (depending on what it is) simply indicates that you have HSV-1 (like most people) and is unrelated to your symptoms.  EWH

This is my third reply to your questions and therefore as per Forum guidelines, this will be my final reply.  The thread will be closed later today as per Forum guidelines. 

Your blood test was performed for herpes simplex virus type-1, the virus that causes nearly all cold sores and some genital herpes if persons who do not already have the infection have received oral sex from an infected person. About 60% of adults have HSV-1 infection whether they know it or not.  Virtually everyone who gets cold sores has HSV-1 and many more people have it but do not know it.  Most people with HSV-1 do not know it and have acquired the infection during childhood.  My advice to you is that I would not worry it- you got HSV-1 at some time in the past.  nothing you have described suggest that you recently acquired HSV-1 (it is rare to acquire this infection through vaginal sex) and  none of your symptoms suggest that this is what is going on.  I would not worry about it.  There is no need for further testing and no need for treatment.  EWH