Hello Doctor, need some help, panicking. Will try to be as brief as possible:

Jan 11: Had vigorous anal sex with a woman for 20 min. Don’t know her sexual history or how many partners she has. I wore a condom and after finishing, withdrew and checked if intact. Looked ok, could see it was holding sperm in the reservoir tip, so assumed no breakage or tearing.

January 29: Went to STD clinic, did 3rd gen HIV rapid (neg) and chlamydia and gonorrhea tests (both neg)

February 1: Had unprotected sex with my wife and finished inside her

February 5: Tested again for all possible urine-test STIs. All neg

February 9: 29 days post-exposure, did a HIV PCR RNA test (Labcorp 139825) and 4th gen HIV duo test (Labcorp 083935). Both from blood sample from arm vein. Received results February 11, all negative/non-reactive.

Feb 13-15: We both have low grade fever, body aches, I have a few flat red dots (petechiae?) on body. She has sinus congestion with yellow mucus. I wake up 3am slightly damp and panicked. Not soaking wet tho.

Do I/we have early HIV? Could the Feb 9 tests have both missed my infection? One thought: we did go to a big party and spend time with relatives and small children (one sick) over the weekend.

It is certain you do not have HIV; something else is causing the symptoms.

You have a common misunderstanding about the HIV blood tests. It is simply impossible to have symptoms of acute retroviral syndrome (ARS, acute HIV infection) with negative blood tests -- in particular the antibody tests or, in your case the antigen-antibody (AgAb, "duo") test. The symptoms of ARS are not caused by the virus itself, but the immune response to it -- and the immune response is indicated by antibody to HIV. In addition, all infected people have positive PCR/RNA tests within 2 weeks (rarely up to three weeks) of infection. Those two negative tests at 29 days are rock solid proof that HIV isn't causing your symptoms.

Further, HIV test results ALWAYS overrule both symptoms and exposure history. No matter how high risk the exposure at the time, and no matter now typical the symptoms are for ARS, the test results are to be believed. And symptoms never can be trusted, despite what seems to be contrary advice from many online sources. All symptoms of ARS are equally or more common in other conditions; and half of all people with acute HIV have no symptoms at all. Therefore, symptoms never are very useful clues as to whether someone does or does not have ARS.

In addition, you describe a very low risk exposure, especially if you're in North America or Western Europe. The likelihood any particular sexually active woman has HIV generally is under one chance in a thousand. And even without condoms, anal sex with an infected partner has under 1% chance of catching HIV -- and with a condom, the chance is nearly zero.

As to what IS causing your and your wife's symptoms, I cannot say. There probably are 10+ relatively common infections that could be responsible. Certainly they don't fit well with any of the common STDs. Because syphilis symptoms can be so variable, I would advise a syphilis blood test if you haven't had one, although I doubt syphilis almost as much as I do HIV. Mononucleosis and related viral infections, especially cytomegalovirus (CMV) can be sexually acquired, but both are very rare beyond age 25. Most likely your symptoms are entirely unrelated to the non-marital sexual exposure described. If your symptoms continue, I would advise seeing your doctor. But you definitely can stop worrying about HIV.

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

HHH, MD

-Exposure was anon online hookup. She initially delayed our meeting, had a “sinus infection” (nasal congestion/blocked ear, possible low grade fever). Her ARS? So she had high viral count and was very contagious? Same question regarding wife exposure to me on Feb 1. Her infection risk much higher if I’m newly pos w/ high viral load?

-I have a very small white fissure on tip of tongue. Possible tiny canker? Lost a few lbs, lack of appetite & 3-4 hrs sleep for few weeks (anxiety/panic?). 4th day with 99.5 fever. Two bright red dots like mine on wife’s upper back

-Could Feb 29 tests be neg because I took them a few days before my symptoms started? Viral count & antigens too low on 2/9 but now high since seroconv has started with ARS symptoms?

-Possible test done wrong at lab? Must happen sometimes. 

Thx for your patience, so scared, all details lining up for HIV. CMV and mono sound unlikely. I know you say you’ve never seen someone turn pos after being neg with these tests at four weeks but I’m feeling like it will be us. Tests missed it.  Only explanation is that I am the 1 in a mil. 

-As I said, the risk at the time of exposure is irrelevant because your tests prove you aren't infected. You could have told me you took a syringe and injected yourself with her blood. I would still reply you were not infected. Yes the negative test Feb 9, only 8 days after exposure, doesn't mean anything. But your later tests prove you were not infected. No mystery in that.

Interesing you got tested for all those cold viruses. Yes, rhinovirus can explain your symptoms. And no, HIV and rhinoviruses are entirely different, not remotely related to one another.

Do your best to accept the reasoned, science based advice you have had, both on this forum and probably from your own doctor(s). You can move on with no further worry about HIV. Perhaps you would also like to know that in the 20 years of this and our preceding forum, with thousands of questions from users concerned about a new HIV infection, not one has yet turned out to be infected. You will not be the first. If and when if finally happens, surely it will be a genuinely high risk exposure, which yours was not; symptoms, if present, will be typical, as yours were not; and the exposure will be a truly high risk one, as yours was not.

-A few typos in my last post, not sure if you saw me mention them. The neg PCR RNA & 4th gen duo tests were done on Feb 9th, 29 days after anon sex exposure on Jan 11th. I accidentally wrote Feb 29th, typo. Feb 1 exposure I first mentioned was wife's exposure to *me*. I didn't mention but with those tests on Feb 9th, I also was tested for syph since they were already doing a blood draw. It was neg but my understanding is the window is 90 days? So will just have to retest in the spring? Or is syph test 29 days post-exposure conclusive?

-Thx for confirming ARS timeline of 2-3 weeks. There is varying info all over the internet (1-6w, 4-6w, 2-4w). Also thx for confirming rhinovirus symptoms. For clarity, I didn't test for them, wife got a flu/covid test at Dr and I guess they included that.

-I will accept the science saying I am not infected, thx for being direct with me. If I am the 1 in a mil, will post again but expect I won't be. There is SO much on internet to drive one crazy, endless reddit threads, quoras, health websites, etc. I'm really grateful to have found this space to engage with knowledgeable doctors, and for you hearing us out, and taking our concerns (even anxious/crazy ones) seriously and responding thoughtfully to our situations.

"...ARS timeline...varying info all over the internet" and "so much on internet to drive one crazy...:  Indeed! Anybody can write whatever they want. For these or any other health issues, I would advise limiting to professional organizations' websites and/or those that are professionally moderated (like this one), and particularly to avoid sites by and for (and mostly used by) people with the problem at hand or at risk for it (like Reddit, for example). That doesn't eliminate varied opinions and advice, but it markedly improves reliability and reduces widely variable advice.

FYI, your closing comment is especially apropos because of our 20 year experience of this and our preceding forum. Among thousands of questions about HIV risks and fears, nobody later tested positive. You will not be the first. If and when it finally happens, surely it will be a genuinely high risk exposure (think unprotected sex with a known infected partner, unprotected male:male anal sex, etc); and not someone with unexpected or atypical test results.

Thanks for the thanks. I'm glad to have helped.

I intended to close this thread two days ago and am doing so now. Best wishes and stay safe.