After this event I presented with every typical symptom of arvs…… mouth ulcers, white tongue, mottled rash, fatigue, lower back pain, night sweats, swollen lymphnodes to name a few. 

So obviously with worry I proceeded to test. I’ve so far to date had the following 

Fourth gen from vein at doctors five weeks and then 12 weeks 

Three postal full panel tests at six weeks, six months and then nine months 

Probably around 10 rapid tests including insti, oraquick, sure check 

And then most recent I’ve gone to a clinic this week 14 months from exposure and they took blood from vein and tested for hiv and syphilis which again were negative. 

But my symptoms now are so very real and very bad that I’m beyond able to move on………. The most concerning is a constant head ache and complete mental confusion. Feels like a constant pressure building up in my head almost like a brain infection. 

I guess my question is can this many tests really of missed the infection?! I know it may be rare but is it possible that I’ve required a strain that tests can’t pick up?? Or maybe I’m just one of the unlucky few that doesn’t produce detectable antibodies?? It’s completely crippled my life at this point and I guess I just need guidance on how to move forward…… would you recommend any other type of test method. 

Thanks for your great service and time 

To cut to the chase:  There is no possiblity you have HIV. I say this for two related but slightly different reasons:  First, the tests you have had, done more than a few weeks after catching HIV, always are positive in everyone with HIV infection. The tests are extremely accurate and there are no exceptions. Second, it is not HIV itself that causes symptoms, but the immune response to the virus -- and the immune response is indicated by antibody to HIV. Therefore, your multiple negative HIV antibody tests prove with 100% certainty that your symptoms cannot be caused by HIV.

Similarly, syphilis also is ruled out by those negative tests. The same comments about HIV testing apply:  you don't have syphilis, and if somehow you did, it cannot be the cause of your symptoms.

In any case, your symptoms are not as typical for ARS as you apparently believe. You do not mention the most common symptoms of all:  fever, enlarged and tender lymph nodes, skin rash, and sore throat. The ones you do mention are consistent with at least a hundred different medical problems. And contrary to what you might have come to believe from online searching, symptoms almost never are useful indicators either for or against ARS anyway. Even the typical symptoms just mentioned are more commonly due to other problems; and half of all new HIV infections cause no symptoms. Lab tests are the only way to helpfully judge presence or absence of HIV -- never symptoms.

As for what IS causing your symptoms, I cannot say. I have no doubt they are real -- this isn't primarily a psychological problem. (That said, it certainly is true that stress or anxiety can magnify various symptoms that otherwise might not be bothersome. But even these are real symptoms. You and your doctor are a better position to judge this than I am.) I have no other tests to recommend. My only advice is that you keep working with your doctor(s) about causes of your current symptoms and what sort of treatment might help. In the meantime, you definitely can stop worrying about HIV and syphilis. I am confident they are not caused by any infection from the sexual exposure 14 months ago; they are unrelated to that event (unless through the psychological connection just mentioned).

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

HHH, MD