[Question #11211] ARS Symtoms and RNA test

16 months ago

Good morning. March 30th had unprotected insertive anal sex with another male. He assured me that he was on Prep and clean. It is not something I normally do. Night of April 8th chills, slight fever and to bed. Next day, no fever, felt run down all week. April 10 and 11 started feeling swollen kneck. No more fever, chills, never any rash or soar throat, but run down with low energy. Got scared, decided to test on April 11 with RNA early test. Kneck was really swollen through the weekend and area around sternum. I could hardly turn my kneck. (Been exercising a lot lately, could have contributed to kneck). The swelling was Only on one side, straight down from jaw. No lymph swelling any where else. It is starting to get better now. I’ve felt run down this week without much appetite, but also very worried. My question, RNA test was negative. Is that conclusive, 12 days after exposure, especially if earlier symptoms were ARS. I met this partner at a motel, if he would have had sex with an infected person prior to me and his ejaculate was in him, could that infect me? My mind was running crazy. Doc, no more unprotected until I’m on Prep. Thanks for the help.

H. Hunter Handsfield, MD

16 months ago

Welcome back to the forum. Thank you for your continued confidence in our services.

Starting with your opening comments, it is almost certain your partner doesn't have HIV (nobody known to be infected takes PrEP); and if somehow he did, his PrEP protected you from catching it.

Nevertheless, I understand your concern and why your symptoms alarmed you. However, your test results prove conclusively that your symptoms were not ARS. It is not possible test negative in the presence of ARS symptoms, so the results mean your symptoms were caused by something else. Equally important, even without symptoms, a negative RNA test at 12 days is considered conclusive. Most experts advise also having an antigen-antibody (AgAb, i.e. fourth generation) blood test after a few weeks. That's increasingly considered unnecessary, but you might want to consider it just for the additional reassurance the negative result might provide.

Could another person's ejaculate be passed on to you and be the source of an HIV infection, even if your partner himself is not (yet) infected? I suppose that's theoretically possible, but the previous exposure would have to be within a few minutes of your own. And in any case, your negative RNA test is conclusive.

So no worries! I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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