On 2/June had brief sex with a girl i met in a club, brief cunnilingus and 4 minutes of unprotected vaginal sex. I talk to her by message and she says she is clean, and even says she will try to ask STD check ups to her GP, for my peace of mind. 

3 days later had sore throat which resolved with amoxicilin, by my GP. But then, 13 days after the last exposure my neck glands started to swolle and unswolle throughout the day, and even today, after 1 week i still have this tight feeling under my jaw, sometimes under the chin and sometimes in the lateral of the jaw. 

Swelling sensation comes & goes. Very weird. The throat is also red.

1 day after the last exposure, i had sex with my wife, and 3 days ago she started to get runy nose and some little cough. 

Day 5 after last exposure: Chlam & Gono swab negative

Day 15 after: Chlam & gono swab and urine tests negative, HIV 4th gen negative, VDRL (RPR) negative.

Day 22 (today): HIV 4th gen negative, VDRL (RPR) negative

1) if the nodes swelling was ARS by hiv, wouldn't the 4th gen be a garanteed positive by now in the presence of these symptom?

2) If it was syphilis, would the test also be positive in the presence of this symptom, aplying the same principle?

4) how accurate is my 22 day 4th gen for HIV, and how confident can i be that results wont change in the 28th day or even the full 6 weeks? And how accurate can be my 22 day VDRL (RPR)?

3) if i get a negative 4th gen and negative VDRL (RPR) test, both at 6 weeks, can i move on with this 100% confident?

6) Is it safe to practice sex with my wife? dont want anything to happen to her

My preliminary response is that you describe low risk exposures. Obviously there was some risk for the first, with unprotected vaginal sex.  (Cunnlingus is near zero risk, even unprotected.) But with such a brief exposure, the risk is very low, even if your partner had an active STI. The second event, condom protected, obviously was very low risk. In addition, your negative test results are completely reliable in regard to gonorrhea and chlamydia, and reassuring if not yet conclusive for HIV and syphilis. (For gon/chl, you didn't need the second tests at 15 days; the 5 day results were conclusive.) To your specific questions, as you numbered them:

1) Excellent question, and you apparently have done your research:  you are correct. The symptoms of acute HIV (i.e. acute retroviral syndrome, ARS) are not due to HIV itself but by the immune response to the virus, which is indicated by antibody. Therefore if symptoms are caused by HIV, the blood tests always are positive.

2) However, this isn't necessarily true for syphilis. But still the chance of syphilis after such exposures is extremely low; and if you had acquired syphilis, by now your probably would have obvious symptoms (chancre, i.e. the ulcer of primary syphilis).

3,4) The HIV AgAb (4th gen) blood tests detect 80-90% of infections by 3 weeks; the RPR for syphilis probably around 50-60%. So these result are reassuring but not yet conclusive. However, given both these results, lack of symptoms, and the overall risk of the exposures described, I will be exceedingly surprised if your 6 week results are positive. I'd put the chance at under one in a million for both HIV and syphilis. When negative at 6 weeks, indeed they will be 100% conclusive.

6) While of course I'm not giving any guarantees, I see no reason not to continue unprotected sex with your wife. That's what I would do if somehow I were in your situation.

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

HHH, MD

1) Nope. This would never be the only symptoms of a new HIV infection -- and cannot be HIV with negative blood test.

2) Chancres usually start within 10 days, probably sooner when inside a mucous membrane area like the mouth.

3) Oral trichomonas doesn't happen, and there is no useful HPV test; and new HPV cannot be detected sooner than several weeks after exposure.

4) That had little or no risk for our wife.

5) Your GP apparently doesnt' understand timing of blood test results.

My swollen neck glands have been the same for 2 weeks now.

sweling/unswelling in the submandibular area througout the day is so stressfull, im always thinking it could be HIV.

In my mind i keep telling myself that i have HIV, thinking: "what if this is ARS and there isnt enough antibodies or p24 antigen at the 22day test to not be able to confirm the glands symptom being from hiv".

I went to an ENT and the only thing he found was that i had some acid reflux whish can explain my red throat.

2) how so sure can i be that the 4th gen AgAb test would be 100% positive if this symptom was caused by my imune system fighting hiv? I just need help to deal with this. Its the main thing thats affecting my mental health about all this.

3) since the 22 day test was negative, what are the odds that my 29 day turns positive?

3) i will do the 29 days after last exposure test for my peace of mind, and will do the final test at 6 weeks (43 days). If the 29 day test is negative, is it a good sign for the 6 week test?

4) is 6 week 4th gen AgAb test really 100% conclusive? 

Can i really forget all this and not get tested later, based on the typical 3 month period told by most GPs? i am regular blood donor, i just dont want future surprises. And i really dont want to do any more testing after the 6 weeks, the anxiety would drive me crazy. I just want to be sure that i put all this behind me after the 6 weeks have passed knowing that i am 100% free of HIV and Syphilis. 

I cannot find an explanation for this weird sensation. And once this is over, for sure i learned my lesson. I love my wife, and this has made me put everything in perspective. I dont want anything to happen to me, but most important, to her.

And thank you for everything doctor. I know it may be a simple interaction for you, given the amount of users here. But for me, i learned so much from you and i hope everything turns out to be ok. And i will forever be grateful for your help.

Please keep this thread open, so i can share my final results with you, if you would like!

1) Did the ENT doc confirm you have enlarged nodes in your neck? If he did not, then your nodes are normal. And self-assessment of enlarged lymph nodes by persons without medical training is notoriously unreliable. And even if your nodes are enlarged, there are numerous causes of symptoms like yours that are far more common than HIV. 

2) "How sure can I be...?" 100%.

3,3,4) "since the 22 day test was negative, what are the odds that my 29 day turns positive?" Almost zero; and your negative 29 day test also will be confirmed at 6 weeks. The result at 6 weeks is 100% conclusive; there has never been a proved case of HIV that took longer than 45 days for the AgAb (4th generation) tests to be positive -- except in people who take anti-HIV drugs as post-exposure prophylaxis.

Can i really forget all this and not get tested later, based on the typical 3 month period told by most GPs? Yes. 

Perhaps it will also help you to know that in the 20 years of this and our preceding forum, with thousands of questions from persons concerned about possible contracting HIV, not one has yet reported they eventually tested positive. If and when it finally happens, surely it will be a genuinely high risk exposure (think unprotected anal with a known infected partner) and not a never-before-documented event like yours; and will have typical timing of positive test results.

Threads are closed after two follow-up exchanges, and we're there. There is no need to share your negative test results; all I would do is agree with something like "Yup, negative as expected. Move on without worry." But I'll make my usual offer:  If a later test is positive, return to let us know and we will refund your posting fee.

I do hope the discussion has been helpful. Do your best to accept the reasoned, science based advice you have had. Good luck.