A little over 5 months ago, I (28 male) had a one night stand with a female unprotected in the US. I tested for HIV with an RNA test at 14 days which came back negative. I then did a full panel test at 45 days and 94 days. This included a 4th gen HIV test. Everything negative. Due to anxiety, I have been consuming more alcohol than normal. I have not had any fever, but notice the occasional skin abnormality. Currently I have a small red mark that resembles a pimple on my neck. I am curious if my test is conclusive or if the excess alcohol could delay seroconversion. I keep reading about late seroconversion and HIV-2 having a longer window period. My anxiety has been very bad, do I need to retest? Are my results conclusive? Is a couple of red marks on the neck across a month a symptom? Thank you.

Such exposures generally are zero risk for HIV; few women in the US -- including those prone to "one night stands" -- have HIV. More important, the test results you describe are 100% conclusive. There are no medical conditions, drugs, or toxins -- including alcohol -- that delay positive HIV test results. You didn't need the repeat test(s) beyond 45 days. The supposed longer window period for HIV-2 means 8 weeks (for the 4th generation HIV tests) instead of 45 days; and HIV-2 is exceedingly rare in the US anyway. I doubt anyone ever has acquired it from an exposure like yours. HIV would not cause "a couple of red marks" as the only symptom, and in any case your negative test results are conclusive regardless of any symptoms of any kind you might develop in the future (assuming no new HIV risk event).

So all is well -- no worries. I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

1. Even if it was 4-10 drinks most nights during the window period, it would not have any effect, correct? There would be some nights I would not drink but it was most nights.

2. These marks on my neck have appeared individually in the past month (4-5 months post exposure, spread out through the weeks, appearing by themselves). They’re pretty noticeable and red, is this a symptom of any STD? It wouldn’t be possible for it to be acute hiv correct? They seem to disappear or at least get better within a week. They start as a red spot and slowly swell then go away; it appears similar to a pimple. I have also had one small canker sore.

3. I have had some red marks near my lips but not directly on them, I have tested negative twice for both HSV-1 and HSV-2, with the latest being 94 days. It was an antibody test, is this considered conclusive? Could these be signs of HIV?

4. I have found a couple of medical articles talking about false negatives for HIV 4th gen tests past 3 months, am I 100% clear of infection? I had three negative tests all nearly past the “conclusive” window period (RNA at 14 days, 4th gen at 45 and 94 days). Do I need to retest at 6 months? Just nervous about late seroconversion or anything else invalidating the results. 

5. Is there any chance of dried bodily fluid spreading the virus to a member of my household with no direct or sexual contact? Had a member of the house acquire a canker sore and I’m very nervous I spread something to them.

6. Is it normal to be able to see your lymph nodes in your lower neck if you turn your head and look for them? I don’t think they’re swollen (they’re not sensitive to touch or large, maybe slightly bigger than the size of a grain of rice ) but I do see them.

7. Do you have any advice on how to convince myself to move on and accept my results? I can’t stop thinking something is off and would love to be able to move on from this chapter.

Thanks again for your advice, I genuinely appreciate it.

2,3. Same for symptoms; and herpes doesn't cause "red marks". And no herpes outbreak lasts more than 1-2 weeks. With those test results, you can forget herpes as well as HIV.

4. This is exceedingly rare; and in virtually all cases of false negaitive results, repeat testing (such as you had) has become positive. 

5. Since you do not have HIV or herpes, you cannot spread these viruses to anyone. Period, no exceptions. And anyway neither of these ever is spread from a contaminated environment.

6. If you look hard enough for lymph nodes, probably you can find them. But anyway, enlarged nodes alone is never the only physical sign of HIV. And once again, test results overrule ALL symptoms, no matter how typical of HIV they may seem to be.

7. Suck it up and believe your test results. If you cannot get past these frankly irrational fears and your seeking of information to you have HIV, I would suggest professional counseling. From a mental health standpoint it is not normal to remain so worried despite the repeated, reasoned, science based advice you have had, perhaps from your own doctors as well as this forum.

Perhaps you also would like to know that in the 20 years of this and our preceding forum, with thousands of questions from people worried about HIV, nobody has been infected. You won't be the first. As implied above, if and when it finally happens, it will be from a truly risky exposure; and won't involve false negative test results before turning positive.

I cannot say "Where...their claims stem from", except that anyone can write whatever they want online. Even health professionals may state personal beliefs that have no basis in documented truth or data.

That completes the two follow-up comments and replies included with each question and so ends this thread. Please stop worrying about HIV and syphilis:  you definitely are in the clear on these and other STIs. Keep working with your doctor(s) about any continued symptoms that concern you. And it also seems you (and your doctor) need to address your alcohol issues.