I had unprotected vaginal sex with a sex worker 7 weeks ago. After roughly two weeks I developed rather bad fatigue and muscle aches. I had a full sti screening at 21 days including ‘4th gen hiv test’ drawn from vein. This came back negative. I continued to have other symptoms on and off including raised lymph nodes in the neck and groin. I had another 4th gen test at 29 days and again at 40 days, both negative. I am writing this message 7 weeks after the exposure whilst on holiday in Spain. In the last 24 hours I have again developed raised lymph nodes in my groin & neck that are causing some discomfort. I am a bit concerned about my last test being 48 hours off of the 6 week recommendation. Any info would be much appreciated. 

P.s I think this forum is a fantastic idea and I have taken lots of encouragement from reading through previous questions, however I felt compelled to ask my own! 

It is very unlikely your symptoms have anything at all to do with the sexual encounter 7 weeks ago. Unequivocally your symptoms are not due to acute retroviral syndrome (ARS, i.e. newly acquired HIV). The symptoms of ARS are caused not by HIV itself but by the immune response to it -- and immune response means antibody. Stated another way, your negative HIV tests prove for sure that HIV/ARS is not the cause of your symptoms. For further reassurance, I agree with your plan to have a final AgAb (4th generation) blood test after the 6 week mark, but you can be sure it also will be negative. (I've never seen anyone who tested negative at 29 or 40 days but later had a positive test result.)

What IS causing your symptoms? Conceivably infectious mononucleosis, or the mononucleosis syndrome caused by other viruses, such as cytomegalovirus. However, there is no treatment for either of these, the symptoms clear up entirely over a few weeks, and most doctors would not recommend further evaluation at all. However, if your symptoms are quite bothersome or they continue in the next week or two, it would make sense to see your GP for further evaluation. However, most likely they have nothing to do with the sexual exposure described.

Having had unprotected sex, it would make sense for you to also have a urine test for gonorrhea and chlamydia and a blood test for syphilis, if not yet done. You can expect negative results, but better safe than sorry.

My final comment is to tell you what you have already probably been telling yourself:  Use a condom if and when a similar situation arises in the future!

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

HHH, MD

If it’s possible I would like a bit of clarification regarding ARS symptoms around 6.5 to 7 weeks. Is this possible / likely? I should add that I have had some mild night sweats the last few nights as well as some fatigue ( at the 7 week mark).  

I will test again in a week or so at the 8 week mark and will let you know the outcome. 

Many thanks 

I had intended for my last question to be me updating you of my final test result. I took an ‘at home finger prick test that is sent to NHS lab’ for testing on Sunday last week. I’m still awaiting the results from this, this test was done at the 60 day mark.  On Wednesday of last week (9+weeks past possible exposure) I came down with another cold, consisting of night sweats, cough, sneezing, sore throat, aching wrist and shoulders and small painless sores in the roof of my mouth. I am sure you will tell me that 9+ weeks is way too long for it to be related to ARS, however my anxiety is unfortunately getting the better of me at the moment. 

That concludes this thread. Please do not return to just report your negative test result. However, I'll make a deal with you:  if it is positive, please return to let us know and we'll refund the posting fee. In the meantime, perhaps it will help to know that in the 20 years of this and our preceding forum, with thousands of questions from persons worried about HIV, nobody has turned out to be infected. You will not be the first. If and when it happens, undoubtedly it involve a truly risky exposure (think unprotected anal between two men) and will not have atypical symptoms or delayed or otherwise atypical test results. Do your best to stop worrying.

I hope the discussion has been a little bit helpful.