[Question #12038] HIV risk, symptoms, testing

10 months ago

28 days ago saw a sex worker. Wore condom and we had vaginal sex for 2 min max. However I was barely inside because I had trouble staying erect. This caused condom slippage but made sure it stayed covering my urethra whole time. Believe I had a small patch of raw skin (friction burn) at base underside of penis (not sure it was ever inside but could have smeared fluid there with fingers trying to keep condom on.) I think she could have had acute infection. 5 days later I had swollen lymph node in neck and by 8 days many in neck. Since then I have lymph node swelling/pain throughout body (+ enlarged spleen confirmed by doctor), fatigue, malaise, fever (99s) in armpits only (so far) dry mouth, one canker sore, dry sensitive skin that seems like rash is trying to pop up and occasional cough. HIV-1 RNA Day 11, neg. Ag/Ab Day 17, neg. This is in window period but with symptoms, wouldn't VL or antigen be detectable if HIV? Is this too soon for symptoms? What my risk? What else could it be?

H. Hunter Handsfield, MD

10 months ago

Welcome to the forum and thanks for your confidence in our services. I'm glad to help.

I certainly understand your concern, given both the possible partial condom failure and the timing of your symptoms. However, it is certain HIV is not the cause. Widespread lymph node enlargements (medical term "generalized lymphadenopathy") is one sign of acute retroviral syndrome (ARS, i.e. new HIV infection), and your other symptoms could fit as well. But you are correct in your own statement about symptoms and HIV RNA ("viral load") and the window periods for the HIV tests: Your test results show these problems are not due to HIV. It is not possible, and in recent years there have been no reported cases of anyone with ARS who did not have both detectable HIV RNA and antibody. And although ARS symptoms could start as soon as 8 days, that's still earlier than usual (10-20 days), and 5 days definitely is too soon.

In addition, you describe a low risk sexual exposure for HIV. You don't say where you are, but the large majority of female sex workers in the US and most industrialized countries do not have HIV (generally under 1%); when a woman has untreated HIV, the average risk to her male partner is under 1 in a thousand for each episode of unprotected vaginal sex to completion (several minutes' exposure); and from your description it seem condom protection was good despite the slippage (covering the meatus, i.e. urethral opening).

Several other infections can cause all this, like mononucleosis, similar viruses like cytomegatovirus, various insect- and other animal-borne infection, and more; your age, potential exposure to young children and various animals, and your geographic location all important in judging these possibilities. There also are potential non-infectious causes of such problems. What has your doctor said along these lines? If she is not an infectious diseases specialist, such consultation would make sense -- especially if additional testing doesn't uncover the answer. For further reassurance, additional specialized HIV testing might be warranted, but I cannot imagine it would be positive. It also might be reassuring to contact your sex worker partner, if you are able to do so, and ask her to be tested for HIV -- for reassurance value of the anticipated negative result.

I'm sorry you're going through this, but hope these comments are helpful. Let me know if anything isn't clear. Good luck.

HHH, MD

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10 months ago

Thank you for responding.

Male, 25 in USA. SW was at Asian massage parlor. The reason I had to think she could have been acute was AFTER our encounter, before I left she had some coughs/sniffles. I thought maybe allergies or cold but have since worried it was acute HIV as I know that means high viral load and increased transmission risk.

I do not know her status.

I don't remember the raw spot on my shaft being there before and only noticed later (but can't be certain) I honestly thought it a result of disinfecting and washing after I got home. It looked like friction burn. Is that much of a risk of HIV getting through? I'm circumsized as well.

She provided condom. It didnt break and from what I could tell didn't leak.

Had nightmare if it had been resued but even then, nothing was in it when she put it on and HIV dies very quickly in air right? And even taking condom off I don't think any fluid touched my tip.

Also wanna ask in advance, I have another couple questions that I'm not sure will fit in one more reply and was hoping you could allow me more replies.

H. Hunter Handsfield, MD

10 months ago

Thanks for the additional information, but it doesn't change my evaluation or advice.

No, you don't know her HIV status -- but for a person like you describe, probably no higher chance than one in a thousand. Acute HIV infection doesn't cause cough or sniffles. (The common term "flu-like" refers to fever, muscle aches, etc, not typical cold symptoms.) HIV has never been known to be transmitted via "friction burn" or other skin exposure. That she provided the condom means nothing; if it didn't break wide open, protection was complete. The idea of microscopic leaks or pores that allow virus transmission in an urban myth. And there's no way she would use a previously used condom.

In any case, these details are irrelevant. The HIV blood tests are among the most reliable lab tests of any kind, in history. Given enough time after exposure, they never miss an HIV infection; your negative test results overrule all other considerations. The amount of risk at the time of exposure is now meaningless. And as I discussed above, the test results also overrule your symptoms.

You haven't said what your doctor's diagnosis or advice has been, either before or after the test results were known. I'd be interested in knowing.

Each thread comes with two follow-up comments and replies. This being your second, you have one more. Ask anything you like -- as long as they are directly related to this exposure and your HIV concerns.

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10 months ago

Doc tested EBV and was neg. He thought maybe toxoplasmosis (since I work in public and around animals but again, nothing like this before) but he didn't test. Got neuro things too, muscle twitches, shakiness, hands/feet go numb easy. Nails are blue/purple. He's waiting until my 45 day full STD panel to go from there. He's PCP not ID. Full panel was done at 10 days as well, all neg.

Now this is strange but please bear with me, I wonder if it affected tests.

I use CBD and when I started feeling bad, locals pushed some ivermectin (they're believers in it). I wanted relief so I took some for 20 days. Studies of the antiviral effects of both on HIV javascript:nicTemp(); javascript:nicTemp();

Since they were in body at times of testing I worry they affected them. But as you say, since symptoms were present anyway at testing, then these weren't affecting body that much and if HIV it would have been detected. I have not taken either for about a week and since mouth has gotten drier, canker sores and sore throat now though.

Do you think these had any effect?

But I've seen some say that even though PEP delays test window, if it fail and seroconversion began with symptoms, someone should still test positive. Is this true?

Sorry to repeat, bottom line, even though RNA, 11 days, 4th gen, 17 days are early, if symptoms were HIV they would have been pos? Since they were neg, my symptoms are alike and well timed after my exposure but not HIV?

And, where would you go/look for from here? What non-infect sources?

Thank you so much for your help Dr.

H. Hunter Handsfield, MD

10 months ago

I have no comment about other possible diagnoses; we limit our comments to HIV/AIDS and STDs. However, the news remains good.

Responding to "I wonder if it affected tests". The answer is no. There are no known medical conditions, drugs, or anything else that have any effect on the reliability or timing of the HIV blood tests. As you suggest yourself, PEP drugs can do this -- but you didn't take them, so that's irrelevant.

I won't go further in trying to guess at other causes of the problem, but I remain confident it isn't HIV. Beyond that, you'll need to keep working with your doctors.

That concludes this thread. I hope the discussion has been helpful. Good luck to you.

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