[Question #12057] HIV related Question

10 months ago

Hi, I've been dating a girl since January 2024. I ended up having unprotected sex with her in March this year. I think 9-10 days later after this, I started showing symptoms like fatigue, muscle pain, join pain, diarrhea, swollen lymph nodes etc. These symptoms went away after a week or so. I had my last HIV test around March last year which was negative. My partner had her last HIV test around July or August of last year which was negative. She met someone after that and was with him till the end of November or beginning of December. They did have sex. But he hasn't taken any tests as such. Nor do we know his HIV status. Regardless, a few days back I started showing the same symptoms I had earlier i.e fatigue, muscle pain, join pain, diarrhea, throat pain, headache, swollen lymph nodes behind my ear, neck and groin and red eye. My left eye seems to be very red. Not sure why. I had seen a doctor for the symptoms. I just took a normal CBC blood tests to check my WBC and what not. They were all normal. Yet to take other tests. My partner, now my fiancé and I are gonna get married soon so it is honestly difficult for me to tell her this. But are we at risk for HIV? Do we need to get tested for HIV?

H. Hunter Handsfield, MD

10 months ago

Welcome. Thank you for your confidence in our services.

First, you describe an essentially zero risk situation for HIV, especially if you are in the US or other industrialized country, where heterosexually transmitted HIV is far less common than you might assume. In addition, neither HIV nor any other STD fits with these symptoms. In general, symptoms are a very poor indicator either for or against a new HIV infection: even with typical symptoms of acute retroviral syndrome (ARS, i.e. initial HIV infection) -- which you do not have -- the large majority of people have other explanations than HIV; and most new HIV infections cause no symptoms at all. In determining possible HIV, blood tests are the only meaningful indicator and always overrule any and all symptoms. Test results also overrule any and all exposures: no matter how high the risk of HIV, the test results are to be believed.

As all this implies, you need an HIV blood test. Presumably you didn't discuss your HIV/STD fears with your doctor or s/he would have advised an HIV blood test. Maybe s/he did that, but you don't say so. In any case, that's what you need now. Not because you actually are at significant risk for HIV -- you are not, and from a medical/risk standpoint testing is not really necessary. However, the negative result undoubtedly would be reassuring, and enough time has passed that conclusive testing can be done now. It should be an HIV antigen-antibody (AbAb, "4th generation") test. The negative result will prove you are not infected and is not the cause of your symptoms.

You also could have routine tests for other common or serious STDs, i.e. urine for gonorrhea/chlamydia and a blood test for syphilis. Based on your history and symptoms, I'm confident these also would be negative, but those results also would be reassuring to you. Discuss them with your doctor.

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

HHH, MD

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10 months ago

Hi Doctor,

Thank you for your swift response. My fiancé and I are from Mumbai but live in Oman. I did not actually think about the possibility of HIV until today. I consulted with the doctor few days back. Since I didn't think about it, I didnt speak to the doctor regarding this. I just have a question since I do not know much about this. Since I am uncircumcised, wouldn't that put me at risk for HIV? Also since I got the same symptoms 9-10 after that exposure, would that be related to HIV?

Since my condition got worse over the days, I thought about the possibility of HIV today. I've been having oral thrush since the day I got sick as well. Up until before I met my fiancé, I have only had sex with protection. The sore throat, fatigue, headaches, joint aches and muscle aches are getting worse. My doctor did suggest that it is a viral infection. So I put one and one together, did some googling and ended up thinking about the possibility of HIV. However, since you are confident about the negative result, I shall take the HIV test on my next visit with the doctor which is in the coming week. As you have rightly said, the negative results would probably give me reassurance and would keep my thoughts at bay.

H. Hunter Handsfield, MD

10 months ago

Thanks for the additional information. Being uncircumcised increases the risk of HIV compared with circumcised men, but still the average transmission risk from unprotected vaginal sex -- if the female partner has untreated HIV -- is still under one chance in a thousand, so your risk remains low.

What is the evidence for oral thrush (yeast infection)? Has that been professionally diagnosed? Coated tongue, for example, is not the same thing. And although HIV could cause the sorts of symptoms you describe, they are not typical. But indeed you should go ahead with an HIV test if only for reassurance.

Threads are closed after two follow-up comments and replies, so let's hold off on further discussion until you have your HIV test result. You don't necessarily need to wait until you see your doctor and then a few days for the result to be available. Enough time has passed for conclusive testing now if you'd like to have the result sooner, either by contacting your doctor by phone or arranging testing directly with the laboratory. Whenever you do it, make sure it's an AgAb (4th generation) test.

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10 months ago

Hi again Doctor. So I had contacted a lab to get tested. But apparently we have a long process to get tested here as STDs in general are very stigmatized here. I am anyway planning to travel to my Home country next month for my wedding preparations. I think its better to get tested there.

And yes doctor, you are right. Im not sure if its oral thrush. I got this and like a jock itch together. So I just assumed. I am using an anti fungal cream for the jock itch now. Its probably some viral infection that I'll have to rest out to get better. My condition is not really getting any better but it's okay, I can still manage. The symptoms don't really start out this late right?

My question is.. is it really necessary to get tested if not for reassurance? I've already got the assurance from you that I'm not at risk and that'll the results will be negative. I just wanted to know if I am at risk and if it's a possibility earlier. So is it necessary to get tested?

H. Hunter Handsfield, MD

10 months ago

Our advice to test for reassurance always is optional, more or less by definition. Our forum experience, though, is that nearly all persons concerned enough to ask -- and to come for our advice in the first place -- are likely to remain concerned until they have a negative test result. For many, a test result seems more reliable than professional advice, no matter how expert. (We don't take it personally!)

Another aspect is that it is routine advice from all public health and infectious diseases specialists worldwide, and from official agencies like CDC (and most countries' comparable regulatory agencies) that every sexually active adult be tested for HIV at least once, no matter their risk level. So you might want to do it now, if not tested previously, while it's on your mind. Here's a link to the CDC guidance on this. Note the list of authors. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm Although written nearly 20 years ago, it's still an active recommendation.

Finally, the chance of HIV from the exposure described is extremely low but not zero; and some (not most) of your symptoms could go along with HIV. There's never been a reported positive HIV test result on our forum, after 20 years and you're not going to be the first.

Anyway, those are the pros and cons. Bottom line: Your decision and choice. (My understanding is that getting tested for HIV isn't an issue in UAE and similar countries, only a positive result is difficult. But if infected, you'll need to leave anyway to get proper medical care, so what's the big deal?)

That concludes this thread. Best wishes and stay safe.

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