Hello doctors, I hope you are all doing well. I have been coming with a concern for some time regarding a sexual encounter I had, and I hope you can help me resolve it.

On August, I performed oral sex on a man, in which there was no eyaculation involved, but he was quite rough with me during the intercourse (sorry if im beeing too explicit). He said he takes prep, but later confessed he has sex with strangers on a daily basis without using a condom, which left me pretty concerned. Also, from what he told me his prep treatment is a combination of lamivudine 150mg and dolutegavir 50mg, which I have never heard of for prep use, so it also seems strange to me.

The thing is that 3 days after the exposure I woke up feeling really unwell, with lots of pain and infection in my throat, accompained with a fever of 38 degrees Celsius, for which doctors prescribed me amoxicillin for 10 days. With this treatment my fever and throat bacteria disappeared after approximately 3 to 5 days, but my throat continues to be quite sore until today, with a burning feeling on it, which I think could be due to having a worsened laryngopharyngeal reflux because of nerves and anxiety. I also have been having frecuent muscle and joint pain, and skin dermatitis, which I also want to think are caused mainly by anxiety.

I took 4 4th generation ECLIA laboratory tests on days 4, 29, 43 and 52 after my encounter, being all of them non reactive, and I plan on testing again on week 9 and 12.

I personally wanted to know what do you think about this whole situation and more important, my question is, in the event that the person I was with has HIV despite using prep, would that affect my HIV tests in any way? Or would they delay in any way my body's generation of the antigen or antibodies? 

I await your response and appreciate for taking the time to read my whole situation.

Your questions and concerns reveal you are unaware of or misunderstand three basic facts about HIV risks, tests, and symptoms. Fact no. 1:  Oral sex is always zero risk or close to it. Only rare cases of HIV are known to have been acquired by penis to oral exposure (and none at all from oral to penis). Fact no. 2: The HIV tests you had NEVER fail to become positive by the times you had them. Fact no. 3:  It is not possible to have HIV symptoms and test negative. Every kind of HIV test that exists is ALWAYS positive if someone's symptoms are due to HIV.

Because of those facts, and I understand your desire to spell out "the whole situation", most of the details of your question do not matter:  not the "roughness" of the oral sex event, which PrEP drugs your partner was taking, or the details of your symptoms, and the rest. And when a partner is on PrEP, they not only are unlikely to acquire HIV, but it usually means they are not infected; and if they are, the chance of transmitting it is significantly reduced. All things considered, this was essentially a zero risk exposure in regard to HIV, even if your partner's PrEP drugs were atypical. Even if you had been infected, your symptoms could not have been caused by HIV; and your test results prove with certainty you do not have HIV. Your HIV AgAb (4th generation) blood test at 29 days test was 98-99% conclusive, and the 43 and 52 day results 100%. As for your ancillary question, whether your partner's PrEP drugs could affect YOUR blood test results -- of course not. How could that be?

The bottom line is that you definitely do not have HIV, indeed were at little or no risk. You do not need any further testing at weeks 9, 12, or any other time. 

So all is well, no further worries from this event. I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Hello again doctor, thank you for your quick response!

I understand that it is very difficult to acquire HIV through oral sex alone, but feeling so sick 3 days after that exposure, and seeing that some symptoms did not disappear over time, made my anxiety skyrocket.

I went to a doctor who told me that my test is inconclusive for at least 3 months, which some doctors say yes and others say no, and that's why it made me doubt my results, but I completely trust your word being an expert on the subject.

My only other question is about what you mentioned that if someone in prep gets HIV and continues taking it, that makes it more difficult for them to infect others. Is that really the case? Because according to what I have read in several forums, they say that the user would generate some resistance to the medication and could transmit that resistant variant of the virus to the other person.

Thank you very much in advance

Yes, HIV resistance to the anti-HIV drugs is possible, but it is rare.

Do your best to believe my advice above. There is nothing you can say, or that you will think of, that would possibly change my advice. There is no possibility you have HIV.

I understand what you are saying, but nevertheless, my symptoms are still present since that encounter (red and irritated throat with a burning sensation), and lately I have also been getting frequent sores on my tongue and palate. Because I continued to have symptoms, my doctor told me to take the test again at week 9, for which I tested negative again. I'm going to have one last test in week 12 just to put my mind at ease.

Is there any possibility or any case that you have heard or experienced that the result changes from week 9 to 12? 

And if it is not HIV (which is most likely) could it be that I have been infected with another STD such as syphilis for example, and that is why my symptoms do not disappear?

Or would you attribute it more to anxiety-related symptoms?

I apologize for the repetition of the topic of HIV, but this whole situation, along with the symptoms that do not go away, have been causing me a lot of anxiety.

I know that the conversation closes after this, so I wanted to thank you in advance for your time, for your answers, and for helping people in similar situations to mine.

"Or would you attribute it more to anxiety-related symptoms?" Whenever someone suggests his or her own symptoms have an emotional/psychological origin, usually they are right. 

Perhaps you would also like to know this:  In the 21 years of this and our previous forum, with thousands of questions from users concerned about HIV, nobody has yet turned up positive. You will not be the first. If and when if finally happens, surely it will be from a genuinely high risk exposure (think unprotected anal sex between men) and will not have atypically negative test results.

As you already are aware, that concludes this thread. Thanks for the thanks. Best wishes and stay safe.