I had a weird experience at work 2 weeks ago. I work for a large international corporate in Portugal, recently, they have started providing flu shots via the medical center in our building & they also do blood draws for other medical procedures. When exiting the elevator, I bumped my leg on the see through bag of someone else, when I looked back I saw what seemed to be syringes in the bag. I was wearing long trousers and after 15 minutes (as I had to do something for work first) I checked for any blood or marks but did not find any, although it may have been wiped off by the movement of my trousers. I am deeply concerned that they were disposing of syringes or blood drawing needles incorrectly & this has put me at risk of HIV as the needle of the syringe could easily puncture the plastic bag. I went to the Doctor afterwards who declined to give me pep as I could not find any blood or wound but he told me to test after 6 weeks. 

Approximately 10 days later, I got a sore throat that lasted for two days with post nasal drip (feels like mucus is coming from my nose to the back of the throat but i am not 100% sure if this is the correct diagnosis), & now I am experiencing a bad cough, nasal congestion and head ache although the sore throat is gone, I have not had any fever. 

I was wondering: 

1. Do I have a risk of contracting HIV in this scenario? 

2. Do my symptoms, as they came after 10 days, sound like ARS? 

Thank you for your time. 

1) I agree with your doctor. There's no way you could have sustained a needle injury sufficient to transmit HIV and not known it at the time. The majority of needle stick injuries in medical personnel, even needles that had just been used on HIV infected persons, do not result in HIV transmission. Real risk from contaminated sharp instruments generally requires obvious, visible injury. I also cannot imagine being stuck through the plastic of the bag and your clothing. I imagine your own doctor may have said much the same, right?

2) The "flu like" symptoms often used to describe ARS refer only to headache, fever, muscle aching, etc. ARS does not cause nasal congestion or cough. Undoubtedly you caught a garden variety respiratory infection. Given its relative severity -- more than the average cold -- you likely have covid or influenza; you should consider testing yourself. (At this point it's too late for treatment of flu or covid to make much difference, but it could help you advise others around you to be alert to symptoms of their own.)

Given your concern about HIV, you might consider testing for the reassurance you might gain from the negative result. You don't need to wait:  if your symptoms were due to ARS, your test result would be positive now. You don't really need testing from a strictly medical or risk perspective; I suggest you consider it only for its reassurance value. 

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

HHH, MD

I had tested for COVID, hopefully to get reassurance, but it was negative. The doctor told me that it was low risk assuming it happened & to test just as a precaution, however, this made me more nervous as if there is any chance I don’t think I will be able to relax until I test outside the window period. He is not specialized in STDs though. 

I had a negative baseline test a day after the event, however looking at the needle hole in my arm it doesn’t seem obvious to me that I would be able to find a similar injury if I looked at my leg as the blood draw marks are very small, especially if I missed it bleeding since I was doing something else before I could check. I will add though that I do not remember feeling pain but worry my anxiety at the time when I thought I saw syringes prevented me from noticing. 

As you probably suspect, I do have diagnosed OCD (that focuses specifically on HIV), so there is definitely irrationality involved. 

If I understand correctly, if a needle were to break through a plastic bag and then through my trousers, would the tip effectively be “cleaned off” or the blood smudged, further reducing any chance of infection?

Lastly, how conclusive would a duo test be at 28 days post event? It seems the recommendations have changed from 4 weeks to 6 weeks for absolute conclusiveness? 

The HIV AbAb (4th generation, "duo") tests are usually positive (over 90%) by 3 weeks, 98-99% at 4 wk and 100% by 6. If I were in your situation, I would not be tested at all -- but up to you if you feel you need it for reassurance. And as I said, a test now (2 weeks) would prove your symptoms were not caused by ARS.

Perhaps it will also interest you to know that in the 21 years of this and our preceding forum, with thousands of questions from persons worried about an exposure and possible HIV, none has yet turned out to be infected. You won't be the first. If and when it finally happens, undoubtedly it will be from a genuinely risky event (think anal sex between two men) and not a sketchy, virtually zero risk situation like yours.