In a long term gay relationship. Suspected possible infidelity. He denied and willingly tested at 9weeks post suspected incident via physician labs, all STD neg. As a bottom after my last unprotected exposure I began 2 weeks later with feeling feverish but normal temps. Intermitted headaches, random intense itching, 10lbs weight loss in 12 weeks,  Very stressed and anxious. Old school, tested 4th Gen lab draw via Quest at 18,32,40, 50, 63, 71, 77 and 91 days. Started with generalized lymph nodes 3-4 weeks post exposure. Burning in neck, armpits and groin, minimal mornings, intensifies by evening daily. Physician could not detect swollen nodes but ordered ultrasounds, "no suspicious lmyphadenopathy" was diagnosis.  Physician does not feel RNA test is necessary.  Tested me and gave ok  to start Prep for protection and peace of mind. I'm hesitant to start as general feeling of unwell. Multiple CBC's/Metabolic, all normal.  Question:  With lymph node pain, headaches, do you see need for RNA test? If so which one? I thought 4th Gen lab draws were best and did consider RNA in the beginning. Trying to trust tests.  STD full lab panels at 3 weeks Quest and 5.5 weeks thru Physician lab. Mouth/Rectal swab tests were at 5.5weeks.  Question: Should I retest for these also? Question: Could Syphilis present these symptoms, I do not recall any sores or rashes

Welcome to our Forum.  Thanks for your questions and your implied confidence in our service.  It's unfortunate to hear of the tensions in your relationship.  I'll be happy to comment on your STI risk and results.---

Thank you doctor for your response. I'm working thru the trust issues with my spouse.  I felt pretty good reading your response however 1hr after,  I had a scheduled tele-visit with a Psychiatrist from a referral by my Physician to help me get on some meds for depression and anxiety resulting from this ordeal.  I was shocked that after the Psychiatrist heard of my  lymph node symptoms that he said "sometimes the HIV tests miss what is actually going on inside the body and you can be positive"  indicating that if there is lymph node pain in multiple areas that my testing out to 90 days could be wrong! This really thru me for a loop and I felt myself going into a panic attack.  I even questioned him why he would say that if doctors are telling me to trust my tests?  He said well I'm not an expert!   I told him how stressed I am and that I am trying to believe my tests and that my Physician is an LGBTQ/HIV specialist.  I don't know why I'm having the lymph node pain and it is very real and has me terrified.   The reason I wanted your expertise is my incessant thinking that only an RNA test is going to tell me if the virus in in my body. That maybe for some reason my 4th Gen tests are not picking it up.  I've read you cant have HIV symptoms if you are positive and have HIV negative tests.   I had a scare many years ago and my same doctor did a 4th Gen and RNA test together but this time with very persistent symptoms they seem to think its not necessary.  In light of my symptoms and therapy session today,  is there any situation with persistent symptoms or a point where you would tell a patient we need to also do an HIV RNA test.  Thank you in advance for taking this last question and any insight.   God bless you for the work you do! 

Oh my, your psychiatrist is not doing you any favors here and he is incorrect.  HIV tests have evolved over the past 10-15 years , steadily improving in sensitivity and overall reliability.  Over 5 years ago the reliability of HIV RNA PCR tests and our confidence in them has also evolved so that their results can be relied upon.  In your case, your multiple negative 4th generation tests unequivocally PROVE that you do not have HIV however, if your concerns linger and given the irresponsible information provided by your psychiatrist , why not get a PCR test.  I assure you it will be negative.  ---

Thank you Doctor for your reply and encouragement. My physician was also very distressed at the comments of the Psychiatrist.  This obviously caused me huge stress over the weekend and with my OCD I ended up testing again at Quest yesterday via 4th Gen lab and I received results back this morning,  negative at 103 days.  I saw my physician today and they ordered the RNA test,  stating this test will   "convince me I'm negative".  Of course my anxiety increased as they completed the blood draw this morning as this test typically takes 3-4days for results.  My last two questions:  Do you feel with the multiple 4th Gen lab tests out to 103 days that my RNA will come back negative?  Could a  Quantitative RNA test show a viral load,  yet with nine 4th Gen lab tests taken from 18 to 103 days still be negative?  Thank you again for sharing your knowledge and providing clear and concise answers.  God bless you! 

I remain confident that your 103 day test will show, once again, that you do not have HIV.  There is no scientific reason with those results that an HIV RNA PCR test would show any different results.  You do not have HIV---