[Question #12605] HIV Risk Inquiry

6 months ago

On Dec 23, 2024, I received a handjob at a SPA place where the provider kissed my body and possibly licked my anus (prior anal eczema, healing unclear). Symptoms: Jan 7, 2025 – wisdom tooth inflammation, sore throat, fatigue (resolved after 6-day antibiotics); Jan 28 – stomach pain. HIV tests: Jan 8 & 20 (hospital Ag/Ab – negative), Jan 13 & 15 (Abbott 4th-gen self-test – negative). Medical history: Ankylosing Spondylitis; Taltz (Ixekizumab) every 8 weeks (last dose Oct 31, 2024). Questions: 1. Was this activity a HIV risk? 2. Can I rule out HIV now or need retesting?

H. Hunter Handsfield, MD

6 months ago

Welcome to the forum. Thank you for your confidence in our services.

The news is good: you do not have HIV. You had a zero risk exposure, or very close to zero: HIV has rarely if ever been transmitted by hand-genital contact (even if genital fluids are used for lubrication) or by analingus. In addition, the chance your spa partner has HIV probably is very low. Second, your test results are nearly conclusive proof you were not infected. Finally, none of your symptoms fits with a new HIV infection. Having ankylosing spondylitis or your immunosuppressive therapy for it (ixekizumab) do not increase the risk of HIV or alter the reliability of any HIV test results.

Those comments start to answer your specific questions, but to be explicit:

1. No, the events described were no risk for HIV.

2. Your current test results are nearly 100% conclusive. For truly conclusive result, I would advise a final AgAb test 45 days (or more) after your spa visit, i.e. during the coming week. Stay relaxed until then; the result will still be negative.

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

HHH, MD

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6 months ago

Thank you very much for your professional comments. Your response has given me great reassurance. Over the past month, I have been experiencing a series of symptoms one after another, including the ones mentioned earlier, as well as dizziness and fatigue. I even suspected that I had developed 1-2 rashes (though they quickly subsided or disappeared).I still have three questions:1.If these symptoms are caused by HIV, would a test at this point definitely be positive? 2.Does having eczema around my anus increase the risk?3.In my country, some doctors recommend testing at 12 weeks, while others suggest 6 weeks (which is the majority), 4 weeks, or even say that testing is unnecessary. What is the latest global standard for HIV testing in terms of weeks?

H. Hunter Handsfield, MD

6 months ago

You misunderstand a basic fact. Nothing unusual, most people also don't understand. Your question no. 1 gets to exactly this point.

1. "If these symptoms are caused by HIV, would a test at this point definitely be positive?" Yes. People with HIV symptoms always test positive for the virus; and a negative test result is 100% proof that the person is not infected with HIV.

2. There are many statements online and elsewhere that inflamed skin increases the possibility of HIV if the skin is exposed to the virus. However, there are almost no known cases in which this actually appeared to have occurred. Any increased risk is purely theoretical; the actual risk appears to be zero for all practical purposes.

3. The science is solid. Any doctor (or anyone else) who states a need for testing for HIV beyond 6 weeks simply is wrong. There could be exceptions in setting where for some reason only older tests that required 3 months were being used. But these tests haven't been commonly used anywhere for over 20 years. The actual time required depends on the specific test done. The HIV PCR RNA tests are conclusive by 11 days, but they are expensive and not recommended except in very high risk situations. The standard, i.e. most commonly used tests are the antigen-antibody tests (AgAb, "4th generation"). About 98% of the time, they are positive by 4 weeks and always by 45 days. On this forum, we (and most other experts) often round this off at 6 weeks.

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6 months ago

Thank you very much for your response. It has been incredibly helpful to me. I will do my best to not dwell on this matter. I appreciate your support and wish you a wonderful day.

H. Hunter Handsfield, MD

6 months ago

Thanks for the thanks. Best wishes and stay safe.---