Good Day Doctors - I am writing out of concern for a recent HIV exposure.   On February 6 I visited a gay sauna and had unprotected insertive (me as top) anal sex with a man of unknown HIV status.  I know for certain that he engaged in similar unprotected activities with another top partner shortly before we had sex.  I honestly don't know what came over me and why I did this.  I am married with a monogmous partner for 13 years.   I have been watching for symptoms (bad idea) and last night I was up all night - I have an itchy rash on my back and my body feels really warm though I have checked and there is no fever.  I also have significant chills, headache and diarrhea.     I know the only way to tell is by testing but I don't know how I am going to make it through the window period with the anxiety I have.  Do these symptoms and timing suggest potential acute HIV?  I did an online assessment with an HIV clinic that suggested PEP was not warranted in the circumstances and my chances of infection were less than 1/1000 - do you agree with this assessment/would you have recommended PEP?  Does the fact that another top potentially ejacutlated in him prior to me increase my risk?  I am what I would describe as "half-cut" - circumcised though they left a lot of foreskin - would this increase my risk?  I was treated for gonno and chlymidia out of caution though I had no symptoms if this is relevant.   I appreciate any advice you may have - I'm convinced I have been infected and not sure how I will ever tell my husband.  Thanks doctors. 

Welcome to our Forum and thanks for your questions.  I’ll be glad to comment.  You assessment of your risk is on target.  If your partner had untreated HIV, your statistical risk for infection would be about 1 in 1000-2000.  The value of PEP in this circumstance is low and it is now too long after the encounter for PEP to be of value.  There are no data on how his prior partner may have impacted your risk.---

 You will recall I had unprotected anal sex (me as top) with someone of unknown status in a sauna. I have been attempting to stay off the internet hence the delay between my messages; however, symptoms have continued and I was hoping for some further thoughts.  As mentioned, I had an itchy rash on my back along with some chills, headache and diarrhea.   I can say for certain that the rash appeared on my belly (one side) on Sunday of this week.   Since then it has mostly cleared up; however, I continue to have diarrhea combined with some dizziness and nausea.  I can also say for certain that my normally unproblematic skin has been showing a number of issues with facial breakouts, etc.    You mentioned in your last response that my symptoms are not classic for ARS; however, I have read firsthand accounts from some online that their first symptoms were rashes/skin related and it wasn't until a month or two after that they developed a febrile illness.   Are you familiar with any such instances?  Previous posts in your forum suggest that ARS almost always presents with a strong fever and sore throat and generally happens by 3 weeks.  Given today is the three mark for me and I have not yet had a fever/sore throat should I be optimistic?   I know you can't tell anything from symptoms alone and I have an appointment for 4th generation this coming Monday (I'm terrified) but I feel like a ticking time bomb and honestly feel like I've ruined my life.    IF Monday's 4th generation is negative at 24-25 days will this give me a good indication and some reason to breathe?  Should I be okay to resume activities with my husband at that point? I ask because we are going on vacation and I likely will get the results while on vacation but I expect some sexual activity will be expected as is normally the case on vacation.   Again - i'm terrified.  Appreciate your help/advice. 

I'm sorry your symptoms have continued.  Less than half of persons with the ARS have a rash and fewer still have diarrhea. High fever. severe sore throat and widespread muscle and joint aches remain the most common symptoms of the ARS.   Your symptoms may be heightened, understandably, by anxiety.  Rashes occurring after more than 30 days would be unrelated to the ARS.  I continue to anticipate that your forthcoming test will be negative, reliably proving that the symptoms you have experienced are not due to the ARS.  If you really want to be entirely sure that you do not have ARS, an HIV RNA PCR test at this time (available at commercial labs or through your doctor) would provide definitive information on whether or not you acquired HIV from the casual encounter you described.  EWH  ---

Thank you.  I tested at 26.5 days and the result was negative.   I am curious how reliable this is viewed as.  I know 28 days was once considered conclusive, but it has been changed to six weeks.    I have had a few random nights of night sweats over the last month but what is concerning me now is that I have had persistent night sweats for the last three nights to the point of soaking the sheets.  This started at 5 weeks post exposure (after my last test).     My questions are: 

As you know, these will be the final responses as part of this thread.---