I am aware of two things now: a 4th gen HIV test at 6+ weeks is conclusive, and performing oral sex is low risk. My risk was fellatio, and I am quite certain there was no ejaculation in my mouth. Exactly 4 weeks later, I came down with a minor illness, yet it was very persistent—definitely lasted over 2 weeks. When I felt better, I went on a trip abroad for a few days, and became much sicker for about 2 days. I had violent chills, sweats, significant joint pain in my knee, strong insomnia, and my slight unilateral tonsil swelling from initial illness would not go down (it still hasn’t). 

Immediately upon returning I went to the ER and had a 4th gen test from a vein. It was non-reactive, and this was about 48 days after the possible exposure. 

Since then, I have been sick much more frequently than has ever been normal for me. On top of that, I have had dry, peeling fingertips for weeks (now subsiding) and a few splinter hemorrhages in my thumbs. 

Because of ongoing symptoms (and definitely catching COVID weeks ago) I was scared enough to buy an Oraquick test—negative. This was roughly 5 months after the possible exposure. Now for the last two weeks, I have felt a slight “something” and I am definitely sick today. No cold symptoms at all, but a strong malaise. My skin has also been kind of red. So, I had a SECOND Oraquick test 3 days ago, also negative but with a tiny blue fleck near the T area.  

I am so convinced that this is still a possibility and I appreciate any reassurance you can give me. I am paralyzed between feeling scared and confident. 

Thank you

You start out by stating your correct understandings about HIV risks from oral sex and the reliability of the HIV AgAb ("4th generation") HIV blood tests. That you came down with symptoms typical of a moderately sever viral respiratory infection doesn't change the absence of risk or the reliability of the negative HIV test. Based on the symptoms describe, it seems very likely you had influenza or covid, or perhaps respiratory syncytial virus (RSV), all of when are quite epidemic presently in the US. I'm not sure I fully understand the timing of your positive test for COVID, but the standard tests for it remain positive for up to several weeks -- so that positive result could have been either from that first infection or a separate infection entirely. In any case, your next AgAb test in the ER again was conclusive proof you do not have HIV.

As for as subsequent Oraquick tests, there was no need. There has never been a case of HIV in which the AgAb tests were negative more than 6 weeks after catching the virus.

In general, people seriously misunderstand the importance (or lack of importance) of symptoms in judging possible HIV infection. Every symptom that can occur with ARS occurs with many other conditions; and most people with new HIV never have symptoms anyway. Therefore, even after exposure of the highest possible risk for HIV (like needle sharing or unprotected sex with a known infected partner), symptoms NEVER are helpful in deciding whether HIV is present; and absence of symptoms NEVER is reassuring. Only testing tells the truth. And the HIV tests are among the most accurate tests ever developed, for any medical condition. When done long enough after the last possible exposure, test result are never wrong; and the results overrule any and all symptoms, no matter how "typical" for ARS they may seem to be.

In summary, despite being "convinced that [HIV} still is a possibility", it definitely is not. Whether these or other symptoms continue, and regardless of whatever new symptoms you might experience, you can be certain it isn't HIV. If they continue or you otherwise remain concerned, keep working with your doctors about the true cause and possible treatment. But truly, you can move on with complete confidence you don't have HIV.

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

HHH, MD

None of this has any bearing on HIV, which unequivocially you do not have. And the timing suggests your initial illness was NOT due to the oral sex event:  4 weeks is too long an incubation period for HIV or any known STI. And in the 3-4 weeks after that event, undoubtedly you had other interactions with other persons that might not have been at all unusual, but nonetheless the source of infection. 

In short, none of this additonal information alters my evaluation and advice above. You do not have HIV and your symptoms are not due to any infection from the oral sex event.

Regardless, I am a bit confused on what you say regarding the incubation period. It was my understanding that ARS symptoms can begin anytime 2-6 weeks after infection. Why exactly would 4 weeks be too long? 

Thanks again and my apologies for the late follow-up.

ARS symptoms usually start within 2 weeks, typically 8-10 days -- consistent with appearance of the virus in the blood (detectable by RNA testing). There are reports of longer incubation, but my personal interpretation is that beyond two weeks, the likely explanation is intially no symptoms at all, then later appearance of ancillary symptoms. For example, it can take several weeks for lymph nodes to enlarge sufficiently to be noticeable.

Another aspect is your possible misunderstanding of HIV test timing. If symptoms are due to ARS, the AgAb (4th generation) and antibody (3rd gen) ALWAYS are positive. Symptoms of ARS are the result of the immune response, not the virus itself -- and immune response always is accompanied by measurable antibody. A NEGATIVE [typo corrected!] test in the presence of symptoms proves the symptoms are not caused by HIV -- no matter how long the time since exposure. This is equally true at (say) 5, 10, 20, or 100 days after exposure.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has helped you accept the unequivocal reality that you do not have HIV. Best wishes and stay safe.