I was recently thinking back of a sexual encounter about 3 months ago and got quite worried, and I hope you would be able to help me, my sincerest thanks in advance.

9 days later, on Jan 1, I started to experience some flu-like symptoms: mainly headache and sore throat. On the 10th day, it developed into a high fever, fluctuating between 37-39°C during the day and eventually subsided by next noon. During the fever I bought some rapid tests for Covid, Influenza A and B, and even one for HIV where they give you a needle to prick your finger and use the drop of blood for testing. They all tested negative. I'm aware those aren't the most reliable tests but they were my only option at the time.

I was reflecting on this today and realized that the fever onset seemed to match the timeline of ARS and have gotten very worried. Does an HIV infection look likely to you, and is this time (77 days after the encounter) a good time to get tested after possible exposure?

Thank you

You don't say so explicitly, but your description of symptoms and mention of menstrual blood suggests you are concerned primarily about HIV. I see no significant HIV risk from the exposure. Unprotected oral sex is little or no risk for HIV; in fact, there has never been a proved case transmitted oral to penis. Second, condom protected vaginal sex also is little or no risk. Third, a "high end escort" is exceedingly unlikely to have HIV. And fourth, even if she had HIV, blood exposure during sex doesn't increase the risk. The amount of HIV is equally high in vaginal fluids and blood, and research has shown than unprotected sex during menstruation with known-infected women is no more risky that sex in absence of menstrual blood.

As for your symptoms, they conceivably could have been due to HIV. However, your negative HIV test was proof they were not:  it isn't possible to have HIV symptoms and test negative. Stated another way, even before the HIV test window period is over, the test is positive if fever or other symptoms are caused by HIV. I can't say more about the cause of your fever, but it wasn't covid, influenza A or B, or HIV.

You certainly should not be seeking HIV treatment at this time. For additional reassurance about HIV, all you need is another HIV test. You can count on a negative result.

I hope these comments are helpful. Let me know if anything isn't clear. (Your previous thread will be closed.)

HHH, MD

I was worried that the quality of the HIV rapid test wasn't that good, or that I didn't conduct the test correctly, in other words, I'm not sure whether I might have gotten a false negative. Is that possible? 

If for my peace of mind I do seek to do an HIV test, what kind of test should I order from the clinic? Thank you again.

It still is true that the OTC self-tests for HIV are less good than lab based tests, i.e. they miss a small minority of infections. But not when there are symptoms. The symptoms of a new HIV infection (called acute retroviral syndrome or ARS) are not caused by HIV itself, but by the immune response to the virus. Immune response involves antibody. So when symptoms are present, so is anti-HIV antibody. Stated the other way, negative antibody in presence of symptoms means the symptoms are caused by something other than HIV.

The most common type of lab-based test is the antigen-antibody (AgAb) test, also called "combo", "duo", and "4th generation" blood tests. That's what you should have. Any clinic or lab will know what you mean. Once positive, the AgAb tests remain positive for life; and detect 100% of HIV infection more than 6 weeks in duration.

Finally, in your opinion, should I go test for HIV anyway? And learning from the many posts that I read here, I'm probably safe from other STD's as well?

This being a very low risk exposure, I would view testing as optional. I wouldn't do it if I were in your situation, but I also would not have done the rapid test either. It's OK to test for reassurance even if there is no need from a medical/risk standpoint. It's your decision.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Thanks for the thanks.