[Question #12819] Follow-up: anal abcess

4 months ago

Good Day - I hate that I have returned here but I have a follow up to question 12695. I had my 41.5 day test on Thursday and it was negative. Dr. Hook confirmed this would be conclusive and I was feeling good. However, on Friday I developed what I thought was a hemorrhoid. I ended up in the ER this evening because the pain was excruciating. The doc diagnosed and drained an anal abcess. I have never in my life experienced such a thing. I also have had a burning tongue for the last week - though no typical symptoms of thrush. As you can imagine I am once again spiralling owing to reports of anal ulcers and abscesses being atypical acute hiv presentations. Especially given my weeklong night sweats. Is there any possibility of a false negative test at 41.5 days? What about hiv-2? I once again feel like I’ve ruined everything.

Edward W. Hook M.D.

4 months ago

Welcome back to the Forum. I'm afraid you are over reacting to your bad luck. There is no realistic possibility that your 41.5 day test was falsely negative, or that you have HIV-2 which would have yielded positive antibodies by this time. A rectal abscess is NOT a manifestation of an atypical presentation of HIV and is an unrelated process. Your anxiety is making you hyper-aware and leading you to jump to unwarranted conclusions. If you cannot accept your test result, test again, either with a 4th generation HIV test or an HIV RNA PCR test. I am confident that testing using either test will be negative.

Take a deep breath, try to relax. EWH

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4 months ago

Your response and patience is very much appreciated. I did as you suggested and had another 4th generation at 53 days - negative. However, at 8 weeks I have come down with a terrible illness. Fever, sweats, cough, body aches, itchy throat, congestion etc. etc. I have also had a burning tongue for a few weeks now and pressure headache for literally weeks. I am a highly educated individual and appreciate this could be any typical viral infection; however, the symptoms are real and I'm just looking for a bit of reassurance.

I know you have indicated that ARS symptoms do not occur after 4 weeks but, if this was HIV-2 with a longer possible seroconversion period, why would it not be possible to experience ARS symptoms at 8 weeks to coincide with seroconversion? Is there any chance this is ARS related to HIV-2 such that a subsequent test will be positive? Is there any realistic chance that i caught HIV-2 as an insertive top MSM in Canada? I will be taking a further test at 12 weeks and will reserve my last response until then but would appreciate your thoughts on the above.

Edward W. Hook M.D.

4 months ago

If this illness were due to HIV of any sort, including HIV-2, a test would be positive. The symptoms of the ARS are due to the interactions of antibodies and the virus and for that reason tests are always positive in the presence of symptoms.

The likelihood of this being HIV-2 is very, very small. HIV-2 is rare in Canada and the US and occurs almost entirely in persons from areas where HIV-2 is relatively common, i.e. India and parts of West Africa. It is far more likely that your symptoms are due to one of the common, every day viral illnesses we all get from time-to-time, i.e. influenza, COVID or another community acquired virus. I remain confident that your testing, whenever you take it, will show that you do not have HIV. EWH

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4 months ago

Thank you once again. I know I indicated I would await my 12-week test results to post again; however, despite your response I do not feel my questions were actually answered:

1 - you indicated that ARS symptoms do not occur after 4 weeks but, if this was HIV-2, (which I understand has a longer possible seroconversion period?) why would it not be possible to experience ARS symptoms at 8 weeks to coincide with seroconversion? This one is particularly perplexing to me. Your response of testing again in the presence of these new symptoms would suggest there is a chance this could be HIV-2 seroconversion.

2- Is there any chance this is ARS related to HIV-2 such that a subsequent test will be positive?

3 - Is there any realistic chance that i caught HIV-2 as an insertive top MSM in Canada?

4 - Would a 53-day 4th generation test to be conclusive for both HIV-1 and HIV-2?

5 - Am I safe to resume sexual activities with my spouse?

Again - with thanks.

Edward W. Hook M.D.

4 months ago

I'm sorry you are having trouble moving forward. You seem to want absolutes. That's not going to happen. In science and medicine there are none- new discoveries and variations occur every day. Strange things happen. The odds that your current symptoms are due to HIV of any sort are virtually zero and repeating your questions will not change that. your risk of having HIV is about the same as your risk of being struck by lightening while reading this reply. Brief final responses:

The reason for testing is for your reassurance, not because I think there is any realistic chance of having HIV-1 or -2.

2- Is there any chance this is ARS related to HIV-2 such that a subsequent test will be positive?

Repetitive. See my response above.

3 - Is there any realistic chance that i caught HIV-2 as an insertive top MSM in Canada?

4 - Would a 53-day 4th generation test to be conclusive for both HIV-1 and HIV-2?

Yes.

5 - Am I safe to resume sexual activities with my spouse?

Yes

This thread is now complete. There should be no need for further questions my assessment is not going to change. EWH

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