[Question #12824] Chances of HIV?

4 months ago

Dear Doctor,

I went on a date with a girl (12/28/24) and before the date I took PrEP on demand. We went to a club and somebody poked me with something that I'm afraid could have been a syringe. About 8 days after this incident I came down with a fever, sore throat, cough and body aches. A few weeks later I had sex with a woman and the condom broke. I was prescribed PEP. About 6 days into PEP I visited a massage parlor and received a handjob from a woman who used some weird lotion that wasn't lotion and I'm afraid could have been semen. I continued taking my PEP until 2/11/25 and again 8 days after I finished PEP I came down with a fever, sore throat, cough and body aches. The girl the condom broke with tested negative so my only concern is I was exposed during the hand job with weird white substance (semen?)

Is there any chance I got HIV from either of these situations? I'm sorry if I'm wasting your time, I feel crazy asking this question as I know my exposures are strange but I've just been consumed by terrified thoughts and I can't focus at work. I took an HIV Oraquick Saliva test 30 days post PEP and again 38 days post PEP on 3/21/25 and both were negative. Thank you for your time doctor.

H. Hunter Handsfield, MD

4 months ago

Welcome to the forum. I'm happy to address these issues.

Most of the information you provide really isn't necessary to be certain you do not have HIV and that HIV is not a possible cause of your symptoms. The symptoms of HIV or acute retroviral syndrome (ARS) are not caused by the virus itself, but by the immune response. Immune response is measured by antibody: anybody with HIV symptoms always has anti-HIV antibodies detected in blood. Therefore, it is absolute certain none of your symptoms was due to newly acquired HIV.

The only slight concern is that the oral fluids test -- Oraquick -- misses up to 5% of HIV infections, no matter the symptoms and no matter how long the infection has been present. We always recommend against Oraquick when people are worried about possible HIV from a recent exposure. You should find a lab for an antigen-antibody (AgAb, i.e. 4th generation) blood test. Almost certainly it will negative, but it's the only way you can be 100% certain. (Alternatively, you could have an HIV RNA PCR test, which always is positive in infected people -- but it's a lot more expensive than the AgAb tests and, at 38 days after finishing PEP, no more accurate.

As for your exposures and symptoms, the exposure really were not very high risk; and the symptoms are not typical for a new HIV infection. But as noted above, the risk of the exposures at the time and your symptoms really don't matter any more, given your negative blood tests.

The bottom line is that almost certainly you do not have HIV, but an additional lab based test -- like the AgAb test (or an RNA PCR test if you prefer) is necessary to be 100% certain.

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

HHH, MD

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4 months ago

Dr. Handsfield,

Thank you so much for your response. I will go ahead and schedule an HIV 4th generation test.

My anxiety is still pretty high here, so I just wanted to double check something. Since I was taking PrEP on demand when I was potentially struck with a needle, would that have provided protection against HIV? Also, since I took PEP when the weird white substance (possibly semen) was rubbed into my urethra during the handjob, was I protected there as well? I know I need the HIV 4th generation test to be 100% certain but knowing that my chances of acquiring HIV are astronomically low would help my anxiety a lot in the mean time.

H. Hunter Handsfield, MD

4 months ago

Since it is almost impossible you have HIV, the risks at the time of exposure remain irrrelevant. I don't care what sort of "white substance" might have been massaged into your urethra, and you shouldn’t either. But even if it was semen, it doesn't matter. When an HIV infected male deposits several ml of semen (a teaspoon or more) into a woman's vagina -- deep inside her body -- her chance of being infected is around one chance in a thousand. What could the risk possibly be with the small amount you are worried about? Plus the fact that nobody has EVER been known to catch HIV by hand-genital contact -- and millions if not billions of such exposures must have occurred, yet no infections.

Perhaps it will also help you to know that in the 21 years of this and our preceding forum, with thousands of questions from persons worried about HIV after a possible exposure, not one has yet turned out to be infected. You will not be the first. If and when it happens, I am confident it will be a genuinely high risk exposure (think unprotected anal between two men), and without atypically negative test results before the final testing was done.

You have one more follow-up comment coming before the thread is closed. I suggest you wait and use it after you have had an AgAb or RNA PCR test. In the meantime, crack a beer, go to a mirror, raise a toast to yourself with "Hey Bro, you don't have HIV", then kick back and relax.

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