Dear Doctors. My exposure was brief unprotected oral performed on me protected vaginal and rubbed her clitoris (felt wet - maybe lube?) with a Thai CSW, in Thailand with a high rate of HIV. This was just over 5 weeks ago. 10 days after I had a mild fever, body aches and mild sore throat which lasted 5-6 days. Shortly after that (by day 19-20 post exposure) my lymph nodes have been aching in the armpit, and especially groin area and this has continued since. And today I had diarrhea.

Welcome back to the Forum.  Thanks for your questions.  I'll be glad to comment.  The encounter you describe was virtually no risk.  Condom protected sex is safe sex and there are no proven cases of HIV acquired from receipt of oral sex.  Rubbing her vagina and clitoris is likewise no risk.  I agree with the doctor you spoke with- after 28 days, a 4th generation test would have detected over 98% of recent HIV infections and if any of the symptoms you describe had been due to HIV, your tests would have been positive.  A follow-up 4th generation test any time more than 6 weeks after the encounter will be entirely conclusive and I anticipate it will be negative.  EWH---

Thank you for your evaluation, Dr Hook. I will follow up next week for 6 week test (10th April). Am I correct in believing that once the p24 antigen is no longer detectable, the ab should be? I read that most rapid tests only look for igG which form a little later than igM antibodies.

I think you are making this more complicated than it needs to be. Certainly the P 24 antigen becomes detectable before antibodies are present in sufficient quantity to be detectable. In untreated persons, however both the P 24 antigen and antibodies may be present.  The reason for the lesser sensitivity of most rapid tests is that they only look for antibodies and not the P 24 antigen. EWH.---

I'm sorry for that, I'm doubting the validity of my rapid test results. At some point, I must have come in contact with her fluid - I'm guessing during the protected vaginal. My mouth has gone dry with a bad taste and I have about 3 small white spots on the right tonsil. My lymph nodes are still causing irritation/ burning sensations and my bowel movements have stopped, which coincides with my appetite loss. If my antibodies are still not detectable by now, do you recommend the RNA PCR? I will post results here after.

It saddens me that you continue to worry about the no risk encounter which you proven you did not acquire HIV from.  If your symptoms, which are NOT those of recently acquired HIV, were due to HIV, your tests would have been positive.  At this time an HIV RNA PCR test would add further proof that you did not acquire HIV.   Alternatively, at any time more than 42 days after your encounter, a 4th generation test would also be conclusive.  I am confident that no matter how you test, your tests will how that you were not infected.---