[Question #12967] HIV

3 months ago

I am a 22 year-old homosexual man. On march 5th, I had receptive anal intercourse with a condom. He did not cum inside the condom (only precum), but when he was removing it, it got caught on my butt and was partially in/out. The top part of the condom (the spot where you blow up the balloon remained fully outside of me and in the same direction, so he just removed it. About 10 days later, I started experiencing spleen enlargement as my first symptom, followed by extreme fatigue, swollen salivary glands/oral thrush/extreme dry mouth, swollen lymph nodes in neck, and then finally swelling of the inguinal lymph nodes. I have had no new exposures since this has occurred. My partner was unaware of their status but got tested using a 4th generation test on April 14th (40 days) and March 24th (19 days). Both negative. He only ever tops and seems to think I am making a big deal of nothing (his last encounter that was not me was February 12th - and claims to have only ever used condoms). We are still seeing each other, but I have sworn off all sex with him until we get this sorted out. I have had a couple tests done. I have had four fourth generation tests done on April 6th (32 days), April 15th (41 days), April 21st (47 days), and April 30th (56 days). All of these were negative. I have also had a couple HIV-1 RNA tests done. At the onset of symptoms (only enlarged spleen), I had an RNA test on March 24th (19 days). I had additional ones on April 6th (32 days) after my thrush and parotitis had set in. Once my faituge started and inguinal lymph nodes began to swell, I had a final RNA test on April 21st (47 days). All of the RNA and fourth generation tests were negative, but the symptoms just seem so similar to ARS. Is further testing required/will my results change at 3 months? Can we resume having sex without worry one of our results were false neagtives?

H. Hunter Handsfield, MD

3 months ago

Welcome to the forum. Thanks for your question.

I really don't understand why you are worried. The risk of HIV in this situation was zero for all practical purposes. Bu even if iwas very high, why do you doubt your test results? The prove with 100% certainty you do not have HIV. Test results always overrule risk, no matter how high the risk; and symptoms, no matter how typical they may seem to be for anew HIV infection. You should ignore your symptoms (something other than HIV definitely is the cause) and disregard the exposure (which was near zero risk anyway).

You should not have any more tests. You could have safely resumed sex with your regular partner. You do not have HIV.

Let me know if anything isn't clear.

HHH, MD

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3 months ago

Thank you so much for your reply. I had a couple follow up questions:

1. If I have no new exposures between now and the 3 month mark, is there no chance that the result will change? I keep reading that some people will not test positive until 3 months.

2. Also in my quest to understand my fears more, if symptoms were related to HIV, would the HIV RNA result be positive, or is this a misunderstanding of how HIV works?

3. How can I apologize for being really mean to him and shaming him for his sexual behavior when I thought he had potentially given me HIV? He still seems to be into me and we go on dates, but I am just not sure how to really approach the situation. If this is like not somethint that this forum iis for answering, I would totally understand.

4. If I went into a doctor tomorrow and tested for HIV, could they perscribe me PREP or would I need to wait for 3 months?

H. Hunter Handsfield, MD

3 months ago

1. Despite personal claims, often from persons who really don't know when and how they were exposed, it never takes more than 3 months to test positive; 6 weeks with the standard AgAb (4th generation) blood tests.

2. Your understanding is correct.

3. As you suspect, this is off topic in relation to our expertise. We're STI/HIV experts, not clinical psychologists. I'm glad you "totally understand".

4. There are no hard and fast rules about when to prescribe or start PrEP. It's most important to see a doctor or clinic with lots of experience in HIV prevention and treatment. Such providers typically are very good at personalizing the strategy according to the patient's risks, priorities and psychological needs.

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3 months ago

Thank you!

So to clarify on my first question. Is what your saying that there is a chance I will test positive 90 days from the initial encounter with a 4th generation ag/ab test, or is there no chance after 6 weeks that the fourth generation test from blood drawn from a vein misses the infection? I am not asking for other types of test, just would like some clarification as your answer was vague.

H. Hunter Handsfield, MD

3 months ago

I'm not sure how you might think you might test positive after 90 days; I don't see how my answer was "vague". What is unclear about "it never takes more than 3 months to test positive; 6 weeks with the standard AgAb (4th generation) blood tests"? Saying it another way, the AgAb test ALWAYS is positive by 6 weeks, no matter how the blood is collected.

That completes the two follow-up questions and replies included with each original question and so concludes this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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