Dear two experts, I had sexual intercourse with an older woman vaginally (using a condom during intercourse), but after finishing intercourse I used my hand and fingertips to contact female genital secretions on the outside of the condom body multiple times (the area that had direct contact with the female vagina). My hand then, approximately 15 seconds to 1 minute later, rubbed directly against the thin skin on the inside of my foreskin, an area containing many Langerhans cells and CD4+ T cells (the target cells that HIV aims for), and this skin became red and swollen from rubbing with my hand that contained the previous secretions (there may have been multiple tears at that time), while the surface of my foreskin was moist with my semen from ejaculation. I also touched the urethral opening a few times where there was a small amount of my semen when my penis became flaccid.

The woman later had a urine test showing results of abnormally elevated white blood cells and red blood cells in the urine many times over (gynecological inflammation/infection). I know that when women have inflammation/infection, HIV-infected CD4 cells and white blood cells concentrate more, leading to viral load increasing many times.

Afterwards, I developed all the ARS (acute retroviral syndrome) symptoms of HIV such as swollen inguinal lymph nodes, fever, rash, weight loss, and oral candidiasis.

Please give me your most careful assessment of my case - could a rare transmission have occurred since the source of infection, transmission route, and entry point as well as the target cells that HIV aims for were all present, and could the amount of virus on my hand when it made deep contact with wounds on the inside of my foreskin contacting target cells replicate and cause infection?“

The exposure you describe was a no risk event.  You apparently do not know that your partner has HIV.  It is statistically unlikely that she does.  Despite the possible transfer of genital secretions the fact is that HIV is not known to be spread in this way.  The symptoms you describe, while consistent with the ARS, it is also consistent with many other viral infections including influenza and COVID.  I suggest that you get a 4th generation test for HIV.  When it is negative that will prove that your symptoms are not due to HIV as tests are always positive when and after persons experience HIV symptoms.  

EWH

Here’s the translation to English:

“Please, experts, assess whether there are any rare cases of transmission occurring in the way I described, if the person I had intercourse with is in the infectious stage with a high viral load. Could contact like this, when the foreskin mucosa and inner surface of the foreskin are injured right at that moment, have a probability of transmission or not?“​​​​​​​​​​​​​​​​Here’s the translation to English:

“Because the secretions on my hand made deep contact with the wounds caused by friction on the inner foreskin skin, is the viral load in the secretions on my hand sufficient to cause infection when there are many target cells there or not? Symptoms began to appear starting from the 7th day after intercourse.“​​​​​​​​​​​​​​​​

One follow up remaining.  EWH

Here’s the translation to English:

“Why do you believe there is no risk, when the foreskin mucosa is injured and Langerhans cells and CD4+ T cells that HIV targets exist there? Doesn’t it only require a small amount of virus to reach these cells for the replication process to begin and cause infection? I have read your previous answers, where you always say that the act of masturbating with a hand containing infected secretions from a patient is a behavior with no risk, but in my case the secretions (from intercourse) stuck on my hand were still wet (because the time of intercourse was at 12 midnight when the room temperature and humidity were low) and only after a few dozen seconds the secretions on my hand made deep contact with the cracks on the inner surface of the foreskin skin due to strong friction, and afterwards I had symptoms. Please evaluate it very strictly (even if rare), as well as whether if there are symptoms of fever and rash, only a 4th generation test will react or will a 3rd generation rapid fingerstick blood test also react? If I took immunosuppressive medication at a dose of 16-32 while having rash symptoms, could this interfere with the virus recognition process and slow down or prevent the antibody production process? If it’s been several dozen days since stopping immunosuppressive medication like methylprednisolone, will the antibody production process start again, when I have prolonged oral thrush and weight loss, as well as muscle and joint pain and fatigue that are still ongoing (symptoms haven’t resolved) even though it’s been 60 days since intercourse with that woman? Does this prove that my immune system has failed to produce antibodies against the virus? If I start HIV antiretroviral treatment when antibody tests cannot yet detect it, will my body continue to produce antibodies later when the virus has been suppressed?“​​​​​​​​​​​​​​​​

“Why do you believe there is no risk, when the foreskin mucosa is injured and Langerhans cells and CD4+ T cells that HIV targets exist there? Doesn’t it only require a small amount of virus to reach these cells for the replication process to begin and cause infection? I have read your previous answers, where you always say that the act of masturbating with a hand containing infected secretions from a patient is a behavior with no risk, but in my case the secretions (from intercourse) stuck on my hand were still wet (because the time of intercourse was at 12 midnight when the room temperature and humidity were low) and only after a few dozen seconds the secretions on my hand made deep contact with the cracks on the inner surface of the foreskin skin due to strong friction, and afterwards I had symptoms. Please evaluate it very strictly (even if rare), as well as whether if there are symptoms of fever and rash, only a 4th generation test will react or will a 3rd generation rapid fingerstick blood test also react? If I took immunosuppressive medication at a dose of 16-32 while having rash symptoms, could this interfere with the virus recognition process and slow down or prevent the antibody production process? If it’s been several dozen days since stopping immunosuppressive medication like methylprednisolone, will the antibody production process start again, when I have prolonged oral thrush and weight loss, as well as muscle and joint pain and fatigue that are still ongoing (symptoms haven’t resolved) even though it’s been 60 days since intercourse with that woman? Does this prove that my immune system has failed to produce antibodies against the virus? If I start HIV antiretroviral treatment when antibody tests cannot yet detect it, will my body continue to produce antibodies later when the virus has been suppressed?“​​​​​​​​​​​​​​​​

If it has been 60 days since you exposure a 3rd generation test will be reliable although a 4th generation test remains preferred.  If you have a negative 3rd generation test, you don’t have HIV and should look for another cause.  EWH