[Question #1463] Worried hiv

45 months ago
Hello Dr

I had an encounter in the Caribbean 45 days back with a CSW. I recall the event to some degree but remember oral received with condom and given without barrier. I do not recall outside that if any sex was involved due to alcohol. I remember telling her sorry that I couldn't stay erect due to alcohol. 

My first time ever doing something like this and I am extremely panicked. I have had 5 HIV tests. 

2 days 4 th gen
10 days single assay
24 days 4th gen
31 days 4th gen
39 days 4th gen

All negative

I will dismiss all symptoms during that time as my tests were negative, however around 39 days I started having sharp knee and leg pains that come and go. I have had major anxiety over the past 5 weeks, like sky high with a feeling of the worse. Perhaps because it's my first time ever putting myself in this position. 

I am literally looking for symptoms. Horrible I know! What level of confidence do you have that the day 39 is near conclusive for both 1&2 HIV. I know 4th gen checks the virus via protein but how about HIV 2 antibody at that time frame?

Should I retest considering I wasn't sure about the entirety of the nights events?

Since I tested neg at 39 days would I feel acute HIV symptoms such as the leg pains that late?

Have followed all your posts and it's literally the only thing that's given me hope over the past few weeks. 

Thanks for answering my preliminary question and this leg and knee/thigh intermittent pain me frightened
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome to the forum and thanks for your question. I'll ask the web adminstrator to edit the last line of your question (the moderators don't have that ability).

It sounds like you had an entirely safe sexual exposure. HIV has never been proved to have been transmitted mouth to penis, even without condom protection; or by cunnilingus either vaginal to oral or vice versa. So even if your partner had HIV, you wouldn't have been infected -- assuming of course there wasn't also unprotected vaginal or anal intercourse that you don't recall (which seems unlikely based on your story). Second, statistically it is unlikely your partner had HIV. Even in the areas of the world with the highest HIV rates (the Caribbean is sort of middle ground in this respect), the large majority of sex workers are not infected.

Finallly, the HIV blood tests are among the most accurate diagnostic tests ever developed, for any medical condition. As long as testing is done sufficiently long after the last possible exposure, the results are 100% conclusive. In your case, the two 4th generation tests at 31 and 39 days were proof you weren't infected with either HIV1 or 2. (The 24 day result was almost conclusive, over 95%.)

Leg or knee pain doesn't even hint at a new HIV infection. Even if it did -- or if you had highly typical symptoms -- the test results always overrule symptoms and exposure history. Even if your exposure was of the highest risk, and even if you had typical symptoms of a new HIV infection, the test results rule. You are home free, do not need further testing. If you have a regular partner, you can safely continue unprotected sex without risk of transmitting HIV.

I hope this has helped. Let me know if anything isn't clear. Best wishes--  HHH, MD

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45 months ago
Thank you Dr for the explanation. Naturally I have seen these responses from other posts but the mind is a unique thing always looking for assurance. 

A few follow up questions. 

1. Around 2 weeks I developed a weird mouth taste assuming anxiety and constant stress created reflux with throats spasms. Anyways I was prescribed omepraziole a PPI. Would that have bearing on the test accuracy?

2. Is 39 days close enough to 6 weeks for HIV 2 antibody as well as others?

3.  Can I presume symptoms such as muscle pain at or around 5.5 weeks as something outside myself feeling affects of HIV?

4.  I get this hot feeling from time to time and I know a rational mind can chalk that up to stress/anxiety but does that alarm you?

5. Are you extremely confident even if somehow I was a drunk superstud and don't remember the amazing performance that a 39 day is conclusive?

I know some questions  or just repetitive and I'm sure you've dealt with thousands of stress written posters however just looking for a shores that I can go back to my life and have unprotected sex ?

 Thank you very much for your time and I'd greatly appreciate the work you do to help people in my position    

Why all of those test that I took were full panel STD tests and they were all negative at the 39 day as well as the previous days
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
1,3,4) As noted above, HIV test results overrule any and all symptoms. Also, when symptoms are caused by HIV, the blood tests are always positive. Something else is causing these symptoms.

2) HIV2 is rare in the Americas, including (to the best of my knowledge) the Caribbean area. But yes, 39 days is close enough to 6 weeks, just 3 days short. And actually, the 4th gen tests are considered conclusive at 4 weeks for HIV2 as well as HIV1.

5) Yes. If somehow I were in your situation, I would not have been tested, or at most a single test at 4 weeks. For sure I would feel no need for any further tests.

I don't understand the closing (unnumbered) question/statement.

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45 months ago
Dr Thank you

Last thread comment from my end

1. My last comment on last reply from me was just that I had taken the full std panel which included the HIV 4th gen. All showed negative. Would I need to test beyond this point for any other std?

2. Perhaps you misunderstood my question about omeprazole. I was asking if it can interfere with the 4th gen test accuracy in anyway?

3. Are you 100% certain I have no need to test say 8 weeks or 12? 

4. Let's say hypothetically that I started to have symptoms today, I can without a doubt say those are unrelated to an std?

5. As I understand, the majority of new HIV+ persons will test positive at 4 weeks. Is that correct? Have you seen an almost 40 day neg 4th gen turn positive?

6. Last question, do symptoms arise during antibody creation or during the detection of p24?  My legs aches started right at my 39 day test. 

Thanks for all your help And please remember my email request from my second post. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
1) Oral sex should be viewed as safe sex, with low risk for all STDs and zero risk for some. I certainly would have recommended againsst any sort of "full STD panel" of tests. But you can rely on the negative results you have had and do not need any further testing.

2) Oops, missed that part. Sorry. But no worries: there are virtually no medications or non-fatal illnesses that delay or otherwise alter HIV test results. PPI drugs certainly do not.

3) How many times and in how many ways do I have to say this? Will it really help to hear it again???  YES!

4) STDs don't cause onset of symptoms this far along.

5) Same question yet again! ALL newly HIV infected people test positive with 4th gen tests at 4 weeks and beyond. I have never seen anyone turn positive at 40+ days and neither has anyone else. (Possible exception for patient receiving PEP with anti-HIV drugs, which might delay antibody production if PEP doesn't work.)

6) Symptoms are generally concurrent with development of antibody, which is why they typically start at 10-15 days after exposure. HIV doesn't cause leg aching as the primary or only symptom.

Please note that forum policy prohiibits repeated questions about the same exposure, testing, etc. If you have any further concerns, you can re-read the present threads, but any new questions about this exposure, testing, and symptoms would be deleted without reply and without refund of the posting fee.

I have informed the web adminstrator about the email address issue. If no change in the next day or so, you can use the Contact Us link(s) to remind them.
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