[Question #1481] HIV anxiety

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89 months ago
Hello again Drs,sorry I am back so soon,I just have a few concerns with what is happening with me lately.
4 weeks ago I had sex with a woman,someone I know,white in her 40s,we are from the uk,same woman from previous exposure.
I used protection the 1st time with no problems,though the 2nd time in the same night I was pretty drunk & can't recall if it failed only that there was blood on the condom when we had finished,I cleaned my penis & there was no blood on it,at first it did not concern me as we practiced safe sex so did not mention this as thought it was safe,now my tingling has gone completely.
I had got my results back from my previous tests & all came back fine,including 11 days after this exposure from a gum clinic,I'm not sure which tests they ran for HIV though.
So exactly 2 weeks after I woke up to the worst diarrhoea,it was like water & had no smell this went on for half the day,I also vomited too.
I checked & at no point did I have a high fever,rash or sore throat through this.This lasted 1 day.
I am now extremely stressed with some pretty bad anxiety thrown in too,so it is now 2 weeks since the diarrhoea/vomiting.I now have an uncomfortable feeling under both arm pits which feel tender along with my whole groin too,I can't see any obvious swelling just strange feeling where I have nodes,this has been going on a week now,I have avoided touching them but am aware of the feelings I have now.
I'm very scared of what it can be & plan to get tested again on Monday 4 weeks after with a rapid insti test.
I am having trouble sleeping,my appetite has gone & I'm getting headaches & feel tense all the time,all I keep thinking is HIV.I did feel a lot better after the advise given before but need to know to what this sounds like & to ease my stress levels,as I feel bad enough for straying but now I can't get HIV out of my head.
I keep thinking back to if the condom was still intact or not,and all I'm thinking now it may have broken.
Does ARS act like this?
Can stress cause these kinds of sensations?
Are ARS related nodes visible when they are swollen?
Are they normally tender?
I've been trying to move forward but Can't.
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Edward W. Hook M.D.
89 months ago

I'm sorry you have not been able to get past the anxiety you describe.  I suspect there must be some guilt contributing to it.  You need to relax and move on.  As I have already told you there is virtually no meaningful risk of HIV from the exposure that you have described.  you need to stop relating every ache/pain and minor illness that you have to HIV.  your exposure does not warrant this. 

ARS does not cause vomiting and when it causes diarrhea the diarrhea is typically accompanied with severe muscle and joint aches, sore throat, high fever and sometimes a rash.  On the other hand, the symptoms you describe could very well be due to and attributed to in part to the stress that you are having.

If your condom had broken there would be no doubt.  Condom failures are very obvious.

Swollen lymph nodes are a non-specific finding which in the vast majority of cases are no related to HIV.  They are typically palpable but not visible.  In the ARS they can be tender, but in established HIV they are not.

You need to move forward.  Now that 4 weeks have passed, when you test with a 4th generation, combination HIV antigen/antibody test your results will be negative and definitive.  Believe the results.  If you cannot move forward, then you will have proved that this is more than you can deal with on your own and, at that time, I would urge you to seek the help of a professional mental health counselor.  EWH

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89 months ago
Thank you Dr Hook for coming back to me so quickly I will use your advise to take my result and move forward,I appreciate you taking the time to answer as you probably answered similar questions hundreds of times.
I do believe you are right and it is in my head making me think/feel this,I have been very stressed recently with this situation added on top. As soon as my tingling stopped all this started.
After your first reply last time it was like a weight was lifted & I slept very well for the first time in a long time,then the very next day I had diarreha/vomiting which put me in bed all day,I'm guessing if it was ARS it would go on for longer than mine did?
I have been very aware of every single sensation in my body the last few weeks,I have stayed off the Internet like you said.
I do feel a lot of guilt about it,I can't not speak to my partner about it as I would lose everything,which of course I don't want.

Like most men it is the reassurance of the negative test that I need.
I did feel a lot better when the text came through saying all my tests were negative after 11 days post exposure (I know this would not be accurate for HIV/hsv etc),but over the next couple of days hiv anxiety all started creeping back.

The gum clinic I visited was part of a hospital in a city,so I would suspect they use 4th generation testing?

Also they use insti rapid tests,would these be accurate after 4 weeks?

Thanks again Dr Hook,your kind words have calmed my nerves again.

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89 months ago
Hi again Dr Hook,I had my rapid insti test done after 4 weeks and it came back negative.
I did ask for them to take my blood again but they said I had to come back in Jan to wait 6 weeks after the first test I did on the 24.11,which surprised me,as the duo would have been conclusive.
She didn't even want to give me the rapid test until I asked.
The negative result did put my mind at ease considering all the things that have been happening to me.
I know I worry a lot I can't help that.
I can't find anything on the window period of the insti test online.
I know you have said that I shouldn't worry but it's hard,when all I want to do is move on & never make the same mistake again.
So I've had the lab test done at 2 weeks post exposure which was negative,then I had the rapid test done on 12.12 which was negative.
Also had bloods taken at my GP which all came back normal too.
I still have the strange feeling in my groin where my nodes are,feels like there's pressure there and it's a little uncomfortable,and now I woke up this morning with a sore throat where it hurts when I swallow.
I know I can't keep putting everything to HIV,I do plan to go speak to something about my anxiety as I understand what you have said I may need help getting past this.
I re-read what you wrote to me before about ars so it being over 4 weeks I'm hoping this is just another cold I'm catching (had one a few weeks ago)as I've had all sorts of symptoms after the past 2 weeks. I know my immune system must be taking a hit with all the stress I have.
I'm not as tense as I was but I just want to feel like me again and not worry about every little sensation I keep getting.
Sorry for not waiting for your reply I thought I should let you know about my results.
  1. Can you please advise how accurate my tests would be at this stage?
2. Should I be happy with 2 negatives at 2 & 4 weeks?
3. How accurate is a insti rapid test?
4. Is not having a fever a good sign?
5. Have you had other people with similar symptoms to mine with stress etc.

Again thank you so much for listening to my concerns it's been a hard few weeks for me.

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Edward W. Hook M.D.
89 months ago

I'm saddened that you are continuing to ask these repetitive questions.  The INSTI 4th generation tests has to pass the same regulatory approval process as other apprived HIV tests and provides reliable results 4 weeks after exposure.  Believe your results.  Your negative tests PROVE that your essentially no risk exposure did not give you HUIV. it is time to move forward. 

Your symptoms are not suggestive of ARS and, even when symptoms are consistent with the ARS, if the test is negative, then the persons does not have HIV and should be looking for other problems that lead them to the symptoms they are concerned about.

You need to move on.  I have suggested what I recommend for you and need not repeat it, nor do you need to keep repeating your question, the answers are not going to change.  EWH

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89 months ago
Hi Dr Hook,

I am sorry I don't mean to ask the same questions,I know I must sound like a broken record.
Reason to which I asked about the insti test accuracy after 4 weeks is because I was told it's only conclusive after 12 weeks by the health worker?
As it's only an antibody test? I didn't know what would be detected first at which time frame.
It's the same one as http://www.biolytical.com/products/instiHIV

I couldn't get a duo combi test as I had one 2 weeks previously which all came back fine.
So I was told to go back in January to have bloods taken for a lab test for a full std panel again.

I am going to set an appointment next week to see my gp regarding how I handle stress/anxiety because I know it's not healthy and it effects who I am which is normally always happy.

I do appreciate the time you have taken to even answer my questions once again.
I will apologise for this again I am just confused with what she had told me regarding the test being only conclusive at 12 weeks.

Many thanks again Dr Hook

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Edward W. Hook M.D.
89 months ago

Sorry, I misremembered. The INSTIU test for HIV antibodies is not definitive until 8 weeks following exposure.  I mis-remembered because at the current time most labs do 4th generation HIV tests which detect both HIV antigen and HIV antibodies and provide definitive results at 4 weeks after exposure.  In either instance however, the package inserts are more conservative than the research shows.  As mentioned above, all 4th generation tests provide definitive results 4 weeks after exposure and third generation antibody tests are typically definitive at 8 weeks.  Sorry if I confused you.

Please remember however, the nature of your exposures were virtually no risk.  You really need to move forward.

As this is the 3rd reply to your questions, as per Forum guidelines this will complete this thread and it will be closed later tonight.  EWH