[Question #1516] Testing

81 months ago
Dr. Hansfield
81 months ago
I pressed the submit by accident.   

Anyhow, I first had concerns about STIs due the fact that I shaved my pubic 12 hrs prior to my exposure which was protected oral and vaginal with a CSW.   

Update - my tests for chlamydia and gonorrhea came back negative.

I was going to take a HIV test (RNA) at 2 weeks but you suggested to wait 4 weeks for the  4th generation test to be conclusive instead.   Anyhow,  Its now 14 days post exposure and I can't get these symptoms out of my head - slight sore throat, canker sores, cold sore,  and now  diarrhea. (yes there are other symptoms that are more in-line with a cold.   Others in my family are battling the sniffles as well).  

In any case, here's my question -

1) If I take the test  at 14 days and its negative, would that confirm that my "symptoms" are NOT HIV related?   Meaning, if its already been a week or so since symptoms first appeared, I would imagine that the 4th gen test would be positive?     I understand that its not "conclusive" until 4 weeks post exposure.

2) Can you also confirm these numbers for me.   The risk of transmission thru insertive vaginal sex with an INFECTED partner is  1/2500.   The odds that a female age 25 to 35 in the US that is HIV+ is 1/250.    Condoms if used properly, meaning no breakage or slippage, is close to 99% effective.     efficacy of 4th generation duo test at 14 days is approximately 90%.

I'm trying to get these symptoms out of my head.     

Thank you again.

Edward W. Hook M.D.
81 months ago

Welcome back to the Forum.  As you probably know clients on this site are not permitted to request who responds to their questions.  All questions regarding herpes go to Ms. Warren and Dr. Handsfield and I split all other questions.  As it happened, today I happened to pick up your question.  As an FYI, having worked closely for more than 35 years, Dr. Handsfield and I never disagree on the content of our replies although our verbal styles vary.  I will be addressing this question.  I have also read Dr. Handsfield earlier response to you and agree with all that he said,  you are not at meaningful risk for STI from what you report.  As Dr. Handsfield told you, while it is a theoretical risk, I am not aware of anyone in who HIV acquisition has been linked to genital shaving. 

As for your specific questions:

1.  If your current symptoms are due to HIV a 4th generation HIV test will be positive at this time. If you test and the test is negative you do not have HIV.

2.  The figures you mention are in the right ballpark.  Estimates vary from person to person but in general, the figures you mention are correct.  When you put those numbers together in your own case, you can appreciate why we are so sure that you did not get HIV from the exposure you describe. 

Take care.  EWH

81 months ago
Thanks Dr. Hook.  

The test came back negative.     So hopefully I can move on from those symptoms.

Follow up questions:

Today, after sex with my significant other, I notice that the tip of my penis under the urethra opening was red and a tad bit swollen.    If I don't think about it, It really doesn't bother me that much.

1)  RE: Herpes - From what I've read on this forum, they usually appear  2 to 10 days after exposure, correct?      Its about 18 days post exposure for me as of today.   
2)  They usually appear  in the area where the infection occurred?    Meaning, since I wore a condom, the tip of the penis was protected.  If I got it, it would appear in the areas not covered by the condom.  such as testicles and groin area.

I've already tested negative for chlamydia & gonnorhea at 6 days post exposure.

I might just go in to my doctor's and get his checked out.

Thank you.

Edward W. Hook M.D.
81 months ago

My goodness, you must feel quite guilty and anxious about this exposure.  Dr. Handsfield and I have both told you that your CSW exposure was essentially zero risk, you have negative tests for gonorrhea, chlamydia, and HIV and now you are worried about herpes because your genital scrutiny should that the tip of your penis was red after sex (this is normal).  In answer to your questions:

1.  Yes HSV lesions most likely would have appeared long before now, typically somewhere between five and ten days after exposure

2.  Correct, if you had acquired HSV, lesions would be expected at a site NOT covered by your condom..

If you go get it checked out (and I see no reason to do this), PLEASE do not have a herpes blood test performed.  Your chances of a false positive test are higher than the likelihood that you acquired HSV from this essentially no risk event. 

My advice however is to work through why you are so concerned about this, possibly with a professional counselor who you respect and trust.  You are really over thinking this.  I say this out of concern for you- nothing more.  EWH

81 months ago
You are absolutely right about the guilt and anxiety.   When I think about what I could stand to lose, it makes me nauseous.  The mind is a very powerful tool.     There was another reason why I had to go get myself checked out - post vasectomy pain in the right testicle which I have been battling on and off for 3 years.    First thing my doctor wanted to do was test for gonorrhea and chlamydia.     I couldn't bring myself to tell her that umm....yea I already did that last week and it was negative.  

As for my last follow up.   

1.  When do HIV symptoms typically appear?   10-to 20 days after exposure?

2.  I was negative at 14 days on a 4th gen.  While the antibody part of it could have been a false negative, the P24 antigen part of it would have been detectible,  if present.  Re-assuring but not conclusive.   I am now at day 21.      The reason why I am asking is that my test at 14 days ruled out the symptoms prior to that, but not after.     Today, I'm experiencing somewhat of a burning sensation/discomfort in both armpits.     Also been alternating between hot and cold with somewhat of a foggy head.     Except for the armpit thing, everything else are all anxiety symptoms (I've googled that too).

Does any of this change your original assessment?    

3. The fact that these somewhat new symptoms appeared after day 20, can I take any reassurance in this?

My mind has already decided that 28 days is conclusive and I can accept this.   I just need to get myself to day 28.  

Since this is my last followup, thank you for your time and have a happy holidays.

Edward W. Hook M.D.
81 months ago

1.  the majority of persons who develop ARS do so within 2-3 weeks of exposure.  Occurrence of the ARS after 4 weeks is vanishingly rare.

2.  Sigh, burning in the armpits IS NOT a sign of the ARS.  The ARS typically involves simultaneous high fever, sore throat, severe muscle and joint aches and, sometimes a rash or diarrhea. 

3.  Your symptoms do not suggest ARS, thus the timing is irrelevant.  If you had typical symptoms it would be unusual for them to occur more than 3 weeks after exposure.

You are correct, a 8 day result (which I am confident will be negative) will be conclusive. 

As you know, this is your final answer and this thread will be close later today.  EWH