[Question #1588] Follow Up

81 months ago
Dear Dr.,
You can see my earlier post for detailed case background, but will summarize here anyway. 
It has now been 45 days post exposure. At 41 days I tested negative on 4th gen hiv 1/2 and antigen. That's 1 day under 6 weeks. So, exposure was with csw in arab country, but girl was from Ghana, she put condom on and oral for 10 seconds then vaginal for 10 minutes. Went to bathroom pushed on the head of the condom (I know protected but I didn't provide it so don't know about holes in it) with it on and there was pressure and it was not broken wide open. However moved to new hotel and this may have been caused by sleeping under AC, but idk, but at 20 days got a fever of about 100 (didnt measure) it was mild. Day 21 fever and sore throat and ear pressure. Day 22 fever subsided, but nasal, sinus congestion with yellow mucus, post nasal drip, sore throat. Felt much better that day besides the congestion. Day 23 took augmentin for 1 or 2 days, stopped it. The next day congestion, sinus was even worse. Congestion/sinus lasted for 2.2 weeks. Fever only for 2 days at start, but persisted in correlation to sinus, as slept under AC again after being much better and sinus became worse again. Sore throat resolved same day as congestion. Maybe sinus infection, idk, but the time period is what scares me. Felt normal after, but 4 days ago got slight pain in inner right thigh under testicles almost near middle of thigh. This became more painful after 2 days and then subsided. hurt when I walked a bit. Then got like a burning on rectus femoris. Was the inner thigh pain a lymph node? It felt like a bump. If I start pushing on the area it will hurt again. I did not have any swollen nodes before. Pulse has been at 80-96. But the thigh thing scared me. How conclusive is the 6 week test I took? What about HIV-2 since she was from Africa. Could antibodies for HIV2 not show? Also woke up shirtless 3 nights ago, found it next to me and it was wet and I took it off in the night. 
81 months ago
Must note, went back on Augmentin after stopping it for 1 or 2 days because nasal/sinus got worse, but then I believe Augmentin worked against the nasal/sinus as subsided or resolved within 3 days. But pressure in sinus persisted long after. However Augmentin did cause diarrhea for 1 week. Probiotic helped resolve that.  
Edward W. Hook M.D.
81 months ago

It has now been two weeks since our last interchange regarding your virtually no risk encounter.  Yet you continue to worry about the possibility that testing has missed an infection, this is simply not realistic  (do the calculations, realizing that ALL of these estimates are VERY conservative- the chance that your partner had HIV was less than 1 in 10 [probably far less] X the chance that the condom failed, particularly after you tested is- far less than 1 in 1000 X the chance of infection following unprotected vaginal sex of less than 1 in 1000 = a total estimated risk of far less than 1 in 10 million) then consider the possibility that your 6 week test, missed infection (again, somewhere between 1 in 1000 and 1 in 10,000 at most) Yet you are clearly continuing to worry.   I have now pasted my last reply to you into this note-

"Final reply. As per Forum Guidelines, this thread will be closed later today. 

Correct, nasal and sinus congestion is not a symptom of the ARS.

The transient right testicular discomfort you describe is not suggestive of any STI, including HIV.

Feeling sick in the way you describe for two days does not suggest HIV.

Time for you to relax and move forward without concern.  I hope my comments will help you to do this."

Today you again  worry that symptoms that previously concerned you such as sinus congestion and transient testicular and thigh discomfort might be related to your exposure.  Not only are these not symptoms of HIV or any other STI but you have reasonable alternate explanations (i.e. reaction to the AC) and you have a highly reliable laboratory tests which would be positive even if you had HIV-2.  Your symptoms not related to the exposure you described in the past.  I do understand how one can continue to worry that an error in judgment might come back to haunt you but there is simply NO realistic reason for your continuing concerns.  It is now well past time for you to relax and move forward without concern.  If you cannot, out of concern regarding how these concerns might impact your life and day-to-day activities, I would suggest working through your concerns (and perhaps guilt) over the basis for them and suggestions as to how to move forward.  There is certainly no reason for continuing concern about HIV (including HIV-2) and no reason for further testing.

I hope this suggestion is helpful and that you will have a happy and rewarding 2017.  EWH

81 months ago
Dr. Hook, 
It has taken a little time to reply to your comment, because I read what you wrote several times and you seem very adamant that I don't have it and that was very reassuring. However, I am still scared and depressed.. The inner right thigh pain (lasted 4 days), which was the worst, then tingling on the rectus femoris (1 day), slight pain on the back of my knees (1 day). All have gone, but I'm scared that muscle pain is a symptom at 6 weeks now? It's resolved now, but I never had such things before. 

In addition, and this is what is strange to me, is that I have never had allergic reactions to food. If you remember I had the small rash that went away after ~13 min on my upper thigh after indian food when I had a slight fever at day 21. Then when I was taking Probioitics 50 Bill. I would have small bumps (one at a time) that would show up on my face or arm and go away within also 10 minutes. Resolved when stopped Probio. Just now I had a small cup of milk and it gave me like a red area above my left wrist, a light red area under skin that went away in 5 minutes. I could always drink milk before although I am just a tiny bit lactose intolerant, but it would just upset my stomach BUT never give me rashes. Could that be from compromised immune sys HIV or stomach still taking time to adjust from antibiotic? although bm are perfect now for 1 week. 2 week since stopped ABX.

Also, had symp at 3 weeks been ARS, then congestion would not have responded to ABX right?

But I am worried about HIV2 since she was from Africa and I heard antibodys take longer to show up. I just want to ask again, since the 6 week test was neg. you confirm again it is conclusive and I can move on? Also will be married soon. Wish I hadn't been so stupid. Happy new year to you too doctor. Best wishes to you in 2017. I will be back with result at 3 month just for my sanity, please don't close thread. 

Edward W. Hook M.D.
81 months ago

Thanks for your careful consideration of my comments.  Please be assured , I am not debating your thigh pain or other symptoms.  What I am however saying is that you did not get HIV (of any kind) of an STI from the exposure that has concerned you.  You are taking 2+2 and coming up with 6.  The symptoms you are associating with this exposure have many, many other causes and "all roads" to not lead to HIV.  You are clearly concerned about this and the resulting focus (hyper-vigilance) is leading you to make incorrect assumptions. 

With respect to HIV-2, even in West Africa, HIV-2 causes only a small proportion of infections.  If you had HIV-2, while it probably would not have been picked up by the P-24 antigen test, antibodies would have been present two weeks after any relevant symptoms and would have shown up in your tests.

I will keep try to keep the thread open.  EWH

80 months ago
Dear Dr. Hook, 
I am going to use my 2nd follow up now. I will be back with the test result at 3 months. I would have tested again already but I learned there is no such confidentiality here as advertised. 
It's great having you with me. Your assurance and the neg test result at 41 days is fantastic, but i'm still scared.
It is now 53 days post exposure at 20 days there were symptoms (you know my case). 
The right inner thigh pain is just about gone. Still on/off slight burning sensation in right rectus femoris muscle. Today after 30 min from eating chocolate candy bar got a burning sensation red rash on top of right leg that itched and had a red bump. Just now ate dinner and got a itchy bump on forehead above right eye. Never in my life had allergies to food, besides milk (upset stomach only/never rashes). Now food allergies ever since indian food rash on day 21 that came and went in 10 mins if you recall when I had fever. Since then I get rashes or a small bump related to food. Could this be the immune system fighting foreign things caused by HIV? And now slight pain on right tricep near armpit. No lymph swelling that I know I'm not a doctor. I don't know if lymph or muscle pain. But I have always been in perfect health. Never a complaint until now. What has really scared me now is "eye floaters" for the past 6 days! A ton of eye floaters from waking up to sleep non-stop. 

-What are your thoughts on the muscle/lymph pain, allergic reactions, eye floaters? Especially eye floaters and allergies omg. 

-Is the ECLIA HIV (1&2 Abs and P24 Ag), Serum 4th Gen less accurate at 41 days then at 28 days? As I heard P24 Ag becomes undetectable around 41 days and then the test is essentially just a 3rd Gen looking for antibodies and antibody may not be at a detectable level. Is 41 day better than 28 or no? Was the test I took conclusive?

-Furthermore, what about the 4th Gen "second window" when there maybe a time when antigen and antibody are both not detectable? And that there is antibody binding to antigen? So not enough whole antibodies. I have heard so many different conclusions about this and even a gov source saying that there is a window. And that has really scared me that maybe my test was false.

Thank you doctor. As I type this I have the allergy bump above my right eye. It will go away soon, but I know it will happen again. I was never like this.

Edward W. Hook M.D.
80 months ago

If you have concerns about confidentiality, please contact the ASHA system administrators.  We believe that your identity is confidential.

My assessment remains the same.  I have already commented on your muscle aches and will not repeat myself.  There are no data to suggest that allergic reactions are a manifestation of HIV infection.  Similarly, as for "floaters", these too are non-specific and are not a typical manifestation of HIV.  Some patients with advanced HIV get retinal infections which manifest themselves as floaters.  This occurs in persons who have had HIV for years, not weeks.  As general advice however, if you are experiencing new floaters or if the frequency is increasing, you should see an ophthalmologist.  while most floaters are benign processes on some occasions they may be a manifestation of a serious ophthalmologic problem. 

No, 4th generation tests do not become less sensitive with the passage of time.  Once a person has HIV (you do not!), their tests remain positive for life.  The information you have "heard" (I presume this means you have been searching for information on the internet.  This is a bad idea as much of the information there is incorrect or presented out of context.  the statement you make about 4th generation tests becoming less accurate after being initially positive if a great example of the sorts of incorrect statements you will find there.)  A 41 day test is conclusive.

See above, a 4th generation test second window is an internet-fueled myth.

Please re-read my earlier responses.  You do not have HIV.  Anxiety is getting the best of you and leading you to mis-use this site.  I would also not be surprised if your anxiety is also negatively affecting your day-to-day function.  My final advice, as this thread will be closed in a few hours is that you do not need more testing, you need to work through your anxieties with a trained counselor or mental health professional.  Feel free to print this thread to take with you if you choose to take my advice.

Please note that the forum does not permit repeated anxiety driven questions by the same users. This will have to be your last one; future new questions on this topic will be deleted without reply and without refund of your posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers; because experience shows that continued answers tends to simply prolong such anxieties, when the real answer normally should be professional counseling; and because such questions have little educational value for other users, one of the forum's main purposes. I trust you will understand,  EWH

80 months ago
Dear Dr. Hook,
I was not insinuating a lack of confidentiality in this forum. It's an excellent forum for education and privacy! I was talking about a lack of confidentiality of test results in the city I am in. As the clinic advertised confidentiality but then sent the blood to a lab which reports results to the authorities and positive results are deported from this country. I learned this when I went to test on day 41 and was given a neg result. I would have tested again but I am waiting until I go back home in a few weeks. 

Really you are the only person I can talk to about this. My symptoms lately prompted me to think about a false negative result and when I did I found conflicting info about a second window period when both antigen and antibody are undetectable. That is why I asked you to clear that up because indeed a second window would cause anxiety in any individual. If you say it is an internet-fueled myth and reiterate (again) that I'm conclusively negative, then tonight you have brightened my spirits and outlook, as you are the expert with years of experience. But I do believe that for the sake of those suffering like me that more research should be done to provide more information on the issue as it is a conflicting issue and the only resolution is a second test at a later time. 

Thank you.