Hello Doctors,

Thank you for the service and expertise you provide. I recently had an exposure that I am concerned about. I am a female and had protected intercourse with an uncircumcised black male in New Orleans. There was also unprotected oral, male to female. I did not thoroughly examine the condom post act to ensure it was intact. 

I was tested at 21 days post exposure for chlamidya gonorrhea and syphilis which were negative. Incidentally I tested positive for a yeast infection which had also appeared in my mouth in the form of a red spot on the top surface of my tongue. At 28 days post exposure, I again was tested for syphilis and HIV 1/2 Ag/Ab Combo test both of which were negative. 

I had 2 small bumps appear on my labia about 14 days post exposure both of which resolved in approximately 10 days time without ulcerating. The doctor I saw at 21 days did not think the lesions looked suspicious for syphilis. No culture was performed. 

I now have a sore throat, and white patches where my tonsils should be. I've been nauseous on and off and my lymph nodes have been swollen for 3 days. 

1. Should I rely on the 28 day HIV 1/2 Ag/Ab Combo test as definitive given the high prevalence in the area/demographic?

2. When should I take another syphilis test?

3. Could this be acute HIV/ARS?

Thank you for your time. 

Welcome to our forum. I'll be glad to comment.  The bottom line on what I'm about to say is that you are doing things right, both by using a condom and by testing as you have done and at this time you should be confident that you did not get syphilis, HIV or any other STI from the encounter you have described.  Let me now elaborate a bit. 

Fist, condoms remain the best method for preventing HIV and other STIs when having sex with a partner whose infection status is unknown.  They are not perfect but they are highly effective.  condoms break about 1-1.5% of the time they are used and when they do, it is obvious that they have broken because they break wide open leaving no doubt about the breakage.  Thus, from the sounds of things you should believe that your condom did not break and it protected you from STIs.

Second.  General risk.  You do not say much about your partner but most people do not have STIs of any sort and when they do, even with unprotected sex, most exposures do not result in transmission of infection.  Thus, odds are that your partner did not have an STI or, If he did, transmit it to you.

Third- specific STIs:

a.  Syphilis.  Syphilis is an uncommon STI.  Last year in our nation of over 300,000,000 people about 25,000 got syphilis and most of these infections (about 75%) occurred in men who had sex with other men, not in heterosexual men or women.  Further, your negative syphilis test at 28 days is further proof that you did not get syphilis. I would not worry further about syphilis.  I see no reason for further testing.  If the lesions you noted about 14 days after your exposure were syphilis, your 28 blood test would have been positive.

b.  HIV.  Your 28 day HIV test is definitive.  No need for further testing. This proves you did not get HIV.

c.  Gonorrhea and chlamydia. These are much more common than either syphilis of HIV and your negative tests once again prove that you were not infection. 

Fourth.  Your current symptoms. You are now beyond the time when the ARS occurs and have negative tests.  It is most likely that your sore throat is just the sort of thing most of us get from time to time through our activities of daily living.  I would not worry about HIV or that your sore throat is in any way related to your sexual encounter a month ago.  The white spots you describe are common with every day viral (non-STI, non-HIV) sore throats.

I hope my comments are helpful.  At this time, between your safe sex practices and your testing, you can be confident that you did not get an STI of any sort form the exposure you describe.  I see no reason for concern and no reason for further testing.  EWH