[Question #2413] Follow-up to Question #2311

45 months ago
Doctors,

I posted Question #2311 back on June 17th about an encounter had with a MTF trans escort I solicited from the Internet earlier that morning while very intoxicated. Things were very hazy for me, but I do know we had used a condom. I cannot remember all the details, but I am fairly certain and she had reassured me that I had finished and ejaculated into the condom before pulling out. I was concerned about some minor abrasions/cuts I had sustained the day before from vigorous sex with my girlfriend that were not covered by the condom and were likely exposed to her anal secretions.  They didn't bleed but they appeared irritated. 

Despite Dr. Hook's reassurances that his was safe sex and her telling me her last hiv test was back in may and it was negative.  I convinced her to get another test. I just found out this evening that she tested positive for hiv, and I'm very panicked!! On top of that, exactly one week after I noticed  a very enlarged and painful lymph node under my right arm. The pain has gone away but it is still very enflamed. I've noticed several others under my left arm, in my groin and under my jaw. Tomorrow morning is exactly three weeks from the exposure, and I have had no other significant symptoms - no fever, rash, or major sore throat. Could the lymph nodes be a sign of ARS? 

 don't know specifics about her viral load, but assuming she really did test negative in may and is newly infected and this is the acute phase how would that impact the likelihood of me acquiring the disease? 

Also, like I said I am fairly confident the condom didn't fail, but if it did and I was exposed am I at greater risk than normal? 

Would the abrasions on my penis which weren't covered make me more susceptibile if she is in the acute phase with a higher viral load? 

I have continued sex with my girlfriend after my exchange with Dr. Hook but have used a condom. Will she be at risk? 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Welcome back to the forum.

I certainly understand your concern. I'm glad your partner agreed to be tested, but her positive result undoubtedly was alarming. And it seems likely her viral load is high, assuming it is true she had a negative result only 3 months ago and obviously is not yet on treatment. (But more about this below.) Nevertheless, the odds remain in your favor. On scanning your previous discussion with Dr. Hook, you describe no risky exposures other than the condom protected anal sex, for which condoms are highly protective. I agree with Dr. Hook's reassuring comments about your penile abrasions. Even if exposed to an especially high viral load, they did not significantly increase your risk.

As for your possibly inflamed/enlarged lymph nodes, you present a mixed picture. A single sore node, like the swelling in your armpit, is atypical for HIV, and an HIV inflamed node would not be expected to have started to improve so quickly. OTOH, if you indeed have several other enlarged lymph nodes, that is reason for concern. But your description makes it seem you've had to actively look for the swellings you have noticed under your jaw, groin, etc -- and self examination for lymph nodes is notoriously unreliable, especially for people without medical training. The absence of other symptoms of ARS (fever, rash, sore throat) also argues against HIV.

However, you should not take chances with this. You need to see a physician ASAP for HIV testing, preferably an infectious diseases specialist or other physician experienced in HIV/AIDS. In this situation, it would be reasonable to have both a 4th generation (antigen-antibody) test and probably an RNA test. Don't panic:  all things considered, I doubt you have HIV. As for your girlfriend, even in the chance you were infected, she is at little risk if indeed you used condoms consistently and correctly for all sexual contact with her since your possible exposure. If you were infected, she'll still need to be informed and tested -- but you can cross that bridge if and when you come to it, i.e. when your own testing is complete. You needn't say anything to her yet (assuming you get tested in the next few days).

One more consideration:  Your trans partner probably is just as upset by these developments as you might be. My guess is she would continue to be interested in your welfare as well as her own health. You might speak with her again and ask, in a sensitive manner, whether she was telling the truth about being tested and negative in May. If she was untruthful then, i.e. in fact has had HIV a long time, and might even be on treatment, that would be important and reassuring information.

I'm sure some of these comments are not what you wanted to hear. But let me know if anything isn't clear. I look forward to hearing the outcome of your exam and testing. Good luck!

HHH, MD

---
45 months ago
Thanks Dr. Handsfield. I appreciate the candor, but yes I am extremely scared. I will plan to get tested early next week. Will a fourth generation test suffice or would I really need an RNA test? It will be 23 days post exposure on monday. 

Also, she had given me unprotected oral sex. I know this is typically very low risk, but with an extremely high viral load would this be more risky? 

Can you give me estimates on likelihood of contracting hiv given this whole experience? I realize it's a total crap shoot so to say, but I am freaking out! I will plan a follow up post once I get my results. I am beyond scared at this point!!!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
A knowledgeable professional who sees you in person is the one to advise on what tests to have and when. Your question suggests to me you're thinking of going online and doing this on your own. DO NOT DO THAT. See a doctor an get professional advice. I will not advise you further on this aspect.

The oral sex makes no difference. No measurable risk regardless of viral load.

There is no solid basis on which to base a numerical risk. Maybe a 1% chance you have HIV, but that's not much more than an educated guess. I could be much more specific if I had the opportunity to examine you in person. That's one reason why you need to see a doctor.

---
45 months ago
Dr. Handsfield,

I took your advice and not only spoke with my partner but was also tested. Had an RNA and 4th generation duo test completed on Monday, July 10th - 23 days, 7 hours after exposure. 

First, as for my partner - she admitted that not only had she not been tested in May, but also hadn't been tested at all previously so was unaware. So it may not have been an acute infection. As for my results - the fourth generation test came back non-reactive. 


The RNA results I'm a little confused by. Here's what the report reads:


The infectious disease doctor has told me that this is normal/negative, but if that was the case wouldn't the read out state "non-reactive" as is the case with my fourth generation results?

Also, I have read from previous posts that 28 day results of a duo test are conclusive but in your experience have you seen someone test negative on a duo and RNA test at three weeks or a few days passed three weeks and then seroconvert later? How worried should I be? Still fairly worried by this, please help clarify! Thank you for all your help! 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
45 months ago
Thanks for the info about your partner. I agree that it is reassuring, because it is likely she has been infected a long time and thus may not have a particularly high viral load. In any case, the level of risk at the time of the exposure now has little importance:  your negative test result at 23 days is highly reassuring. Regardless of the risk at the time, the result is 90% conclusive that you were not infected. The negative RNA test also confirms that result -- in fact, having both negative tests probably raises their collective reliability to the 95-98% range. The RNA test is not reported by the lab as "negative" or "nonreactive". It counts the number of virus particles in the blood, but the test is unable to detect counts <50/ml. So technically, a negative result could occur in someone with a very low viral load. That said, almost everyone infected in the previous few weeks would have a count of thousands or even millions. So the negative RNA test is very strong evidence you aren't infected, regardless of the wording used by the lab. (I'm confident your ID doctor will confirm these comments.)

Current thinking is that the duo test is about 98% reliable by 4 weeks, and in the past couple of months we have been advising 6 weeks as the time for 100% conclusive results. So have a final test at that time. I have never seen or heard of anyone with negative test results at the times you had them who later proved to have HIV. There is almost no chance of it, so stay mellow as you wait for final test results.

Please note the forum does not permit repeated questions on the same topic or exposure. This being your third question about this exposure and your concerns about HIV, it will have to be your last; future new questions about this exposure, testing, and your fears about HIV or other STDs will be deleted without reply and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, experience shows that continued answers tend to prolong users' anxieties rather than reducing them. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thank you for your understanding.

---