I'm not sure what you are "confused about". Your questions are straightforward and don't reveal any obvious misunderstandings about HIV and the standard HIV tests. Before going to your specific questions, I'll answer the question as posed in the title you chose for your question:  "Bad choices, any hope?" I assume you mean "Is there any hope I don't have HIV", right. Indeed, there is not only hope -- there is virtually no chance you caught HIV from these events. You had only safe sex! Oral sex is safe sex; there has never been a single case of proved HIV transmission mouth to penis. For vaginal sex, condoms are highly protective, especially with the very brief exposures you describe. Finally, it is likely your partner don't have HIV. Even if they do, the average chance of HIV transmission by vaginal sex, to a male partner, is around 1 in every 2,500 exposures -- and that's without a condom. In addition, your symptoms are NOT typical or even slightly suggestive of HIV. 

Now to your specific questions:

1,2) All people who are sexually active outside a mutually committed monogamous relationship should be tested from time to time (e.g. once a year) for HIV and other STDs, even if all sex was apparently safe. On that basis, testing now makes sense if you haven't been tested recently. You have already been tested and negative for HIV. For a few months, there was concern that the Alere Determine test wasn't quite as good as other 4th generation tests. However, the company recently modified the test, and it now performs just as any 4th generation test -- i.e. conclusive results usually by 4 weeks and always by 6 weeks after the last possible exposure.

3) With no symptoms of penile discharge, painful urination, or genital area sores, the chance you have any STD is very low. However, as noted above, all people at potential risk should be tested. So if you haven't had STD testing in the past year, I would recommend a urine test for gonorrhea and chlamydia and a blood test for syphilis. You can expect negative results, but better safe than sorry!

4) For sure you don't have HIV, and probably no STDs, so no problem in getting back with your ex. However, she probably would appreciate it if you have the STD tests just mentioned, in addition to your already negative HIV tests.

5) Abdominal pain and diarrhea are almost never the main symptoms of a new HIV infection, and your test results show you don't have HIV. Most likely you've had a garden variety gastroenteritis virus. But see a doctor if your symptoms continue.

6) Rapid oral test (OraSure):  3 months. Rapid third generation (antibody-only) blood tests 6-8 weeks, even though official advice often says 3 months. Rapid duo (4th gen) tests, like Determine, 4-6 weeks as noted in ansser (1,2).

7) [no question]

8) The negative test was not only a week after onset of symptoms, but apparently it was 4+ weeks since your last sexual exposure (June 30). The negative result is nearly conclusive, especially since your exposures were such low risk for HIV, and the symptoms aren't typical. However, if you want an absolutely 100% conclusive result, have another duo test at the end of next week, i.e. 6 weeks after June 30.

9) A single dose of fluconazole wouldn't have any effect on diagnosing thrush. Anyway, thrush isn't an important sign of new HIV infection -- even if you had thrush, it would not raise my concern you have HIV. More important, white coated tongue isn't the same as thrush, and is common in virtually any viral illness and other minor health conditions. So you probably didn't have thrush, just as your doctors said.

Bottom lines:  these were extremely low risk exposures for HIV, your symptoms are not those of ARS, and your test results so far are nearly 100% conclusive. You really needn't be worried about it. Have the additional STD tests for further reassurance, but you can expect negative results.

I hope this infomation is useful. Best wishes and stay safe--   HHH, MD

I will get the STD testing you recommended in two weeks when my new insurance goes into affect.  I will also get an additional HIV test (alere determine) at the end of this week.

Update:

I did get back together with my long time girlfriend.  

My stomach is still bothering me.   It has been about 12 days.  I still have abdominal pain and either constipation or diarrehea.  Today I had a solid bowel movement when i awoke, and then diarrehea in the early afternoon.  I am just eating light and keeping hydrated.

Mouth problems have resolved.

Questions:

1. Can I wait a few more days regarding my stomach issues before I see a doctor?  (I find doctors dont do much for stomach issues)  If I do see a doctor what could they do for me?  Can stomach issues last this long?

2.  Do you still believe these stomach issues arent ARS?

3.  One symptom I didnt mention in my initial post  is last week when I grinded my top and bottom teeth together it felt like there was a little grit  / sand between them.  Does that mean anything to you regarding ARS?  I read it could be plaque.

4.  What is the hiv risk of fingering a girl with a cuticle tear (like I did to those two massage gals).  The nicks were slightly raw.   The next day i poked at them and made one slightly bleed.  I dont believe they were bleeding at the time of insertion.

Thank you for your time.  Ill report back after my next series of tests.

Thanks for clarifying the likely reasons for an extra level of anxiety over these events. But of course that doesn't change my opinions or advice -- except to point out that you show lots of evidence of unresolved issues, and it would seem you would benefit from counseling.

3) This is called bruxism, which almost always is related to anxiety or other psychological issues, or sometimes because of some sort of dental problem. If this has anything to do with the sexual exposure, it is because of your fears and anxieties over a sexual decision you regret, not from any infection. Google bruxism for lots of information.

4) Nobody has ever been known to catch HIV by fingering, and of course there have been billions of fingering episodes with infected partners, and mllions of those must have occurred with cuticle problems, cuts on the fingers, etc. But no HIV transmission. So no risk from this.

Threads are closed after two follow-up comments and replies. I'll be happy to advise you one more time if you would like to post your future test results, but no more questions or comments until then -- OK?

Updates:

-My stomach still has been hurting and I have on / off diarrhea and constipation.  It has been going on for 16 days.  The fever / aches that started with the stomach issues  only lasted two days.

-I had a white little sore under my tongue yesterday which I scraped off.

-I had my 6 week rapid alere determine rapid duo completed today.  It was negative.

1. Since todays hiv test was completed 17 days since my stomach symptoms began, does this prove they are not due to ARS?

2. I asked the hiv testing counselor if he knew anything about the performance problems that were reported about the alere determine.  He said no.  Am I done testing?

3. Can I wait a little longer before going to the doctor about my stomach issues?  I am just hoping they pass.

4.  I looked up what bruxism is.   I fully understand it.    I was more concerned about it feeling like there was sand or grit between my teeth (sometimes) when I grind my teeth together.  Should I be concerned about this?

5.  Do I need hep c testing from the exposures I explained in my initial question?

6.  After STD testing can I be sexually active with my long-term partner whom I recently reconciled with?

7.  Even if a person has say a high risk like having unprotected vaginal sex with a women whom is hiv infected, is a 6 week rapid duo or a 6-8 week antibody text adequate?

8.  Do ARS symptoms come and go all at once?  IE: I got a fever /aches  and diarrhea.  The fever and aches lasted two days but the stomach issues continue.

 It is sad to say but in the United States it does not seem like GP's and Internists(at least the ones I have seen) know that much about HIV Prevention.  Thank you so much for your time and the information you provided!!!  Hopefully I can calm down a bit.

K

Thanks!!!

Thanks.

The additional symptoms don't concern me. HIV doesn't cause such symptoms.

2) The problems with Determine were not widely publicized or well known. Most HIV test counselors probably were unaware of it. In any case, it is no longer a problem.

3) I have no further comments about your symptoms other than what I said in my original reply.

4) This is a peculiar sounding symptom and I don't know what to make of it. It's not HIV or any other STD.

5) Hepatitis C has been oversold as an STD. The only proved, common sexual transmission scenario is men having potentially traumatic (bloody) rectal sex with one another. It is rarely if ever transmitted heterosexually, and for sure is not known to be transmitted by oral sex, especially mouth to penis. You don't need testing on account of the exposure you have described.

6) There was no good reason to stop having sex with your regular partner. You certainly can and should resume your normal sex life, without waiting for any more test results.

7) Yes, the duo test is conclusive at 6 weeks regardless of the type of exposure.

8) I'm through discussing ARS symptoms with you. You already have 100% conclusive evidence you don't have HIV or ARS from the exposure described. Believe it and move on, regardless of what symptoms you have now or any time in the future.

9) No and no. You were not at risk for HIV and did not need testing for it.

I agree with your comments about the knowledge level of many physicians about HIV prevention. Most know the basics (transmitted by sex, shared drug injection equipment) but many do not understand the details.

That concludes the two follow-up questions (actually, you've had a lot more than that!) included with each question, and so concludes this thread. Please don't be tempted to return with any more questions about this exposure and your symptoms. Repeated questions are discouraged, and you can be sure there are no other circumstances or symptoms that will come to mind that would change our opinions or advice.

So really, move on without worry. I understand the impacts that PTSD, alcohol addiction, and other issues can have when people have sexual exposures that concern them. But trust me, there is no chance you caught HIV. Separate the scientific evicence and reasoned reassurances you have had from your emotional responses to a sexual decision you regret. They aren't the same.

Best wishes and stay safe, as apparently you have done to date. I hope the discussion has been helpful.