[Question #3022] HIV risk and testing - Gay kissing with blood and chipped tooth.

40 months ago
Dear doctors 

On the 3rd of November I had an encounter with a gay man whose status I dont know and we ended up kissing deeply and I tasted some blood, at the time It didn't strike me but I realized later that I have a chipped molar with the nerves exposed. I am now very worried that I might have contracted HIV from him. 

I noticed some of the ARS symptoms like swollen lymph nodes specially in the groin and shoulder and some sore throat with some tingling in legs etc which are all supposedly potential HIV ARS symptoms. please help.

I took the HIV RNA TMA test on the 10th day post exposure and the HIV 4th gen duo test on the 17th day post exposure on advice from planned parenthood and they both came back negative. 

How worried should i be based on this exposure and should the above testing provide me any assurance whatsoever?

It is currently the 25th day post exposure. How much additional testing  would you suggest.

Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Welcome to the forum. Thanks for your question.

First, kissing does not transmit HIV, regardless of possibly tasting blood. Second, your symptoms are not suggestive of ARS, which does not cause localized lymph node enlargements:  they would be enlarged and inflamed all over the body, not just in the groin and shoulder. Thirst and probably most important, when ARS symptoms have been present more than a few days, the blood test is always positive. Therefore, your negative test results, especially the one at 17 days, shows that your symptoms are not due to ARS. If they persist and or continue to concern you, see a doctor to help figure out their non-HIV cause. I'm confident they are not from any infection from the exposure described.

"How worried should i be based on this exposure and should the above testing provide me any assurance whatsoever?" You should not be worried at all, and the negative test results are highly reassuring.

"How much additional testing  would you suggest?" I would have recommended against any testing at all. But since you have started down that path, it would make sense to have a final antigen-antibody HIV blood test at 4 weeks and perhaps once again 6 weeks after the event. You can expect these tests to also be negative.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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40 months ago
Thanks doctor, but there are a couple of things I missed in my intial question.

1. I started noticing these symptoms 20 days post exposure after I took both of the blood tests on the 10th and 17th days, something i missed in my earlier message.

2. Symptom wise - I do feel like lymph nodes in several places other than armits and groin, especially in the calf where it actually hurts when i apply pressure and also in the thighs, I also have some slight diarrhea, extreme anxiety and some very slight sore throat, however no fever so far.

So given this 

1. I wonder if I should retake the HIV duo test tomorrow ( that would be the 25th day post exposure - 24 days and 10 hours).

2. How conclusive are these tests that I have already taken

     a. RNA TMA test (labcorp) at 9 days and 12 hours.
     b. HIV 4th gen duo test at 17 days and 12 hours.

3. You mentioned that kissing does not transmit HIV but is this true even in my case where there was blood and i have a half chipped molar with with nerves and blood vessels exposed?



40 months ago
I want to add that I also noticed a peripheral neuropathy in the list of symptoms and this has really got me freaked out since most sites mention that this is a an ARS symptom. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
20 days is too long for onset of ARS. Conceivably it could take that long, but usually 7-15 days.

1. A duo test at 25 days would be at least 95% reliable. But why not wait to 28 days and get 99%?

2. RNA at 9 days probalby 50%, duo at 17 days around 60-70%. (No point in narrowing it down to hours. Even for whole days, the data on results between about 7 and 25 days is approximate, not precise.)

3. Look at it this way:  Billions and billions of kisses between HIV infected and uninfected persons since the worldwide HIV/AIDS epidemic was recognized 30 years ago. Bleeding in the mouth is pretty common, so there had to have been millions or even billions of kisses that involved slight blood exposure. And no known cases of HIV by kissing.

Neuropathy is almost always a symptom of overt AIDS, i.e. in people infected for several years and with lots of other AIDS symptoms. It's very rare with ARS. And anyway, if you'll concentrate on my initial reply, I said that the HIV duo tests are ALWAYS positive in people with symptoms of HIV or ARS.

I'll leave this thread open for one more cycle of comment and reply, then it will be closed. I suggest waiting until you have your next test result, which I recommend you delay until 4 weeks after the kissing event you are concerned about. In the meantime, stay mellow. I am confidenet you don't have HIV and that any and all future tests you do will remain negative.

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40 months ago
1. Doctor just so I understand you clearly about the ars and duo test results. In my case I only saw the ars symptoms on the 20th day but took the duo test on the 17th day, do u mean that if the symptoms I showed on the 20th day were ars symptoms the duo test from the 17th would have come back positive? 

2. I am also worried about this tingling feeling the feet which now cover my thighs as well and have some unsteadiness while walking, do  I need to be worried, should I admit myself?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
1) yes, that's what I mean. There is no possibility your symptoms are caused by HIV.

2) This is not a worrisome symptom. Most likely it's just anxiety magnifying trivial symptoms or normal body sensations.

Trust me on this:  You are NOT at risk for HIV and there is NO chance you have it. For additional reassurance, feel free to have another duo test at 4-6 weeks. It will also be negative.

That completes the two follow-up comments and replies included with each question, and so concludes this thread. Best wishes and stay safe.
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