[Question #3065] Possibly HIV/Unprotected Oral

40 months ago
Hello Dr’s,

On Oct 3rd I had a possible exposure with a trans escort. We only had unprotected oral sex. I sucked her for a bout two minutes(no ejaculation or didn’t taste any pre cum). She sucked me and I ejaculated on her chest.

Two days following the events I developed what turned out to be Henoch-Schönlein Purpura on my legs. This lasted about 1 1/2 months and has since subsided.  About two weeks after I got really tired one day and napped for about two hours(very unlike me). After that throughout the the following weeks I developed loss of appetite, headaches, muscle aches, weight loss, loose stools, sever night sweats and a sore throat that hasn’t gone away to date. I also developed tinea versicolor on my leg. I’ve also been urinating a lot more frequently. And have also been getting sharp pains in my stomach region; more in the upper left abdominal. 

I’ve tested numerous times. They are as follows:

20 day Nat test - Neg
30 day duo -Neg
30 day Pcr DNA - Neg
49 day duo - Neg
50 day Nat - Neg
65 day - oraquick/swab - Neg

I’m pretty certain I caught it and it hasn’t showed up yet. I’m about to test again at 10 weeks with a duo and I convinced my PCP to order a CD4 count to see where my counts fall. 

Do you think my results will change? Does the duo and Nat tests pick up Non clad B viruses? Could I be a rare case where I need to test out to 6 months and Beyond? 

There’s definitely something viral going on inside me because somedays it takes me a while to get out of bed and it feels like a truck ran over me. 
Edward W. Hook M.D.
Edward W. Hook M.D.
40 months ago
Welcome to the Forum.  I'll try to help.  As I suspect you know, Henloch-Scholein Purpura (HSP) is a rare vasculitis associated with complexes formed of antigens and antibodies.  HSP is rare overall, the causes are varied and unclear, and while there have been persons reported with HSP who have HIV, it has not been reported as part of the ARS or in association with newly acquired HIV.  Further, your HSP apparently had its onset before a person would be expected to have developed antibodies to HIV.  My suspicion is that your HSP is unrelated to the sexual encounter you describe which, by all criteria was low risk for acquiring HIV.  Further, HSP is associated more with high, rather than low antibody levels would make your tests for HIV reliable. The caveat to this is that if you received steroids or other immunosuppressive therapy for your HSP, the therapy might have modified your antibody response. Nonetheless, in such a case, I would anticipate that the antigen test in your multiple combination HIV antigen/antibody tests would have been strongly positive, as would have your NAAT test for HIV RNA. 

Thus, based on the information provided above (I hope I have expressed it clearly, if there are questions, please use your follow-up questions to seek clarification of any part of this that is confusing), I would have total confidence in your test results.  I see no need for additional testing related to the exposure you have described. 

Your persistent symptoms are more likely to be residual to your HSP than to be due to HIV or any other STI

I hope these comments are helpful.  Take care.  EWH
---
40 months ago
Thanks for the response. 

My PCP prescribed methylprednisone on day 21. When you say “modified” what effect would that have on my testing?

Also, what about non clade B viruses? Would the duo and Nat test pick this up? 
Edward W. Hook M.D.
Edward W. Hook M.D.
40 months ago
As I noted, methylprednisolone might slow or impair development of antibodies however, if you had HIV and have not been taking methylprednisolone for several weeks antibodies would be formed.  Further, as I said, your HIV NAAT and antigen tests would in no way be affected by methylprednisolone use. 

The NAAT would pick up non Clade B HIV.

I urge you to believe your tests.  EWH
---
40 months ago
Hello Dr.,

Back again with a new fear. One other question; If i was exposed to the virus and had infected my GF during the acute phase and then she passed the virus back to me. What type of affect would that have on me? Dual infection? Co-infection?  Would that delay an antibody test? 

I took a 89 day insti test that came back negative. Any reason to retest if i'm still experiencing enlarged spleen, frequent urination, headaches, muscle & joint aches, night sweats, kidney pain, shortness of breath, sever fatigue, loose stool symptoms? I have to sleep 9 hours in order to get a quality day in. 


Edward W. Hook M.D.
Edward W. Hook M.D.
40 months ago
When persons acquire STIs and pass them on to partners, then clear the infection (typically with treatment for bacterial STIs) but are re-infected by a partner whom they infected earlier we refer to this scenario as "ping-pong" infections because of the way they pass back and forth.  This phenomenon does not occur with HIV or other chronic viral STIs.  Thus the scenario you describe is not scientifically plausible and has not reported.  There is no reason for concern that your testing was inaccurate.

Your 89 day INSTI test is conclusive.  I urge you to believe it. The symptoms you describe are most likely due to some other process.  I would urge you to work with your doctor to sort out the origin of these symptoms. Your tests show that it is not HIV.

I hope my comments have been helpful.  As per Forum guidelines, this thread will be closed in a few hours.  Take care. EWH
---
39 months ago
HelloDr.,

I read the info in this article below. Is this true. 

" however, repeated re‐exposure is common and that can seemingly prolong the seroconversion period."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563905/




Edward W. Hook M.D.
Edward W. Hook M.D.
39 months ago
No.  No change in my assessment or advice.

End of thread.  EWH
---