Dear Drs, 4 weeks ago I had a low risk exposure where I fingered a stripper for several minutes. I didn’t have any open sores on my fingers, but often bite my fingertips/have hang nails. Out of fear and anxiety, I tested (negative) for all STIs 11 days after the exposure. I also tested negative on an HIV RNA at 14 days. However, due to several flu-like symptoms and increased flush/rash-like appearances, my physician was still a little weary and my anxiety grew. I did another HIV 4th gen at day 26 that is negative. Further, no HSV type lesions have developed in the 4 weeks (whitlow was another fear of mine). Are these tests conclusive? I know the standard is 28 days but is the combo of HIV RNA at 14 and duo at 26 days for this low risk exposure enough? Thanks for your guidance. 

Welcome back, but sorry you found it necessary. As Dr. Hook informed you, there was absolutely no chance you could have caught HIV from the exposure described. The combination of HIV RNA at 14 days and duo test at 26 days indeed is conclusive proof. It's also proof something else is causing your symptoms:  it is not possible to have HIV symptoms with a negative blood test.---

Thank you for answering, Dr. Hook. I do want to add that after fingering, I did masturbate myself after, about 10-20 seconds after. I've read that genital fluids during this interaction pose a no/low threat. However, since this exposure (32+ days), I have developed 4-5 ulcerations throughout my mouth and I feel a random/intermittent pain on my penis and an urge to urinate (my UA was negative, but abx cleared the urgency, but not the pain). I haven't developed any lesions on my fingers or my genitals. I feel generally lethargic, have an occasional sore throat, and noticed that my skin is often flush/red. Would you suggest another blood test for HIV and HSV now that its post-28 days? Am I just overthinking it all/anxious? I think I know the answer, but would like to hear your opinion.

Dr. Handsfield* typo before

4+ weeks is too long for onset of symptoms of a new HSV infection; and although HIV can cause oral ulcers, your negative HIV test proves HIV is not the cause. Same for your lethargy and other symptoms:  the HIV test results overrule all symptoms, if testing is done sufficiently long after exposure. As for HSV, if the oral ulcers continue, you should be examined professionally and have a PCR test for HSV. However, I really don't think herpes or any other STD is a serious concern at this point.---

Thanks, Dr. H. 

1) Initial herpes lesions can be widespread, not limited to the immediate site of exposure -- anywhere in the general area is consistent. However, herpetic throat sores typically are incredibly painful, and would typically include fever and inflamed lymph nodes in the neck, all starting within a few days of exposure. Almost certainly you have a less serious viral infection, unrelated to the sexual exposure.  But if you want to seriously address herpes (mostly for reassurance), you should see a doctor immediately, so the throat sores can be swabbed to test directly for the virus. Blood testing usually is less secure in either diagnosing or excluding a new HSV infection, especially oral/HSV1. But if you turn out to have oral herpes, so what? So do half of all Americans, and it isn't considered an STD -- no matter how it might have been acquired. That will have to conclude this thread. If you remain concerned about herpes, you are free to post a new question for new discussion with Terri Warren.---