[Question #3303] Overwhelmed with HIV scare

38 months ago
Hello Dr Hook!
Unfortunately I had involved in receptive and insertive oral sex with some man I met on the bus about 1,5 years ago and there was some fingering on his part. He did not ejaculate but I read that precum usually goes unnoticed and very infectious, so I know I was stupid I didnt ask his status but he told me he got intimate with another man one more time before me. My testing history: 
3, 5, 6, 7 months ELISA
11 months VIDAS hiv duo ultra
13 months RNA PCR undetected (<77 copies, artus qiagen)
14 months ELISA
All of them are thank God negative but I'm still acared as I have neck pain and headaches that come and go and change in intensity througout the day. I pushed my neck and felt a couple of lumps but they're not really visible by eye, is this lymphadenopathy?! And I have burning under my armpits whenever I use deodorant roll on. And in this summer I had a burning mouth for about 5 months but currently gone ( I also learnt I have Crohns disease after one year, is there relation). By the way when I apply heat on my neck pain subsides. There's some doctors in my country that says testing up to 5 years is neccessary after hiv risk?! What do you think about this and my situation? Is further testing warranted? This was just one time curious incident but my life has become an utter hell. And in my country you cant donate blooad after MSM risk, why is that if the window is only 3 months? I'm studying medicine and I'm scared I cant become a doctor now?!
Thanks,
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Welcome to the forum. Thanks for your question. As clearly explained in the introductory information and FAQs, users do not select the moderator who responds to their questions. I'll be answering yours. Dr. Hook's and my expertise is identical and our advice never differs significantly.

First, you had an extremely low risk exposure, even if your bus partner had HIV. Oral sex carries little or no risk. Second, your symptoms are not typical for HIV. Third and most important, your various tests prove without doubt that you do not have HIV. And even if the risk had been high or your symptoms typical, the test results always overrule both exposure history and symptoms. You have been seriously overtested. The dotors who advise testing for "up to 5 years" are simply wrong, or you misunderstood.

Many countries' blood donation policies have asked MSM to never donate blood, even after a single sexual exposure. That was the policy until recently in the US as well. That is changing gradually, but sometimes changing bureaucratic policies and procedures is slow. You are absolutely correct that with modern HIV testing methods, people at risk for HIV -- whether MSM, injection drug users, or those with other risks -- can safetly donate blood more than 3 months after the last potential exposure. (In fact, 6 weeks would be entirely safe.)

Finally, there are no restrictions to being a physician because of HIV risk or HIV status. Many physicians have HIV. I doubt there are any such restrictions in your country. In any case, for sure you do not have HIV, so it's not an issue for you.

Finally, it is apparent you have some serious unresolved psychological issues about the sexual experience described. But don't confuse your emotions about a sexual decision you regret with infection risks from the event. They aren't the same. Deal with the former as you need to, perhaps with professional counseling. But do your best to disregard any concerns about HIV or other infection from it.

I hope these comments have been helpful. Best wishes for success in your future medical career.

HHH, MD
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38 months ago
Thank you doctor Handsfield! No no I've been following you and Dr Hook for a long time ( as you might assume) on medhelp and I admire you both but I had to type very quickly before the prof came back to room, hence the typoes and stuff. You really eased my pain on this one, just a couple questions
1)is it normal to palpate several nodes around neck when I push on them, or is it lymphadenopathy? They're not visibly large but still one can feel it by touching.
2) They did the PCR one week after I gave my blood sample because they said they only do it on tuesdays and I went there tuesday afternoon. Is that an acceptable method for this technique? I read that it should be done within 5 days?
3) I saw people online claiming to have seroconverted after 2-3 years despite previous neg tests. Is this possible? If so a p24 or PCR would still catch it no matter how late the antibody response is?
Many thanks,
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Thanks for the kind words.

1) Many people have residual lymph node enlargement from past minor infections etc, usually quite small e.g. pea-sized. If the lump is painless and not enlarging over time, almost certainly it can be safely ignored.

2) The methods for these tests are highly standardized and I would assume any lab in Israel would be using reputable, standard methods. And from a chemical perspective, DNA is highly stable, and most DNA based tests can go long periods (days, weeks. even months) without deterioriation in test performance. A particular test manufacturer may have only studied test performance up to 5 days and hence set such a limit out of conservatism. But most such stipulations in fact make no dfference.

3) Any such online claims are bogus -- either intentional or inadvertant, such as in fact having been infected more recently. I am unaware of any scientifically credible reports of this sort. I would encourage you to stay away from website run by and for people who are infected with HIV or fearful of it. You'll be unlikely to be led astray if you stick with professionally run and managed sites like this one, CDC, ASHA, or academic or public health institutions.
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38 months ago
I appreciate your fast and calming comments Dr Handsfield, it was really good for me to consult here. Have a nice day!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Thanks for the thanks. That's why we're here! ---