[Question #352] HIV Risk / Symptoms

95 months ago
Dear Doctor,
I write you because I am insanely worried since three weeks.
6 weeks ago I had a brief non-protected insertive vaginal intercourse with a young girl (23 yo) of unknown status. I am uncircumcised.
19 days after that I started feeling important chills (as if a fever was coming), some muscle ache on my legs and some night sweats. No fever, no rush.
After 5 days I went to see the doctor, also because I felt some discomfort urinating. No discharges, but some small traces of blood were found in the urine test, so she prescribed me a STD anti-biotic (1 injection and 4 pills in 1 dose) for precaution.
The discomfort disappeared. But after 18 days since the beginning of symptoms, the chills are still there with still some muscle ache. Now accompanied by a light sore throat and a general feeling of weakness.
I went to see the doctor again. He performed urine test (they are now fine) and blood work (WBC in the norm, just slightly higher Neut% and slightly lower Lymph%, but absolute values are in the norm). He confirmed: no fever, no rash, everything apparently fine, just a light sore throat. He says: nothing to worry, but for a high blood pressure.
I told him about my anxiety about ARS and he said he does not think I have to worry about it. I insisted. He proposed me a test to calm me, but I was too scared to do it.
I am terribly worried, cannot sleep at night and can only think that I have been having chills and muscle aches for almost three weeks (19 days to be precise), and now some cough and stuffy nose.
I cannot think about nothing else than ARS.
Please, give me your point of view.
Thank you very much!
H. Hunter Handsfield, MD
95 months ago
Welcome to the forum and thanks for your question. I can help.

It is exceedingly unlikely you have HIV, for several reasons. 1) The frequency of HIV in 23 yo sexually active women in the US is extremely low. No matter how sexually active she was, probably she chance your partner had HIV was under 1 in a thousand. Second, if she were infected, the transmission risk for a single episode of unprotected vaginal sex is no higher than 1 in a thousand, probably closer to 1 in 2,000. So even before we consider symptoms and other factors, the odds you were infected were 0.001 x 0.001 - 0.000001. That's one in a million.

Third, your sypmtoms don't fit ARS. Onset was too late (normally 7-10 days after exposure), and the symptoms themselves aren't typical. For example, acute HIV doesn't cause cough or nasal congestion; and absence of fever, by itself, is evidence against HIV as the cause of your muscle aches etc. You have had some sort of minor, garden variety viral infection -- as your doctor probably told you.

So I agree with your doctor. It was a mistake to decline his advice to be tested for HIV. Frankly, I have no patience with refusing testing for a serious conditions (whether HIV test, colonoscopy as cancer check, women refusing mammograms, and so on) because of fear of the result. Intellectually you know it's nonsense:  it isn't the test that gives someone HIV. You have it or you don't, and if you do, you have a responsibility to know and take care of it. Most important, research shows that when people decline testing for fear of the results, anxiety and stress decline after testing is finally done, even if the result is the feared one. In other words, fear of the result is more stressful than having an answer, even if the answer is the "wrong" one.

So give your doctor a call and arrange for the HIV test. Do not have the oral fluids home self test; that's the one HIV test that takes up to 3 months to be conclusive. Tell your doc you want a lab-based blood test, preferably the "4th generation" or "duo" test (for HIV antibody plus p24 antigen), which is conclusive any time 4 weeks or more after exposure.

I'll be happy to comment further if you would like to return and let me know the test result, but I won't have anything more to say until then. There's nothing you can add that would modify my opinion that you don't have it or my advice that you be tested. But stay mellow in the meantime. You can definitely expect a negative result.

Best wishes--  HHH, MD

94 months ago
Thank you very much Doctor Handsfield,
Your answer is reassuring and helping me dealing with my terrible anxiety.
As you recommended, I went today for the HIV test (these days I'm not in my hometown so I had to go to the hospital: results only next Saturday, still 3 days to wait).
I cannot really relax in the meantime: it is now almost 5 weeks since the beginning of the symptoms (almost 8 weeks since the risk) and they are still there (body aches, fatigue, dizziness, sore throat, stiff neck, night sweats, cough). But so far I have not experienced fever, have not experienced rash.
I could really use some words from you to smooth the next 3 days of wait for the test results.
Thank you!
H. Hunter Handsfield, MD
94 months ago
Thanks for the follow-up comments. It's very good to hear you were tested. You still can expect a negative result; it remains extremely unlikely that your symptoms are due to HIV. Some of them likely are the physical manifestations of anxiety about it. Try to stay mellow until Saturday. Happy new year.

94 months ago
Dear Doctor Handsfield,
I just collected the result: negative!
The test is a 4th generation HIV1-2 test Ab+Agp24, that I understand from your posts, is conclusive after 4 weeks.
Can I move on?
Thank you very much for your great help!
H. Hunter Handsfield, MD
94 months ago
Congratulations -- of course I'm not surprised, even if you are! Anyway, the result is conclusive and indeed you can move on without giving it another thought.

Thanks for the thanks. I'm happy to have hellped. Happy new year.