[Question #4139] Tested negative for hiv, still worried.

32 months ago
Dear Dr. Handsfield / DR. Hook,

I am a male and my possible exposure is unorotected vaginal intercourse for several minutes until i realized the condom breakage.
After the incident i experienced the following:

1 week later, i had a flu like ilness that lasted for 5 days without fever

I am sorry if this sounds ridicilous but around 12 days later, i had several mosquito bites. They took very long to heal, the itching went away after 2 weeks and today, 8 weeks later i still have the marks(still healing) Worried if that points to a weakened immune system.

3rd week until now (lessened over time) several itchy skin rashes-never in the face or torso 
intermittent pain in elbows

burning throat

sores in the mouth - difficult to see but hurt for more than 2 weeks. 

Pain in lower back neck -not stiff- started 6.5 weeks after the incident -on and off-

A mild diarreah on and off for a week  now

3,4,5,6 week and 54 day negative ab/ag tests with blood drawn from vein.

I know these results are considered conclusive. However my mum has seronegative arthirithis and i am worried i may have it too. Could kindly give me your opinion on the following:

1 - Are the issues mentioned above similar to hiv symptoms? Can a person start getting hiv symptoms at week 1 and still develop new ones at week 7?
2 - Can seronegative artirithis also mean person is seronegative for hiv? If the antibody production is delayed, how reliable is the p24 part of the test alone?
3 - How logical would it be to ignore hiv-2 in this scenario assuming ab production is impaired the ag part of the test can only pick up hiv 1 antigen?
4 - Regarding the mentioned exposure, is it safe to assume that I am hiv negative? If not, could you please advice on the course of action?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
Welcome to the forum and thanks for your confidence in our services.

Congratulations for having safe sex, i.e. using a condom in a potentially high risk situation. Although it failed this time, your intentions were good. The first thing to recall is that even among the highest risk female sex partners (e.g., sex workers, bar pick-ups, etc), at any point in time, most have no transmissible STD. Second, don't make the mistake of liking every itch and twinge to that particular event. I'm sure you realize that all the "symptoms" you report are normal body sensations or minor occurrences experienced by everybody from time to time. (I'll also point out that around the time of  your sexual exposure, you also shook hands with people, may have been served by a waiter or store clerk with a cold, or might have otherwise been unknowingly exposed to various infectious conditions. There is more rationale to link your symptoms to the sexual event than to all these other, unknown life events.)

More important, and more to the point of your questions, there are no STDs that cause the sorts of symptoms you describe. Maybe a few of the individual ones, but not this cluster of symptoms. And even individually, the odds are near zero any of these would be due to any infection from that event. And for sure these symptoms are not from HIV. Finally, it is impossible to have HIV symptoms with negative HIV tests at the times you had them. Your test results not only show no HIV, they PROVE that HIV is not a possible cause of any of your symptoms.

Finally, there are no medical conditions and no medications that alter the reliability of HIV testing. I'll repeat that, NONE. Even the theoretical ones you probably have read about (e.g. potent chemotherapy) actually have never been shown to actually have such effects, especially with the modern HIV antigen-antibody tests of the sort you had. Even if you also have seronegative arthritis or are destined to get it someday, it has not changed the conclusive nature of your test results -- which indeed were conclusive, especially the 6 week test.

Those comments pretty well cover your specific questions, but to be explicit to assure no misunderstanding:

1) The symptoms don't suggest HIV; and no, acute HIV symptoms do not come in two waves.
2) In the event some condition delayed antibody production, the antigen levels in blood would rise to even higher levels, and the test would be just as likely (even more likely, perhaps) to be positive, and positive earlier.
3) No worries about HIV2, which is not "ignored" by the standard Ag/Ab tests. The Ab component detects virtually all infections by 6 weeks. In any case, HIV2 is vanishingly rare in the US.
4) It is 100% certain you did not acquire HIV during the exposure described. You shouldn't have any more tests of any kind and should move on with your life without worry about it

I hope these comments are hellpful. Best wishes and stay safe!    HHH, MD

32 months ago
Thanks for the answer Dr. Handsfield.

I apologize because of the misunderstanding, what i meant by 'ignore'hiv 2 is that the ag component of the test cannot detect hiv 2 infection. And i was worried about the whole seronegative business, and the possibility of the test missing hiv 2 infection.

I do not reside in the US and the incident occured in eastern europe but still, having a condom failure + my partner being hiv positive + it being hiv 2 + transmission occuring in a single episode of sexual act + me being hiv seronegative therefore the ag component not picking it up... I guess the odds of that happening is the same as being struck by lightining and bitten by a cobra at the same time... twice... So it is time for me to move on.

Once again thank you for your time and guidance Dr. Handsfield. You guys are doing a terrific job helping educate people and offering them some peace of mind in their troubled times.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
No need to apologize for anything.

When a woman has HIV, the average transmission risk for a single episode of unprotected vaginal sex is 1 in 2,500. That's equivalent to unprotected sex with infected women for 7 years before infection is likely. (That's why many spouses of infected persons never become infected -- which perhaps you didn't know.) So the odds are very strongly in your favor -- and I agree with your analogy about lightning and cobra attacks!

Thanks for the thanks!
32 months ago
Hi Dr. Handsfield,

If you could have the patience to answer one last question, no matter how stupid it may be, and perhaps stupid is an understatement:

I know we have already established the chances of me being infected with hiv 2 is extremely low, if not nonexistent, however, I am a single dad and my daughter is 2.5 years old. About 12 days ago i bought her ice cream. She wouldn't eat it so i started eating it, i'd pretty much licked the entire thing. Then she decided she wanted to eat it (kids!). Last night she was having a sweat during sleep although the room temperature was fine and today she had a bit of a fever. She's also had a dry cough for a few days now. She's a child and those could happen for thousands of reasons but if i were going through acute infection, would there be a chance that i could give her... you know.

I am embarrassed to ask even. Probably an extremely stupid question but my daughter means the world to me and i couldn't not ask. Anyways, a final thanks to you and promise you wont hear from me again.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
32 months ago
HIV is never transmitted through shared food, or by contact with saliva. (Kissing carries little or no risk, for example.)  Minor illnesses cause symptoms like your child's all the time. It has nothing to do with the sexual exposure on your mind. You don't have HIV2. Believe it! Time for you to move on.

That concludes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful.