[Question #4170] nothing new

30 months ago
Dear Doctors,I am sorry for taking your time, because I have nothing to say that hasn't been asked before. I had a very low risk exposure, protected insertive vaginal sex and unprotected receptive oral sex with a CSW. From your previous answers, I know most single exposures don't lead to infection even when one partner is known to have hiv. I am not on chemo or pep, I did not have organ transplant, and overall I am a healthy adult. What should further ease my worries is I tested negative with ab/ag tests administered at 2 different labs 20,22, 28, 34, 41. and 53 days post exposure. The last test was mainly for peace of mind, as is this post. I have a few questions that I hope you will kindly comment on:

1 - Can hiv symptoms span over a period of 8 weeks? i.e. get the first symptom 1 week after, a different one at week 2, another at week 4, etc... up to week 8?

2 - If the first symptom shows at week 1, can one still be experiencing symptoms (not necessarily the same one from first week) at week 9?

3 - After the 4 week negative test, my partner and I resumed unprotected sex. Now she has skin rashes similar to mine. She also quite often has an abdominal pain which most of the time is followed by diarrhea. Could these 2 be the only symptoms of an infection?

4 - Two things that bother me the most are skin rashes and mouth ulcers (or maybe trashes). Rashes started around 3rd or 4th week and to this day they continue. They disappear in a day or two but then I get new ones. Mouth ulcers (or trashes) started around week 4. Lasted 2 weeks. 1 week break in between and started again and I still have them. (A few and only in the upper half of my mouth) Would that raise any concern?

5 - Even if my exposure was an extremely high one, after these test results, would i it possible to completely rule out an hiv infection? Is there anything that I am missing?

6 - Is 4th gen an umbrella term that is used for any and all tests that work with ab/ag?

Thanks a million in advance.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
30 months ago
Welcome to the forum.

I agree with your self assessment. This was an exceedingly low risk exposure -- basically zero risk for all practical purposes. Your test results prove 100% that you did not catch HIV; and because HIV test results overrule any and all other considerations (how high the risk was at the time, symptoms, medications being taken, other health problems, or anything else you can think of), those negative results predict the replies to your specific questions.

1) Symptoms of acute HIV come on pretty much at once (or within a few days of each other) around 10-15 days after exposure. But this doesn't matter. The nature and duration of your symptoms are irrelevant. The test results prove you don't have HIV.

2) No, very unlikely.

3) HIV doesn't cause such symptoms.

4) All symptoms of HIV are nonspecific, meaning the same symptoms occur with many other conditions. There are many, many causes of all the symptoms you report, most of them far more common than HIV. And once again, your blood test results prove HIV is not the cause. There are NO exceptions!

5) Yes. See above.

6) Most experts are moving away from the "generation" terminology for HIV blood tests. But the answer is that AgAb tests and 4th generation (as well as "duo" and "combo") are synonyms. They mean exactly the same thing, i.e. the current crop of antigen-antibody combination tests.

I hope these answers give you the peace of mind you seek. Let me know if anything isn't clear.

HHH, MD
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29 months ago
Hello Dr. Handsfield / Dr. Hook,

Thank you very much for your answer. I did have a last test at 9 weeks, just before i left home to work overseas, negative of course, and i have no concern about hiv. I just wanted to ask you a last question on behalf of a friend before the thread closes (and i hope that is not a violation of forum rules).

Could the infamous 'flu like symptoms' start as early as 5 days after a possible exposure and is it safe to assume that either the ab or ag component of a blood test will always turn up positive if a person's symptoms are indeed caused by acute hiv infection (regardless of how soon they start)?

Once again a sincere thank you to all three of you for this forum (and everyone else involved in the making and maintaining of it). It is an invaluable source of most accurate and up-to-date information on std's on the internet. I have learned so much from reading here about safe sex and the risks involved and how to avoid them. Thank you so much.

A final note for the admins: before i found this forum, i did a lot of research about hiv on the internet, googled so many key words but your forum never showed up in search results. Most of the information i found was from different websites and some of it quite outdated too. I was only able to find this forum when i googled Dr. Handsfield's name. I think it may be possible to reach more people if you could somehow make it show more often on google search results with certain key words.
29 months ago
Ps. Dear admins, if you review the questions before making them public, please feel free to delete the last paragraph about my google search suggestion.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
5 days is too soon for onset of any symptoms due to a new HIV infection. It always takes at least 7-8 days and usually 10 or more days.

Thanks for your suggestion about search terms etc!
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29 months ago
Dear Dr Handsfield / Dr Hook,

Before my thread closes, i would really appreciate if you could clarify a point. I read in earlier posts that ab/ag tests are conclusive at 6 weeks for both hiv 1 and 2. However, in a very recent post, Dr Hook said it is generally agreed that current tests will turn positive for hiv 2 by week 12. My question is, does the 6 week negative ab/ag is conclusive rule not apply to hiv 2 because there are not enough cases to study? And a more personal question is does my 9 week negative ab/ag test conclusively rule out hiv 2?

I understand hiv 2 is rare, even in places where it is most common, and harder to transmit. Yet i cant help but worry, especially because I am back to the country where i work and cannot get tested although its been 12 months since the exposure, because expats who test positive for hiv are deported from this country (they really are).

This will be the last i am allowed to write in this thread. Once again thank you both so very much for all the assistance you provide to people in their difficult times.

29 months ago
I am sorry, i meant 12 weeks.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
29 months ago
I would assume that Dr. Hook's statement about 12 weeks for HIV2 testing alludes to continued use of older (e.g. second generation) antibody tests in some settings. My understanding and belief is that the newer tests (3rd gen and the antibody component of the Ag/Ab i.e. 4th generation) would detect all HIV2 infections by 6-8 weeks. However, I'm not sure how carefully this has been studied, given the rarity of HIV2 in many settings.

As for not testing for HIV because of being in a country that may deport HIV infected persons (mostly UAE, perhaps where you are), it's commonly stated on this forum. But it's nonsense. It isn't being tested that gets someone deported. When the chance of having HIV is nearly zero, as in your case, the reassurance value of the expected negative test should be much more important than the on in a million chance of a positive result. And if you have HIV, you'll need to leave anyway in order to get proper, life-extending medical care. So it makes no sense to avoid testing in situations like yours.

Thanks for the thanks about our services. I hope the discussion has been helpful. Best wishes, stay safe, and get tested for the reassurance you obviously need!
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