[Question #4532] Test result doubt, please help!

28 months ago



I am still concern that I may have HIV. 

I am really concern with a few symptoms I have been having for the last few weeks, I didn’t include them in my previous question # 4463. 


Because based on previous responses I read to others questions, HIV can not be diagnosed based on symptoms alone. 


However my symptoms are getting the best of my better judgement and I feel as if I should let you know for further guidance. 


Since my last HIV test at 46days-HIV 1/2 4th Generation ag/ ab- results negative. 

I have been experiencing swollen tonsils, no sep throat or bacterial infection, which I was informed it was due to acid reflux- (Swollen tonsils) which I have not experience before. Nasal Congestion, which I was told was due to rhinitis.

Not been able to sleep without waking up at least two to three times in the middle of the night. But the thing that is making me worry the most is my neck pain that seems to go up and down in pain level for the last week, I have been feeling a wave of of pain that comes in goes. The neck pain seems to be getting better but it’s all too strange. Also been feeling a strange weird ear drum pain and headaches but I don’t appear to have any ear infection. No fever or lymph swollen. 

Also at about 4 weeks after my HIV test I had a full blood panel and my white blood cell count was high at 11.4 (proper range according to the document provided is 3.8-10.8) my doctor said maybe I was fighting off an infection at the time of the test. That makes me concern because I wasn’t sick at the time of the test. 


I have been hesitating whether I should even post this question with these symptoms since they don’t seem like typical symptoms that I have seen in others questions posted regarding HIV. 


I have never had HIV anxiety before but I am still a little scared with my neck pain and headaches. I don’t typically get headaches and neck pain but the last few days it’s been painful. (Neck is not stiff, just pain) 


Like to also ad that Just recently been taking iron pills 65mg for anemia, I don’t know if this even matters since I have always be anemic but never took pills for it . 


I am just wondering if it’s possible that I might have not developed enough Antigen or anti bodies for my 46 day HIV test to pick up for a positive result. Would you recommend that I retest since now it’s been more than 3 months. 


Is it possible that my 46day  combo Test was a false negative ? 


My apologies if my question sounds repetitive but I like clarification if there is a possibility that I could be one of these rare cases that test positive beyond 46days? 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
Welcome back to the forum, but I'm sorry you found it necessary after the reasoned, science based reassurance you had from Dr. Hook.

As he told you, the HIV AgAb ("4th generation") HIV tests always are conclusive by 6 weeks. There are no reports of false negative results after that period of time, i.e no "rare cases that [first] test positive beyond 46 days". To put it another way -- if somewhat bluntly -- the AgAb tests are far, far more reliable than symptoms. The symptoms of HIV are "nonspecific". That's the medical term for symptoms that do not point to any particular condition. Every symptom you have is caused much more frequently by things other than HIV.

In addition, there are no medical conditions and no drugs or treatments that interfere with HIV testing. Certainly that includes iron, but it also includes other stuff you can find mentioned online, like immune suppressing drugs or chemotherapy. (They might have had that effect, very rarely, with the original antibody tests, i.e. types never done anymore. But not with the 3rd generation antibody tests or the AgAb tests.)

The bottom line is that as long as testing is done sufficiently long after the last possible exposure, the results always overrule symptoms in judging whether or not someone is infected. They also overrule exposure history. No matter how high the risk of HIV at the time of the exposure, and no matter how typical the symptoms might be, the test results rule. 

So all is well. For sure you don't have HIV. Should you test one more time, beyond 3 months? From a scientific or medical standpoint, there is no need and I certainly would not do it if somehow i were in your situation, or if I were advising someone personally close. That said, some anxious persons find lab results more reassuring than adviced based on science, probability, and statistics. If you're in that category, feel free. If you do it, you can be assured of another negative result (of course assuming no more recent exposures).

I hope this settles things for you. Let me know if anything isn't clear.

HHH, MD

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28 months ago

Thank you for you response. 


I don’t want to continue to worry about the possibility of HIV but my symptoms are what have been getting the best of me. ( especially neck pain) and I am low on Vitamin D, along with anima and acid reflux. Also like to add that I just discovered a thyroid Nodule (not cancerous) All of this is making me irrational and terrified. Can’t sleep,  


I discovered all these symptoms after my last test.


Could any of this have to do with HIV ? Could any of this be a late reaction to HIV ? 


I am scared to try to have sex with my partner and exposing him. I confessed everything to my partner and he agrees that I shouldn’t worry about having this disease. That these things all seem like coincidence. (By the way just for your information he is 100% clean, confirmed with recent testing just to be safe about a few days ago). He decided to test himself in light of my confession. 


But in the back of my head I keep wondering if a 46day- HIV combo test was enough time to ensure that I was negative. My partner has forgiven me and wants to move on from this and get married and have a family but I am still scared. Unlike some people I am too scared to retest because I think I may get a positive result later on ? Could my over reaction to these symptoms be just unnecessary since they are unrelated to HIV? Sometimes I feel like I am choking or having trouble swallowing which the doctor said it’s not due to the nodule but believes it has to do with Anxiety. 

All of this started because a tec told me that it’s takes 5 months for a test to turn positive and then I tested positive for HVS2, which I am confused about because my partner (have been together for over 10yrs) is negative for HVS2, the sexual encounter was only one time (unprotected vaginal in July 21st) I was told was a low risk (1 in 1000 chance of getting it from that encounter) but it can’t be that low risk if I tested positive for HVS2 after that encounter, my 10yr partner doesn’t have it. This is why I wonder if I got something else from that encounter ?

I tested for everything else and I was negative except BV and HVS2? Nothing else, I didn’t mention the BV before because I read that this can be also cause by douching. Just for informational purposes my HIV 1/2 4th Generation combo at 46days was before I took any medication of any kind. The Iron pills were prescribed afterwards and meds for the BV were afterwards which cleared about 5 days afterwards. At the time of the test I had taken only two Tylenol’s for a small headache. Sorry for providing so much information but I felt that I needed to get all of it out there for piece of mind. 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
The synptoms of ARS, i.e. a new HIV infection are not due directly to the virus. They result from the immune response to HIV. And that immune response includes antibodies detected by the blood test. Therefore, if symptoms are caused by HIV, and have been present more than 7-10 days, the blood test has to be positive. Therefore, your negative test results show that any symptoms you have are not possibly from HIV. 

As for HSV2, your symptoms are not typical. It is true that "flu like" symptoms (headache, muscle aches, fever, etc) can accompany an initial HSV2 infection. But only for 1-2 weeks, and always accompaneid by other typical symptoms of initial genital herpes, i.e. painful genital blisters, sores, etc.

Also, interpreting HSV2 antibody tests can be tricky. If you'll tell me the details of the test result -- i.e. the name of the blood test (your doctor or the lab can tell you) and the detailed result (the numerical value), and also the timing -- when you were tested after the last possible exposure -- I might be able to give better advice. But from what you have said so far, I am sure you do not have HIV and pretty sure your symptoms are not due to HSV2.
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28 months ago

-The one time unprotected vaginal sex occurred on 7/21/18

-I had a small bump appear on 08/20/18 near my anus, no itching, no multiple bumps, no pain when I pee- no fever or muscle aches 

  • Performed a swab text on 08/24/18 ( Planned Parenthood) for HVS2, also full testing done including HIV Alera 4th Gen combo test (finger Prick) Received results on 08/29 negative for everything except HVS2 swab that’s all they told me. 
  • Later on 09/05 received full STD testing including HIV 4th Gen combo test (blood from the vein) positive for HVS2- blood test 
  • Test type -HVS 1/2 IGG antibodies 
  • Results; 
  • HSV1 IGG AB Herpaselect 29.00 
  • Herpes Simplex Virus 2 IGG- quest 18.20 
  • This is what was written on my results, I have always known that I had HVS1 which I got from my grandma when I was like 15yrs old, gave it to my partner over ten years ago, but he tested negative for HVS2 and positive for HVS1 which we knew he was going too for HVS1
  • He has never had any symptoms for HVS2 and his IGG blood test only test positive for HVS1 18.00 

The only possibility for me to have gotten HVS2 has to be that one time in 07/21, because if I had it from before I would have given it to my ten year partner, we didn’t use condoms for ten years. Also I verified my partners test just to be sure he wasn’t lying so I am sure he is negative based on his test done on 11/19 HVS IGG test. I am so confused because if I got this over ten years ago before I met him, I would think he would have gotten it. Also if I got it recently from a one time sexual encounter which according to the nurse I was told, it was considered a low risk. But it couldn’t have been a low risk if I got it from this encounter ? 

This is why I am also scared for HIV. 

Why did I get my bump near my anus when I didn’t have anal sex with this person ? Only vaginal 

My doctor emailed me back and said that I shouldn’t worry about HVS2 because I could be worrying about something that I may or may not experience symptoms for. 

But my bump tested positive, my doctor never swabbed the bump since it disappeared before I visited his office. 

All this is confusing information which is why I have been doubting my HIV 4th Gen combo test at 46days. 

This is making me very depressed. I have avoided sex with my long time partner since the July encounter. 


My partner isn’t worried about any STDs or HIV because he feels that I have done sufficient testing and based on my doctor also emailing me that based on my last 46day negative results are conclusive. I just have fear that I am trying to get over. 


By the way I have not had any fevers or any swollen lymph nodes. I checked and I also walked into the emergency room to double check a few times. 


I did realize that the pain in my neck seems to appear to be a pinch nerve and could be caused by me placing a few books underneath my mattress a few weeks ago when I found out I had acid reflux, was told it would help with the acid reflux if I slept tilted. I found out about a month later from my last HIV test I had acid reflux which is why my tonsils were swollen, no pain just swollen and I found out I had a large nodule in my throat. 


All of this worrying is making me crazy and neurotic. I have never been worried about these things before. The one time encounter was a huge mistake and was not planned, the individual claimed he is clean and was extremely offended when I suggested he gave me something and according to him he was more worried about me giving him something. Honestly I don’t believe him and I don’t know him well. I am just extremely worried about my own health and the possibility of giving something to my partner. I like to someday also have children. 


- like to inform you that all this testing was done in US, NY, don’t know if this matters but like to provide you with this information 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
28 months ago
This is far too complex an issue for a reply as a follow-up comment. Your HSV2 blood test result indicates you are infected with HSV2, but that doesn't mean that it necessarily explains any symptoms you have. I see you had a past discussion with Terri about this. If you remain uncertain, you might post a new question for further discussion with her. However, most likely she will not be able to advise you any further. Perhaps the best approach is to find a health care provider knowledgeable about herpes at take it from there.  Good luck to you.---