I went for a 4th generation test 28 days after exposure and was negative. For peace of mind I went for another 4th gen duo test 34 days after the virtually no risk exposure (unprotected cunnilingus on an escort) which was negative.

My concern is I now have a yellow coated tongue and my glands on the left side of my neck are tender to the touch. Does constantly feeling your glands actually irritate your lymph nodes?

Can I be rest assured guaranteed that any symptom or new symptom I experience is not due to HIV? There is basically no chance in heck I have HIV and the results will not change?

Is a 6 week duo any more accurate than a 4 or 5 week duo?

Would accepting my 34 day duo results as definitive and moving on with my life be the thing to do here?

Here in Canada most experts say 6 weeks for conclusiveness. In In the UK it's 4 weeks. In France it's 6. I know every place has their own guidelines. But you are the experts who see actual fact and scientific data and do not get enough credit and I wish you had the power to change the guidelines based on your 30 years of experience rather than beauracrats.

Again I appreciate your time.

Because the 4th generation tests are foolproof and error free at 4+ weeks, the results always overrule all other considerations. No matter how high the risk of HIV might have been at the time of exposure (yours was very low) and no matter how typical the symptoms might be for a new HIV infection (yours are not typical, especially in regard to the timing), the test results tell the truth. Your negative tests prove you do not have HIV, assuming no more recent exposure you haven't described. To your specific questions:

Tongue, lymph nodes: See above. Coated tongue is exceedingly common and not in itself necessarily abnormal, and self examination of lymph nodes by medically untrainted persons is highly subjective and usually unreliable. And yes, constant probing node bearing areas can result in swelling, discomfort, and tenderness. Finally, acute HIV symptoms cannot be delayed so long. They start within 1-2 weeks or not at all.

"Can I rest assured...?" Yes. You do not have HIV and your test results will not change.

"Is a 6 week duo...?" and "Here in Canada...." In addition to the institutional conservatism described by Dr. Hook, the data on HIV test performance are not very precise. Few people with HIV know exactly when and where they were exposed, and following such persons with precisely timed tests for several weeks is pretty much impossible. So we're left with biological principles, animal studies, and scant data in exposed or newly infected persons. So there's a lot of room for experts or institutions to consider different intervals as definitive. All I can add is that neither Dr. Hook nor I, nor any HIV experts with whom we have spoken, ever have seen a patient with negative duo testing 4 weeks after exposure who turned out to have been infected. There may be occasional exceptions when persons have received anti-HIV drugs for post-exposure prophylaxis (PEP) that didn't work, but even this appears to be rare.

So do your best to move on without worry. Thanks again for the appreciative comments.

HHH, MD

In regards to lymph nodes and swollen glands. Would they be very clearly visible in a person with acute HIV? Would they be body wide including all lymph areas or just generalized to one area (Neck)? Would they be painful? Also is it normal to feel a lymph node without being swollen?

I went to the dentist and the dentist said there is clear evidence of teeth grinding and he felt my jaw and said it was very tense. Could Bruxism cause tenderness in the neck lymph area?

Once again. My thanks.

But these questions are irrelevant, since the blood test results prove you do not have HIV. The main point of the replies both now and previously is that the test results overrule examination, risk history, and anything else you can think of. Even if you had typical symptoms of acute HIV and body-wide lymph node enlargements, the clear conclusion would be that something other than HIV is the cause. Do your best to believe it, accept it, and move on. If you cannot, professional counseling might be in order. I suggest it from compassion, not criticism.