[Question #4829] HIV risk and test

28 months ago
Hello Dr.'s I hope you are well. About two months ago, I had several episodes of unprotected sex with a female. One week after the first time I had sex with her, I had a very severe sore throat. Ten days after the first encounter, I had another unprotected encounter. Two weeks after this second encounter, I started having headaches that would start in the morning and last for a while. I came to realize they were related to my sinuses, as they began and come back when I am in the cold. They have also progressed to include ear pain. My nose feels uncomfortable on breathing in cold air. I still have headaches on and off again. At this point I became very worried about HIV. I asked her when the last time she was tested was, and she said three months prior to meeting me, and that she hadn't slept with anyone since that test. I also asked her to get tested again and she told me she did and everything was negative, but I never saw the results on paper. I later realized that my sore throat was pericoronitis, and a doctor said my headaches/sinus symptoms were common and did not seem related to HIV. I got tested with an ag/ab combo test 42 days after my first exposure, which was 32 days after my second exposure. It came back negative. I am worried that the test didn't pick up my second exposure, and that these headaches and sinus symptoms could be due to HIV. What are your thoughts? Should I get tested again?
28 months ago
I'd like to expand on my sinus symptoms a little bit. I had some headaches, followed by two days of post nasal drip, and now continued headaches, and some sinus pressure that comes and goes. Ear pain on exposure to cold.
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Welcome to our Forum.  I'll be glad to comment.  Your exposure was statistically low risk.  Relatively few women have HIV and even when they do, transmission is rare.  During unprotected, heterosexual vaginal intercourse the statistical risk of HIV transmission is about 1 infection per 1,200 sex acts.  In other words, more than 99.9% of exposures of this sort do not lead to infection.  In the circumstance you describe, the risk is even lower because:
1.  She said she was tested and negative.  Probably a true statement and you cannot get HIV from an uninfected person.
2. Combination HIV antigen/antibody tests are 99% sensitive at 4 weeks and entirely sensitive at any time more than six weeks after an exposure.  Thus you certainly were not infected with your initial exposure and there is a more than 99% likelihood that you were not infected on the second exposure in the unlikely event that she had HIV.
3.  Finally, when persons are symptomatic from HIV for more than a few days during the so-called ARS(Acute Retroviral Syndrome) their tests are always positive.

Thus, while I completely understand the concern over the onset of your symptoms and the possibility of HIV, you can be confident that your headache and sore throat were not a manifestation of HIV.  

Bottom, line.  While testing is a personal decision, for all the reasons I have mentioned, I am confident that you did not get HIV from the exposures you described.  Were I you, I would not worry and would not seek further testing related to these exposures.  EWH
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28 months ago
Thanks for your response. I will do my best to put this out of my head. I believe that when one event follows another, the human mind tends to think that they are linked. I'm also a medical student, and I'm surrounded by talk of HIV all the time in the hospital. In addition, I felt extremely guilty about not wearing a condom. I spent a month and a half convincing myself I was positive, now I have to do my best to convince myself I'm not.  Any tips to get it out of my head?
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Thanks for the additional information.  With sexual health issues we do tend to be a bit guilt ridden and as a medical professional, we tend to be particularly vulnerable.  That said, we use believe our tests- that's what they are for.  EWH---
28 months ago
Dr. Hook. For the last few days I have been experiencing various episodes of peripheral neuropathy. Some of these can be explained away, i.e. I am rather overweight and I put my pants on too tight one night which might have caused a neuropathy down my leg. I also might have slept on my arm all night and caused some numbness for a few hours the next morning. However, I have recently had tingling in the bottom of my feet, as well as weakness in my hands today that I cannot explain away. In the picture of headaches and sinus issues that started two weeks after unprotected sex as well as these episodes of peripheral neuropathy, could these symptoms point to HIV infection? 
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Absolutely not.  When neuropathy occurs in HIV it occurs late in the course of infection, after years of untreated, progressive infection.  

Further, I would point out that the association of sinusitis with HIV is also an association with late, not recently acquired infection.

This is my 3rd response to your questions. Thus, as per Forum guidelines, the thread will be closed later today without further responses.  Take care and please don't worry. EWH
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27 months ago
I'm sorry Dr. Hook. One final question. I also noticed that hepatitis C/B can cause peripheral neuropathy. Is this also a late stage symptom of these viruses? I've been vaccinated as a child for hepatitis B. Am I still at risk? And I've seen you say on the forum that most young women in American do not have HIV. Is this similarly true for hepatitic b/c? I also don't believe she is an injection drug user.
27 months ago
I'd also like to note that I was vaccinated at one year old, and I am 26 now. I had a titer checked twice. Once in 2014 and once in 2017. The 2014 one was negative (<8.5). The 2017 was positive (19). Am I at risk?
27 months ago
Sorry, I made a mistake. My value in 2014 was 66.
Edward W. Hook M.D.
Edward W. Hook M.D.
27 months ago
Your hepatits B vaccination protection is still present. You are not at risk for hepatitis B and hepatitis C would not cause this sort of discomfort.  You really need to move on.  EWH---