[Question #5439] Symptoms: Tests conclusive yet?

22 months ago

Dear doctors,


I am a 29 year old woman who unfortunately had a risk of nonconsensual, unprotected sex with a white male on 4/21. (No ejaculation but it was prolonged and rough) He claims to be straight and non-drug user but sometimes men lie about bisexuality &/or drug use due to stigma, so who knows)! He also has traveled a lot and has lived in South America. I have had several hiv tests so far, including a 31 day 4th generation plus RNA PCR. I know that this should rule of hiv despite symptoms from my research on these forums but I’ve had frightening long-lasting symptoms that remain till this day: persistent sore throat/swollen tonsils, with painful neck nodes starting a month ago along with burning and swelling under my arms (although they both have gotten much better) and most recently, a tender groin node that I noticed last night. 


For complete piece of mind I plan to get tested at 42/45 days. But should I be worried considering everything plus my results thus far? I’ve never had such symptoms and the timing of the sexual incident is super concerning! 


Here’s an outline of my testing history: 


5/1: Negative baseline duo


5/2: Negative 10 day RNA PCR 


5/7: Negative 15 day duo 


5/13: Negative 21 day duo 


5/20: Negative 28 day duo


5/23: Negative 31 day duo & RNA PCR


Please let me know your thoughts and recommendations on the situation.


Thank you! 

22 months ago
Forgot to add that I noticed my sore throat on 4/25. Underarm pain began on 4/30. Neck nodes began 5/5.  And wanted to correct typo above: “I know this should rule *out* hiv despite symptoms” instead of “rule of.” 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome to the forum. Thanks for your confidence in our services.

As it seems you know, the AgAb ("duo", 4th generation) HIV tests are highly reliable. Al by itself, it requires 6 weeks for conclusive results, but the test is 98-99% reliable by 30d ays. However, the combination of tests you have had -- negative AgAb at 28+ days plus negative PCR at 10 days, as well as negative PCR at 31 days -- is 100% conclusive. For sure you did not acquire HIV and do not need any further tests.

In addition, it is not possible to have HIV symptoms more than a week and have negative antibody tests (the Ab part of the duo test). So the results also prove that something other than HIV is the cause of your symptoms.

I hopet this information is helpful. Let me know if anything isn't clear.

HHH, MD
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22 months ago

God bless you Dr. Handsfield (and Dr. Hook as well). Thank you so much for your completely clear and fast response to my questions. It is beyond helpful and I had to take a few days to process it. I’ve followed you both since Medhelp and you both are providing an invaluable service to the public. This has been the most difficult time of my life due to me always having a heightened and irrational fear of hiv before I even became sexually active. With the unfortunate nature of the incident and timing of unusual symptoms I have legitimately gone crazy/had life stop the last few weeks. Words can’t express how grateful I am for your professional and expert opinion shared in regard to both my question and thousands of others. 


I wanted to let you know that I went to my doctor for my symptoms and she said exactly what you said: that there was no way I could have hiv with having a PCR and duo at 31 days. How awesome is it that doctors are finally coming up to speed on hiv testing and leaving the outdated 3 month rhetoric behind! 


It’s such a relief to know that I’m 100% negative. I most likely will get one more test due to my irrational anxiety/fear but will now be working with a counselor so I can believe these results. The mind is so powerful that you can believe you are infected despite irrefutable evidence otherwise—It’s truly a disease in itself that one has to actively re-train the mind to overcome. Thank you so very much again for your knowledge and insight Dr. Handsfield! 


I do have 2 more questions however:


1. If I decide to test at 6 weeks with the duo, will it be 100% conclusive for hiv 2 or do I need to wait longer? I know hiv 2 is rare but this guy traveled a lot which makes me think what if.. 


2. If my symptoms were due to hiv 2 (rather than hiv 1), would the duo I had at 31 days have been positive? 


Thank you so much! 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Thanks for the follow-up information, and for the thanks. I have to admit I read your initial question too rapidly and missed the nonconsensual part. This must have been a very hard time for you, and I apologize for not being sensitive to that aspect.

1) Yes, the antibody portion of the AgAb test covers HIV2. In addition, HIV2 is almost absent in the US. In over 30 years, I believe there are fewer than a couple of hundred documented cases, almost all of those in people who acquired it in Africa. There are few cases in their sexual contacts.

2) Also, yes. It is not possible to have HIV symptoms (for either HIV1 or 2) and still have undetectable antibody more than 7-10 days after onset of symptoms.

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22 months ago

Wow. I struck gold to have such a fast answer again! What a blessing. :) 


And thank you Dr. Handsfield for your compassion. No need to apologize! It’s been hard but frankly the majority of what I’ve been struggling with/upset about was the possibility of hiv! But now I can begin moving forward in all aspects. Thanks so much again for all of your expertise and advice! 

21 months ago

Hello Dr. Handsfield, 


I know you stated earlier that I didn’t have hiv and didn’t need further testing. You were absolutely right. I’m sorry to say worry got the best of me because of my lingering throat/tonsil problems. I wanted to return to let you know that I had a 43 day and a 48 day duo and they were both negative. Thank you so much again for all of your help! Hopefully I’ve eliminated any chances of false negatives with my PCRs and two 6+ week tests?? 


I want to finally put this behind me for good and free myself from continuing worry/anxiety and STOP testing which inevitably makes it worse. I’ve found a counselor who specializes in trauma and health anxiety to help me get through these feelings as well. 


Also you can tell the most anxious people on here that the CDC hiv/aids helpline says that duo tests are conclusive at or beyond 45 days. I know you’ve directed people to their website/published studies, but I wanted to let you and this forum know about the helpline advisors if other posters are struggling to believe the CDC’s window period for the duo despite you repeatedly telling them of this fact. Thank you so much again for everything! 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
21 months ago
Glad to hear about your additional test results -- although ofocurse not surprised by teh results. Thanks again for yourkind words about our services. Take care and stay safe!---