[Question #5457] One follow up

23 months ago



I realize I’m using a follow up quickly. I assure you this thread and questioning will be my last. I’ve seen people who post more than twice get deleted and understand your reasoning, frankly. The more you ask questions the more stressed you get.


When I got my last 4th gen back this past December (a full year after my first exposure and close to 6 months after my second) I genuinely calmed down for about 5 months. However, with my daughters white tongue (likely not thrush) followed by me looking into my flaky skin by nose (when you google that seb. derm comes up) as well as my weird string of a few months of loose stool, the panic rushed back. So, I have a few follow up questions I hope you can answer.


  1. My first event, November 2017, was with someone I had a professional relationship with. I know that she’s married to a Jamaican man and was vacationing in Jamaica 2 months prior. If she picked up any virus there from him or otherwise (she admittedly has an open marriage) would there be any strain or HIV 2 that wouldn’t pick up in my regular 4th gen here in NY? Or my RNA?

  2. My wife got a siemens 4th gen for life insurance test this march. In the first week of February prior she got a really bad 48 hour stomach virus, throwing up all day and night, just 2 days after we had relations. I believe I’ve read that if that stomach virus was ARS her March test 30 days later would be positive?

  3. I gave a run down of all of my tests in my last post. I have 2 questions related to them. For Ghon/Chlym urine test – I did 3 of these, but the first 2 I have no idea how long beforehand I peed. Nobody told me when taking the test I should wait an hour. The third time, December 2018 (a year after first exposure and 6 months after receipt of oral) I did another where I definitely held it for over an hour. I may have filled up more than I was supposed to, I wasn’t told that either. Is there a time period too long after exposure where the test wouldn’t register?

  4. Same for 4th gen. Is a year too long after? Is it possible something wouldn’t trigger positive?

  5. Lastly – and believe it or not the most ridiculous of the questions…I read that the lunula on fingernails (half moon things at bottom of nail) are not present in many people with HIV. Low and behold I only see them on my thumbs. Is this a cause for concern or totally ridiculous?

Thanks. Go Mariners

Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Straight to your follow-up, and, it seems to me, guilt and anxiety-driven, questions:
1.  Current HIV tests test for HIV-2 as well as HIV-1.  There are fewer than 100 HIV-2 diagnoses made in the U.S. each year, most typically in persons from West Africa or India.  HIV-2 is very rare in Jamaica and overall HIV-prevalence in Jamaica is only slightly higher in than in the U.S. (1.5%, primarily in men with male sex partners and drug users)
2.  Correct.  4th generation HIV tests are typically positive at the time the ARS occurs and certainly would be positive soon after the onset of symptoms if she had the ARS.
3.  Despite the package insert information which calls for initial void urine and specified volume, neither makes much difference in urine test results for gonorrhea and chlamydia and after three negative tests you can be absolutely confident you are not infected.
4.  Wrong.  No such thing as too long afterwards for a test to be positive.  Once positive HIV tests are positive for life.
5.  Totally ridiculous.  PLEASE STAY OFF THE INTERNET!!!!!

23 months ago

Thanks again. I'm sure it is anxiety and guilt but these coincidences make it tough to swallow. I thought I was over this months ago.

1. Last summer I had a slight but present sore throat from roughly memorial day into early august. It was in one spot, back left...felt like it was close to adams apple. Every dr I saw said it's allergies or anxiety as they found nothing. Now that we're into allergy season though I was looking forward to feeling it again to confirm and don't have anything. Would a longstanding sore throat like this roughly 7-9 months after exposure be cause for concern?

2. last fall I had what I thought was a canker sore in my mouth but my dentist told me my parotid duct (stensens duct) had a slight infection. Again - this is something connected with HIV that I NEVER experienced before all of a sudden popping up 10 months post exposure. Still this is not a cause for concern? Dentist told me it could happen if my immunity was low. So this and the seb. derm are 2 things I know I never experienced prior to the past year and a half. And they were not things I was looking for...I only found out their connection to HIV after I experienced them. The lymph nodes I have are things Ive looked for after the fact.

3. My Lab Corp Panel 4th gen test reads as HIV 1/O/2 antigen and antibody. Does this mean it only tests for a strain O? Aren't there a lot more strains? I attached a link to the panel below for your review. This also, by the way, notes the possibility of biotin interference. https://www.labcorp.com/test-menu/28801/human-immunodeficiency-virus-1-o-2-hiv-1-o-2-antigen-antibody-fourth-generation-preliminary-test-with-cascade-reflex-to-supplementary-testing

23 months ago
4. I guess I'm concerned if there's a strain somehow not tested for and that's the one I have then that would be how my wife tested negative, too. Would her very bad 2 day vomit episode 2 days after relations be reflective of ARS?
Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
Sigh.  Your guilt-fueled anxiety and inability to accept definitive test results using some of the most accurate tests in all of medicine is saddening.  You really need to get over this.  Clearly factual data is of little help.  I suggest you seek professional counseling to help you move forward.  I make this statement out of concern for you, nothing more.  As for your somewhat repetitive questions:
1.  NO!  A chronic sore throat is in no way suggestive of HIV.
2.  Noticing common occurrences, possible seborrhea salivary gland inflammation, and attributing them to HIV in the face of negative test results is a sign of your continuing inappropriate concerns, not HIV.
3.  Oh please.  No, these tests test for multiple (effectively all) strains of HIV and reliably detect them at any time more than 6 weeks after an exposure.  Concerns about HIV strains being missed by current tests is a hallmark of internet fueled misinformation.
4.  No, vomiting 2 days after sex is not a sign of HIV or ARS.

You really need to figure out how to move forward on this.  EWH
23 months ago

Thanks Dr. I apologize for the annoyance I've caused. I know you can't get in the mind of someone who has lost it, so this must be frustrating to you.

I am already looking for therapists who can potentially help my level of hypochondria. I've always suffered slightly from that, but never anywhere close to this. I guess the ramifications being life altering/ending in terms of my family and their health is what did it.

Last couple questions, maybe for peace of mind. I appreciate it:

1. I've had this potential mild seb. derm since January. That would be 14 or so months after exposure. Would you think generally this would be too early to begin to see symptoms like that if I was infected? Same goes for loose stool?

2. It's gross to even say this. But my biggest concern is my childrens health. There is NO way outside of something incomprehensible (ie abuse) that I could pass h I v on to them, right? So - getting a bloody nose on them for example and them sucking thumb with that is not a risk?

3. You kind of answered this re: Jamaica but Caribbean in general...are there any strains in that region that tests here do not pick up?

Thanks a lot.

Edward W. Hook M.D.
Edward W. Hook M.D.
23 months ago
I am not annoyed, just saddened by your inability to accept the overwhelming data that you were not infected by your missteps.  Final responses:

1.  Yes, far too early.
2.  Correct, no way.  OTOH, if your paranoia is impacting your relationship with them, then that may be doing harm
3.  No

This will complete this thread.  As you already know, further repetitive, anxiety driven questions of the sort you have been asking provide little benefit to clients and little benefit to others who may read the posts.  Hence should you post additional questions, the question may be closed without further response and without return of your posting fee.  This thread will be closed shortly.  EWH
23 months ago

I appreciate it. You should have led by telling me it's too early for those symptoms!!!

I'm kidding. I'll do my best moving forward. You're right about the kids too...before this I really was a good dad...but I'm sure with this in the back or front of my mind I am showing them less affection with my fear. I appreciate your comment there.