15 days past exposure had negative std screen for syphilis, clamydia and gonnorhea and a non reactive 4th gen duo test for HIV.

Followed up with 4th gen duo test for HIV at day 21 and 27, which both came back negative.

Would you recommend a follow up test down the road?  The major concern was the very swollen lymph nodes behind the knees which have now subsided.

Thanks

I have had the vaccinations for both Hep A/B.

Would exposure to HEP result in the swollen nodes behind both knees?

For sure your HIV test results are conclusive -- or so nearly so that I see no need for further testing. The first negative test (15 days after exposure) wasn't conclusive in itself, but it did show that your symptoms were not due to HIV. Anyone with HIV symptoms a week or more in duration has a positive blood test. (It's the immune reaction to HIV, not the virus itself, that causes symptoms. And so anti-HIV antibody as measured by the blood test, a measure of the immune system's response, must be positive.) Your n egative result at 4 weeks (27 days is close enough) is at least 98% reliable. If you want a truly conclusive lab result, have another AgAb (duo, 4th gen) test at 6+ weeks. But given the low chance of infection in the first place (low chance your partner had HIV, average risk if she did around 1 in 2,500), if it were me, I would not feel a need for further testing and would continue unprotected sex with my wife without worry.

As for the other STD tests, the negative gonorrhea and chlamydia tests at 15 days were conclusive. The syphilis blood test was too soon, however; it takes up to 6 weeks for syphilis blood tests to become positive. Syphilis is very unlikely in this situation, especially since you apparently did not develop a penile sore (chancre) in the next 3-4 weeks. I would recommend another syphilis test at 6 weeks, but you can expect a negative result.

Your lymph nodes:  Self assessment of lymph nodes by medically untrained persons is notoriously unreliabale. Not all pain or swellings behind the knee are necessarily lymph nodes. In addition, acute HIV infection never causes such localized lymph node inflammation; the swellings would be body wide (neck, underarms, groin, etc). Based on your obvious avocation (based on your username and email address), I would wonder whether you pulled a tendon or muscle while golfing. In any case, your test results prove it isn't (or wasn't) HIV. If that discomfort or swelling reappear, see a doctor. But I'm sure this has nothing to do with your massage parlor adventure.

Final comment:  Unprotected vaginal sex? With a commercial sex worker (or massage attendant)?? In Bangkok??? I'm guessing alcohol was involved!  ;-)  Anyway, I hope you'll get into the condom habit for similar events in the future.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Thank you again for the reassurance. It is a great service which you provide.

That completes the two follow-up comments and replies included with each question and so ends this thread. I'm glad the discussion was helpful; thanks for your kind words.