[Question #6041] Fear of HIV status.

17 months ago
Hello. I am a 56 yr old male. I have engaged in protected (latex condom) vaginal sex with prostitutes (approximately 3-4 times) in 2019. Most recent occasion was on June 27th with possible messy condom removal.   I saw my GP on 5/20 about a severe sore throat. He prescribed me an antibiotic and I completed the prescription.  Throat pain subsided but was left with a mildly constricted and dry throat. Noticed swollen neck glands for months, (at least since late June, maybe longer). On 8/30, I researched and became aware that my symptoms fit those of HIV . I became extremely alarmed  due to this realization and panic set in when my girlfriend mentioning sore lymph glands in her neck and sore throat.  By Sept. 6, dry mouth, night sweats, sore glands in my arm pits, elbow crease and torso, loss of appetite and mild discomfort in my right testicle and tip of my penis had developed and I had dropped 10 pounds. GF has since stated that glands are normal. But I have noticed she has a dry cough beginning soon after Sept. 6 to present. We are both dry in mouth and eyes. I took a 10 STD panel on Sept. 6 which included an HIV 1/2 Antigen/Antibody, fourth generation w/RFL. All came back NON-REACTIVE.  I had also taken an Oraquick Oral Home Test on Sept. 9- NEG.  These tests took place 71 and 74 days post exposure.  Since then addt'l symptoms include: Gland tenderness everywhere they exist (knee creases, nape of neck, feet, hands abdomen, testicle plumpness and tenderness from anus to testies.  Occasional minor congestion with mild and brief headache.  (No pain killers taken) Mildly scratchy throat with cough, (GF too).  Appetite and energy good, stools good, no nausea or fever, regained 1-2 lbs. Question: I remain concerned regarding HIV status.  Should I be? Should I have additional testing done?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
Welcome to the forum. Thanks for your question and your confidence in our services. My reply is straightforward: the bottom line is that for sure you do not have HIV.

Acute HIV infection can cause sore throat, but so can any garden variety cold, strep throat, and many other minor infections that are far more common (even in people at risk for HIV). Your other symptoms don't even hint at HIV. And you were at very low risk for HIV anyway. The large majority of female sex workers do not have HIV, and even without a condom, the average risk from vaginal sex, if the female partner is infected, is once for every 2,500 exposures.

Most important, however, the HIV antigen/antibody (AgAb) blood test is conclusive any time 6 weeks or more after exposure, and your negative result is 100% proof you weren't infected. This test is among the most accurate diagnostic tests ever developed, for any medical condition. (There are many other infection tests that I wish were this reliable!) Therefore, the results overrule all other considerations. Even if you had had a truly risky exposure and more typical symptoms, the test results are conclusive.

So no more testing is required. It's time to stop worrying about it!

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

HHH, MD
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17 months ago
Thank you for the speedy response doctor.  I’m still concerned  for the fact that my girlfriend and I both have had the chronic scratchy throat for weeks.  Is it possible that there are viruses out there other than HIV that can manifest that?  Naturally I’m not looking for a diagnosis, just whether there is a possible explanation other than HIV? 

Finally,  how should I view all the information that I have read that indicates that 12 weeks or 90 days is the threshold for 99.9% conclusive results for the 4th generation test. And some even suggest a re-test at 6 months.  

Again thank you for your attentive and encouraging response.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
As I said, your test results overrule any and all symptoms. Anyway, probably nobody with HIV ever had scratchy" throat as the only symptom. There are a number of viruses that cause throat irritation -- anything that can cause common colds -- although such a symptom continuing more than 2 weeks is more likdely due to allergy, or nothing at all -- this could easily be a psycholgical reaction to your fears of HIV. Another factor is that symptoms of HIV are caused by the body's immne response to the virus, not to HIV itself. Therefore, if symptoms are due to HIV, antibody must be present. In other words, if someone within 6 weeks of a new infection has a negative AgAb test, it proves the symptoms have some other cause, even if not yet possible to conclude ithere is no infection. Stated another way, your negative result proves two things:  that you don't have HIV; and that if somehow you did, HIV isn't the cause of your scratchy throat.

There are innumerable discussions on this forum about time to reliable HIV testing. Twelve weeks, 3 months, etc is old news, left over from the earliest HIV tests. All expert resources, such as CDC and most other public health agencies, are consistent in 6 weeks as conclusive for the AgAb tests. Some individual physicians and clinics still advise 3 months from excessive caution or advice from their legal departments. And some are simply being untruthful in a misguided attempt to frighten people into better sexual safety. FYI, here is a link to the most recent expert review of time to positive test results, the source of our advice about 6 weeks; it also is the main resource CDC cites in their testing recommendations:  https://www.ncbi.nlm.nih.gov/pubmed/29140890 

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17 months ago
Thank you again doctor for your time and effort to inform, educate and reassure me. I am certain I’m not the first person who has difficulty letting go of the fear that an experience as this brings with it. Especially after enduring the perceived realization of it for 3 weeks.   Tonight after reading your reassuring responses, I attempted to relax and enjoy a pleasant evening with my GF.  After dinner a martini  and a movie, I returned home for a second diarrhea movement for the day.  After a short respite, (the past 3 evenings ) I’m feeling flush and took a damp t-shirt off after dozing on the sofa in a 73 degree room. That along with all the other mentioned symptoms persist.  As does my GF’s lingering dry and scratchy throat.  So here , finally is my question...I have read that those with suppressed immune systems can receive a false negative from the aforementioned HIV test I took. Before this I was always a healthy individual, so there is no medical reason I’d be immunosuppressed. But could the abject terror and extreme stress I experienced the 8 days leading up to the test negatively impact my production of antibodies to a degree to bring them to an undetectable level?  I look forward to your answer and will do my best to accept and rest in whatever it is.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
17 months ago
There are NO medical conditions, drugs, or other factors that alter the reliability of the AgAb (4th generation) HIV tests. Being stressed over all this has no effect on your test results.

It really isn't normal to remain so fearful and stressed after the repeated science based reassurance you have had, both here and perhaps from your own doctor(s). If you can't shake it, professional counseling would make sense.  I suggest it from compassion, not criticism.

That concludes this thread. Please do not start a new one on this topic. There is no additional information you can provide or questions you will think of that wouldl change the oopinions and advice you already have had. I do hope the discussion has been helpful.
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