[Question #6318] Unprotected vaginal sex, Negative RNA 15 days, ARS symptoms

15 months ago
White heterosexual college aged male here. On 14 October I had unprotected vaginal sex with a  girl I was not dating. She said she had been tested and was clear before we had sex, I had been as well. The day after I woke up with sinus pressure and green and yellow mucus. Aside from that I felt fine for a week, but then got scared I may have HIV from reading symptoms online (stupid I know). I reckon I was also feeling guilty about having casual sex. At ten days or so I may have had a small fever and sweat a bit at night for two days and also lost my appetite for several days. I convinced myself I had HIV, and decided to pay the premium on RNA testing for peace of mind. At 15 days post-possible exposure, I took an RNA Qualitative full test from LabCorp. The test came back negative. Immediately following this all symptoms went away, aside from the sinus congestion and drainage which has remained. Historically, I get sinus infections several times a year. On 19 November, I went to the campus health centre for my sinuses and they diagnosed me with a sinus infection and gave me a Augmentin. I am worried again because I woke up on 22 November with a sore throat and had sweat a small amount over the night, but only from the lower body. In the past I have come down with colds at night in winter if I don't wear long sleeves and last night I had slept in a t shirt. My sinuses are still plugged up and so far today my appetite has disappeared, perhaps because I have begun thinking I have HIV again. This has been compounded by the fact that I read RNA tests are not conclusive or very accurate inside four weeks, and that makes me worry I had a false negative. Does my situation sound like someone who has been infected with HIV, how trustworthy is my 15 day negative RNA test, and is it possible anxiety is simply amplifying sinus symptoms? Also, my tongue has been greyish white since the possible exposure if that matters. Thank you.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Welcome to the forum. Thanks for your confidence in our services.

The bottom line here is that you can be very certain you do not have HIV. In fact, I came to that preliminary conclusion before reading your question at all, based only on the title you chose for your question. The HIV blood tests, including the RNA test, always overrule symptoms. It is not possible to have ARS symptoms with negative RNA testing. So no matter what symptoms you have or had, you can be sure HIV is not the cause. Also, the symptoms you describe do not suggest HIV anyway. ARS does not include nasal congesion, sinus symptoms, and so on. As for your sore throat and coated tongue a few weeks later, that's much too late for ARS symptoms to start. And yet another factor in your favor is that the frequency of HIV in sexually active women in the US is very low; the chance a youg woman (rougjly your age) has HIV is well under 1 in a thousand. And even if she had HIV, the average transmission risk from a single episode of unprotected vaginal sex is 1 chance in 2,500. That works out to having unprotected vaginal sex with infected women once daily for 7 years before HIV transmission might be likely.

My final comment responds to your question whether anxiety might be magnifying your sinus symptoms. The answer is definitely yes!  Further, whenever someone suspects his or her own symptoms might have an emotional or psychological origin, usually s/he is correct.

Had you asked about this before your RNA test, I would have recommended against any HIV testing at all. However, having started down that path, it would make sense for you to have a definitive, conclusive test. It is wrong to state that RNA tests are not very accurate inside 4 weeks. They are good at 15 days, but probably misses up to 2-5% of new HIV infections at that time. Although that negative result proves your symptoms aren't ARS, it does not conclusively prove you didn't catch HIV. So you should have an HIV antigen/antibody (Ag/Ab, "combo", "4th generation") blood test 6 weeks afte tthe event, a few days from now. You defnitely can expect another negative result.

You don't mention chlamydia and gonorrhea, by far the most likely STDs in this situation. If you caught gonorrhea, you would know it by symptoms (urethral discharge, painful urination), but chlamydia is much more common and the nost frequent STD in people your age. If you have not been tested yet, it would be reasonable to have a urine test, probably when you go in for repeat HIV testing in a few days. Also a syphilis blood test would make sense, although the risk of syphilis in your situation is almost as low as for HIV.

I hope these comments are reassuring, as they should be. Let me know if anything isn't clear.

HHH, MD
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15 months ago
Thank you for your prompt response Dr. Handsfield.  With regards to the entire situation, had these symptoms occurred anytime not after unprotected sex, I would not have thought anything of them. However, since it occurred right around then and combined with a bit of guilt over the whole thing had let my mind wander. As far as chlamydia and gonorrhea goes, I took a urine test at 15 days post as well, and those were negative. Oddly enough, one week after the episode while I had been feeling fine aside from my sinuses, I initially thought I had an STI and began surfing the Internet because I peed and it burnt mildly, however, upon further analysis I think the tip of of penis had just been irritated by something and it didn't burn or hurt again. You note that many symptoms can be created or magnified due to anxiety, would you reckon such things as appetite loss and headache could be induced by that? Additionally, would 5 weeks post possible exposure be too late for ARS symptoms to arrive such as my sore throat I woke up with today? I have not had any rashes, no fevers aside from maybe a mild one a day or two, and no swollen lymph nodes that I have noticed. Today I just woke up with a chill and a sore throat and became ever more worried again. If you had to ballpark some a probability for me in this situation, I reckon it would be infinitely small? I will be going in for a duo test on 25 November for final confirmation, and I will save my second reply to update you on its results once they have been received. Thank you again, and I apologise if any of this was repetitive. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
While at one level I understand your concern, it really isn't logical. Aside from the sexual event, a hundred other opportunities to acquire a virus of the sort that causes such symptoms probably occurred in the days before the symptoms started. It is purely a psychological issue that directs your focus to the sexual event.

I'm glad to hear of your negative gonorrhea/chlamydia test.

Yes, appetite loss and headache are classical symptoms of anxiety, or anxiety magnifying other minor symptoms or even normal body sensations that otherwise wouldn't be bothersome and maybe not even noticed.

"would 5 weeks post possible exposure be too late for ARS symptoms to arrive such as my sore throat"? Answered above; re-read my reply.

Your further description of symptoms makes no difference in my assessment or advice. Perhaps it will also help you to know that in the nearly 15 years Dr. Hook and I have been doing this and a previous similar forum (since you were around 5 years old!), with thousands of questions like yours, not one questioner worried about HIV turned out to have caught it. You won't be the first. If and when that happens, almost certainly it will be from a truly risky exposure and not one with virtually zero risk like yours. So stay mellow pending your test in a few days. There is no realistic possibility you have HIV. Believe it!


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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
One other suggestion I forgot to include above:  Why don't you speak with your partner, and perhaps encourage her to be tested for HIV? And also reassure her about your own negative test. Statistically, women are at higher risk for HIV from their male partners than men are. For all you know, she is going through the same anxieties you are. If she says she has been tested recently or if she gets tested now with negative results, you'll know you could not have been infected. This probably is the most responsible, mature approach to all these issues.---
15 months ago
Good evening Dr. Handsfield, I apologise for the belated response, but I wanted to save your final reply for after I had obtained my IVth Gen test results. I took the test yesterday 25 November and received my results today as non-reactive, which I presume to mean negative for HIV 1 and 2.  Just as you stated they would be.  I am joyously ecstatic. Thank you for your words of reason in the face of my emotional delusion. For our final interaction in this thread, I just want to run a few more things by you before I express my gratitude once more. The first would be related to my initial HIV fears largely being that my head cold/ sinuses/ general fatigue seemed to occur within ten days of my unwise sexual activity. I know you said sinusitis and HIV are not linked, but it has now been 5.5 weeks or so of sinus drainage and symptoms and so far the Augmentin has been less than effective. Is it very well possible my anxiety from this episode which I confess caused me to lose sleep and not eat, also suppressed my immune system to where a viral or bacterial sinus infection was able to hang around far longer than it would have otherwise? I know that is not related to STIs, but I am curious on your professional opinion. Secondly, seeing as my first STI test panel was done 15 days prior and therefore syphilis and hep would not be detectable, would you advise going back for more testing for this at 8 weeks? I have been vaccinated for one or two of the heps, and I haven't had any symptoms of syphilis as far as I know. If the likelihood of it is rather low though and I have not had any genital canker sores or lymph node swells, I would like to put this behind me fully and move on with my life. Also, I certainly appreciate your comment about handling things like this maturely with your partner. As I said earlier, I had heaps of guilt over all of this because it was casual sex and aside from that night little contact was maintained after. Before hand though she did say she was clear and had been tested and seemed quite confident in that as I was the only one freaking out and having anxiety over the last 6 weeks. Lastly, with the negative RNA and IVth gen at 6 weeks, I believe I can take those results as wholly conclusive?  Once again, thank you so much for your words of wisdom and professionalism, I am deeply appreciative and will be sure to ensure the rest of my sexual decisions are protected. Have a Happy Thanksgiving!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Of course I am not surprised by your negative test results.

Anxiety has no effect on the immune system, at least none proved by medical science. And any effect from sleep deprivation probably is minor and certainly could not affect test results. Neither anxiety nor sleep issues had effect on your risk or test results. All your HIV test results indeed are "wholly conclusive".

That concludes this forum. Thanks for the thanks; I'm glad to have been of help.
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