[Question #6566] Dear Dr. Handsfield, some assurance please

15 months ago
The details: 

Approximately 2.5 years ago I had an unprotected vaginal intercourse exposure with a prostitute. About 3 weeks later I woke up feeling a strange dull pain in my penis and groin area. I also experienced stomach pain in lower region. I went to Dr and was prescribed medication treating UTI. 

I then panicked and decided to get tested. Took a 3rd gen rapid test along w/ chlamidia & ghonoria. All negative but at 3 weeks. 

Took another 3rd gen test at 7 weeks. 
Rapid 4th gen duo test at 12 weeks. Negative. 

Was feeling strange symptoms like burning sensation on face and legs. Sore throat started at around 4 weeks and has actually persisted on and off through 2 1/2 years though it’s very mild ache. A Dr thought it was acid reflux. 

I have also been diagnosed with Seb Derm. I first noticed a red rash above my lip at around 3 months post exposure  which has since spread to areas beside nose and on cheeks. 

At 6 months I took a lab blood from vein duo test along with syphilis, ghonoria, chlamidia and herpes tests. All negative. 

I tested again 4th gen rapid at 10 mths and a year. All negative.  

I’m very concerned because I’m married and have noticed my wife has developed some small skin bumps on her face and has complained of sore muscles and gets sick more frequently. Her nose area has also developed some redness that wasn’t there in past. 

Questions:

1. Is it possible the tests missed any infection ?

2.  Are my symptoms related to HIV ?

3. Do I need any additional tests?

4.  Can I 100% move past the thought of having HIV ?

5. Have you heard of a 6 month + test changing to positive?

6. Would you have had unprotected sexual relations with your wife after the 12 week negative test as I did?

Thank you Dr. 
15 months ago
Hello 
I can’t see response to 6566 
I would like to read your answer 
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

Welcome to our Forum and thanks for your confidence in our service. FYI, Dr. Handsfield and I answer questions on the Forum interchangeably and clients are not permitted to request response from a specific person.  We have worked together for more than 35 years and never disagree in our advice to others although our verbal styles may vary.  Today I happened to pick up your question.

The encounter 2.5  years ago was relatively low risk.  Despite having a somewhat higher occurrence of STIs than the general population, most commercial sex workers do not have STIs and even when they do, most encounters with persons who have STIs do not lead to infection.  Further, the symptoms you describe (dull pain in my penis and groin area) are not typical of any STI..  with that as prelude, I'll now address your specific questions:

1. Is it possible the tests missed any infection ?
Unlikely.  Your multiple 4th generation tests unequivocally rule ot the possibility of HIV and current tests for gonorrhea and chlamydia are very, very sensitive almost never missing infection if present.

2.  Are my symptoms related to HIV ?
No, none of your symptoms are at all suggestive of HIV.  Nor are the bumps you have noticed in your wife.

3. Do I need any additional tests?
No.

4.  Can I 100% move past the thought of having HIV ?
Yes, absolutely.

5. Have you heard of a 6 month + test changing to positive?
I presume you mean a 6 month negative test and the answer is no, I know of no such situations in which a test negative six months following an exposure then became positive.

6. Would you have had unprotected sexual relations with your wife after the 12 week negative test as I did?

From your questions, I find myself wondering if you may have been searching for information about HIV on the internet- some of your questions are quite similar to those asked of us based on internet searches by others.  Unfortunately, while the internet is great for communications, internet searches are often misleading, providing data which may out of date, taken out of context or simply and sadly, wrong.  I suggest you avoid the internet when seeking health related information.

I hope that this information is helpful.  EWH

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15 months ago
Thank you Dr Hook. 

A few follow-up questions:

What particularly worries me is the seb derm. I had never experienced this before and I am 45 years old. I find it hard to believe it’s a coincidence that after this exposure I developed the Seb Derm around the 3 month mark. Any opinion as to what that could be?

I am also concerned about frequent diarrhea over the last few years as well as the sore throat I mentioned.

I guess I just find it difficult to believe I’m truly hiv negative given those ongoing symptoms even after multiple negative hiv tests ( total of 8 negative tests over the course of the first year from exposure). 

Thank you for your feedback. 
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago
My comment regarding the Internet above was specifically intended to address your mention of seborrheic dermatitis.  The fact in that the vast majority of persons with seborrheic dermatitis do not have HIV.  Further. The occurrence of seborrhea C dermatitis increases with age after age 30.  In the face of your multiple negative HIV tests it is clear that the occurrence is coincidental!!

I have no information on what your occasions of diarrhea might be but once again, I am confident it is not related to HIV.  When persons with HIV have HIV-related diarrhea it is severe and unremitting, not episodic. 

We regularly interact with persons who are nervous about possible HIV  who are mislead by Internet-derived symptoms which they find on the Internet.   I worry that this may be the case for you.  Currently available HIV tests are amongst the most sensitive tests in all of medicine.  The extraordinary instances in which infections are missed on occasion are virtually never missed on repeat tests......and as you have pointed out, you have tested negative 8 separate times.  

I urge you not to worry further about the possibility that you acquired HIV from your relatively low risk encounter more than 2.5 years ago.EWH
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15 months ago
Thank you Dr Hook. One last observation from some of the questions I’ve seen addressed on this forum. 

I understand that after 6 weeks, the human body would always produce either antibodies to HIV or the protein P24. Therefore, scientifically, it would be impossible not to produce one or the other and subsequently, impossible for a test not to pick up either the P24 portion of the test or the antibody portion of the test for a duo test taken at 12 weeks and most certainly taken at the 10 month and 1 year intervals post exposure. 

Would this be an accurate statement?

Thank you for all of the work you do and you may now close the thread after this final response. 
Edward W. Hook M.D.
Edward W. Hook M.D.
15 months ago

Thanks for your follow-up question.  The answer may help you.  It appears that you have a misunderstanding of the 4th generation tests..  You are correct that they detect antibodies to HIV BUT, they do NOT detect antibodies to the HIV p24 antigen, they actually detect the antigen itself.  The p24 antigen is protein material which is part of the virus itself and thus its presence is a reflection of the virus itself, not the antibody response to infection.  Thus DUO tests detect not only the infected person's response to infection (the antibodies) but a part of the virus itself (the p24 antigen).  Thus even if for some reason a person were not producing antibodies to their HIV infection (I should add that this does not happen- all infected persons do produce antibodies to the virus.  I make the comment because we are frequently asked if it is possible for an infected person to not produce antibodies to HIV)., the infection would still be detectable in the form of the p24 antigen.

I hope this clarifies things and my responses have helped clarify matters for you so that you can put your concerns about the encounter you describe behind you.  As per from guidelines, as well as your request, this thread will be closed shortly without further responses.  EWH

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