[Question #6739] HIV window period

15 months ago
Hello,

I had a risky encounter with a sex worker in NYC 10 weeks ago (male, gave and received anal and oral, with a condom on the whole time for both of us). I’ve had a rash on my stomach that comes and goes, and mouth sores that come and go. I’ve gotten 4th generation tests every week from week 3-10 all negative. I’ve gotten HIV RNA tests at 30 and 53 days that were negative, and an HIV 2 RNA DNA test at 9 weeks that was negative. The symptoms all suggest HIV and they are absolutely not in my head. Could I be the .0001 percent of people that don’t test positive for antibodies until 6 months? I’m otherwise healthy. The person was Brazilian so I’m worried it may be HIV-2. 

I did get treated for either mgen, chlamydia, or gonorrhea about 4 days after because I had urethritis. It went away from the antibiotics. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
15 months ago
Welcome and thanks for your confidence in our services.

I suppose you could look at this encounter as risky -- sex between men falls into that category. However, condoms work, making it a very low risk event. That said, having had nongonococcal urethritis (NGU) is consitent with a lapse in condom success, and it was reasonable for you to be tested for HIV.

But your symptoms don't fit with a new HIV infection (acute retroviral syndrome, ARS) as much as you think. You really can't read lists of symptoms that may occur, and conclude on that basis that you're infected because you have a few of them. Virtually all ARS symptoms on such lists occur far more commonly in people without ARS. Much more important than individual symptoms is the pattern and timing, and your pattern and timing don't seem to fit. Mouth sores are absent in most people with ARS, and the skin rash of ARS doesn't come and go. The typical pattern is fever, sore throat, enlarged lymph nodes in several areas, and skin rash, all starring 7-10 days after exposure and clearing up entirely by 4-6 weeks.

But most important, your blood test results prove without doubt you weren't infected with either HIV1 or HIV2. I'm not sure where you read about any percentage of persons who don't test positive with the tests you had until 6 months. To my knowledge, this simply doesn't happen with the HIV tests in current use. And you had all those RNA tests as well as antibody testing.

So all is well. You should not have any further HIV tests and can go forward with complete confidence you don't have HIV.

I hope these comments are helpful. Let me know if anything isn't clear. Best wishes and stay safe.

HHH, MD
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