[Question #7330] Concerned about HIV

5 months ago
I'm married. 13 wks ago had Unprotected vag sex with a man of unk status. got sick 2 weeks later. severe mouth outbreak. It almost looked like a HFM disease. Sores and ulcers everywhere. I have an IUD. My period lasted 3 wks. Had another period 1.5 wks later. discharge in between the two. Discharge white w/a smell and cramping. never had a period that long and twice in 1 month. No pain during intercourse. 

Week 11 my husband had a fever and night sweats for 4 days. No other symptoms.

At 10 wks 3rd gen rapid HIV test, finger prick, negative.  I requested the partner I had at least send me a OTC oraquick swab result. Negative. 

At 11 wks I was tested for trich, bv, gonorrhea, syphilis, chlamydia. 4th gen ab/ag finger prick as well as blood draw. Done at hospital clinic. All negative.

Week 12. Negative oraquick oral swab. 

I have Crohn's disease, inject Humira weekly.

I read PCR RNA tests are a waste of money. Do you concur? 

Do I need to test again for syphilis?

Does Crohn's/Humira affect my window period? 

Would HIV cause menstrual issues so soon? Same thing w/PID?

What causes people to take longer than 3 months to develop antibodies?

Do oral/gum issues tend to happen?

Is the ab/ag combo more reliable in the early weeks?
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago

Welcome to the Forum and thanks for your question.  I'll be glad to comment.  You don't say much about your partner but I will presume that you are located in the U.S. and that here is no reason to assume that your partner has had sex with other men or is an injection drug user.  That being the case (and, to be honest, even if he did not have those characteristics), this was a low risk encounter.  The reason I say that is that for non men with other men as sex partners, somewhere in the neighborhood of 1 in 1000 persons, at most have HIV and while other STIs are more common, most people do not have STIs.  Further, most single exposures to infected partners d not lead to infection.  Your tests serve to further confirm that you were not infected and should be believed.  The viral illness you experienced about two weeks after the encounter are most likely coincidental and I suspect you passed it on to your husband.

To answer your specific questions:

I read PCR RNA tests are a waste of money. Do you concur?
Yes, I concur- at the times you were tested, even while taking Humira, your test results were conclusive.  Even if your antibody production was compromised by the humira, HIV antigen would be present and detected if you had been infected.  Believe your test results. 

Do I need to test again for syphilis?
No, syphilis is extraordinarily rare.

Does Crohn's/Humira affect my window period?
In theory but questionably in practice, your Humira might delay antibody production but would have no effect on the presence of antigen which is also detected by the 4th generation HIV test that you took. 

Would HIV cause menstrual issues so soon? Same thing w/PID?
This is most unlikely. Further, if you had PID, I would expect your tests for gonorrhea or chlamydia to have been positive. 

What causes people to take longer than 3 months to develop antibodies?
This does not happen often.  Just about everyone has produced antibodies by 6 weeks.  As I mentioned above, your Humira might slightly slow antibody response but I would expect you to have antibodies present by 8 weeks and as I said above, even if, for some reason your antibody production was delayed, antigen would be present and detected.

Do oral/gum issues tend to happen?
No, not with either STIs or even HIV.

Is the ab/ag combo more reliable in the early weeks?
Results of 4th generation HIV antigen/antibody tests are completely reliable at all times more than 6 weeks following exposure.  You can believe your test results.

I hope that the information I have provided is helpful. If anything is unclear, you have up to two follow-up questions which can be used for clarification.  Please don't worry.  Have confidence in your tests.  EWH
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5 months ago
I was doing my best to stay within the character limitation for the first question lol

But yes, I'm in the US. My partner, from what he has told me, has never been with a man, nor does he use drugs, he has to take drug tests for his job. But I only met the guy like a week earlier, so I don't know much about him outside of he is married also, and he and his wife have had instances where they have foursomes with other couples. So that is moreso why I'm a bit anxious as well.

So are you saying menstrual issues don't happen in the first few months of infection, or at all? I've read that women who are infected can have these issues (poz website), but I'm not sure if it meant further into the infection or not.

In regards to the 4th generation, I read that the antigen tapers after a few weeks, so wouldn't my 11 week test be picking up antibodies only? And if Humira possibly delays development of antibodies, could that make my test be negative? 

I should also say that my 90 day oral swab was negative also. But I know not to put too much weight on it as it's an OTC test. I'm actually scheduled to go to Planned Parenthood Thursday to test again....even though this may be overkill. 

The only reason I am questioning the window period for myself is due tonthe possibility of late antibody development due to the Crohn's and/or the Humira. I've had a rough time these past three months and I'm not sure i can mentally make it through another 3 without having a nervous breakdown. 

There was a huge gap where I was sick and then my husband was sick....with different symptoms. That's another reason I am more concerned. 

All I can say is lesson learned. 
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago
I appreciate your efforts to observe our character limitations and thank you for that.  I also understand your concerns, particularly given your Crohn’s and the Humira but I remain confident that you are in the clear.  I’ll be glad to explain.

In persons with far advanced, late stage HIV (AIDS), as they are ravaged and debilitated by the disease there can be menstual disorders but this is more likely the result of the diseases overall impact on health, not the HIV itself.  Menstrual problems are not part of early HIV.

You are correct that HIV antigen levels can decline after the first 8-10 weeks of infection but this is because of the development of antibodies and partial immunity.  If you were not developing antibodies because of your Humira, your antigen levels would be high and easily detected by the 4th generation tests.  You can believe your test results.

As I said above, your results are conclusive.  You don’t need further testing from a scientific perspective.  If you test again at PPH, please let it be your last test related to this encounter.

I hope this helps clarify things.  If there are further questions, please don’t hesitate to ask.  EWH
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5 months ago
Hello again!!

I did have my appointment with PPH, 13 weeks after my questionable incident. I had them do a finger prick rapid, which I believe was a 3rd gen at this location, as well as a blood draw 4th gen. Both non reactive. 

I think where I, and so many others, get hung up on is that many websites continue to say that some people take longer than 3 months to develop detectable antibodies. PPH being one of them. Whereas the CDC and POZ sites, as well as this site, i-base, and medhelp, stick with 6 weeks and/Or 12 weeks conclusive. I want to be confident. But I am still not able to move past it. I wanted to feel relief. If anything I feel less confident, like I need to continue testing for longer. I understand the anxiety that surrounds everyone here asking questions. We are terrified we may fall into that small little window of folks who won't test poz until a little later down the road. I met with my gyno on Wednesday, and even she stated I needed to retest at 6 months. I'm so confused on the way forward from here. 

Something else maybe you confirm. Many of the posts here, or on poz and medhelp, there are people who have months of unexplained medical issues that 'conveniently' pop up after a sexual encounter. After testing at 3 months, they still cannot accept the results and move on, and that is typically because they are still having ailments. But when someone has an acute hiv infection, that typically does not cause months of ailments after the initial infection, correct? Maybe just a week or two of being sick, if sick at all, and then the body just goes back to ops normal until later on? 

I am working with my gyno on the menstrual issues. Thus far we cannot attribute them to STIs, she felt the need to again test for gonorrhea and chlamydia, a yeast infection, BV. Again all negative. I kind of find gross humor in being able to accept these results, but not the HIV results. She put me on doxy for God knows what, maybe a just in case measure until I have my ultrasound. But you have already addressed that acute HIV does not cause menstrual issues nor PID. I'm only reiterating that for other women who may seek this forum for medical counsel. 

I thank you for your time and your intel. I know it cannot be easy to have the worry warts constantly questioning your medical counsel. But we appreciate you.
Edward W. Hook M.D.
Edward W. Hook M.D.
5 months ago

Thanks for your follow-up post and thoughtful reflections.  It's good to know that despite all the conflicting statements, your rational self (as opposed to our emotional selves [we all have an emotional self], where rationale arguments don't always suffice) sees the logic in my reply.  A major problem with the internet is that once there, things don't go away.  Further, both a strength and a weakness of the internet is that it is un-edited.  These facts allow confusing mis-statements, out of date information, and statements which are presented out of context to accumulate and sometimes shake our confidence.  Finally, all too many clinicians and even some "official" sites are so worried that they might be wrong that they take well proven scientific facts and then expand them in a mis-directed effort to "be sure" no appreciating the anxiety that such overly conservative recommendations cause.  Your GYN is, unfortunately, being overly conservative.  In 6 months your results for the encounter you described will be the same as they were most recently when you were tested.  Stay strong.  Over time, I suspect you will allow yourself to no longer worry about HIV from the encounter you described.

You are correct.  When persons become symptomatic from recently acquired HIV, those symptoms are not long-standing and typically resolve in a week or two following their onset.  When persons worry about HIV (and other illnesses, including other STIs) they tend to pay closer attention to themselves, their body, and sensations which are normally not noticed or felt to be abnormal.  This heightened awareness certainly can exacerbate concerns in the way you suggest. 

As you know, we provide up to three responses to each client's questions. This is my 3rd response. Thus this thread will be closed later today without further responses.  Take care.  Try your best not to worry.  You do not have HIV from the encounter you described.  EWH


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