[Question #7529] HIV Symptoms and Testing

4 months ago
Hello Dr, thank you for the service, very grateful in these hard times. I am now at week six from possible exposure and of course I am riddled with anxiety. I wanted to include as much information as I can to help make things clear.so I got black out drunk on 11/11/2020 I don't remember the day but remember the date very clearly. I ended up in a hotel room, naked and robbed. looking at my messages I had spoke to many people on a dating app, at least one two people came and went, don't know what happened and didn't message further. I got so nervous and scared. I gathered my things, went home, deleted the apps and wallowed in shame. I thought to maybe get PEP since I had taken it before but I was robbed, didn't have ID and just felt so shameful, truthfully I tuned out for a couple days. now on to the weeks that followed.week 1: I was depressed from the situation and reeling in with my drinking problem. I tried to make myself busy with work and keep my mind off things. then I got a swollen lymphnode in my neck and ulcers in my tongue (one minor and went away in a day). I tend to always get these coming and going so thought nothing of it. stomach started acting up but also concluded it was my IBS and I was just being overreactive.week 2: I began to feel fatigued, stressed and more depressed. angry with my actions and also my reactions to the situation. constant diarrhea and fatigue. week 3: things started to turn for a weird turn symptom wise, sharp stomach pain that felt stabbing and continued diarrhea. then i experianced a new feeling, clamminess in hands and feet. it lasted for almost two weeks. week 4: got tested with determine rapid AG/AB test and came back negative. a wave of relief. when i got home i had a weird rash on legs and back then appeared and disspaeared several times. then i started waking up with daily tongue ulcers. every motning a few on sides and tip of tongue that went away in couple hours. this and the rashes began to start making me worry again. n

4 months ago
continued:

the rashes and the mouth ulcers at week 4 have still been going on now into week 6. they come and go constantly. i still have diarrhea every now and then and headaches and body sweats. the sweats have been mostly around my neck when i wake up.

the person i tested with at week 4 said that the rapid ag/ab test is good by 28 days. but of course the internet has conflicting information. some say that it is only effective at two weeks and then antigens go away.
so now onto my questions

1- is it possible i missed the window period for the rapid ag/ab test?
2- how reliable are these rapid tests (alere, determine) at 4 weeks?
3- can anxiety create symptoms the more my mind wonders?
4- do rashes connected with hiv come and go and change location or are they on a spot for a while and stay? how about tongue ulcers?

Thank you so much for everything and all the best. looking forward to hearing from you soon.

Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago

Welcome to our Forum and thanks for your questions.  I'm so sorry to hear of your trauma and robbery.  Several general comments and then I'll get to your specific questions.  When persons are robbed, unless it is part of the act of robbery, assault- sexual or otherwise- is rarely part of the activity.  Thus it is somewhat unlikely that you were sexually assaulted.  Secondly, HIV tests can be expected to perform in different way in different situations. The first situation is testing of otherwise asymptomatic persons to determine if they may have become infected without knowing it, the most common way HIV is detected.  The second way however is to test to determine if specific symptoms are due to HIV- this sounds like the situation you're in.  When persons are tested to determine if symptoms are due to HIV, then, if the test is negative the person can be completely confident that their symptoms are NOT due to HIV since virus levels and/or reactive antibodies are invariably present if symptoms are due to HIV.  Thus, with your negative tests, you can be completely confident that your symptoms are not due to HIV. 

One additional comment.  Please don't be misled by the internet.  Statements found there are often wrong and there is not good way to determine what statements are correct vs those that are out of date, taken out of context or just plain wrong.

Now for your questions:

1- is it possible i missed the window period for the rapid ag/ab test? 
NO.  The idea of a "window" period is internet fueled misinformation.

2- how reliable are these rapid tests (alere, determine) at 4 weeks? 
       At 4 weeks these tests will detect well over 99% of recent infections.  As I noted above, if your test is negative, this would also PROVE that any symptoms you might have were not due to HIV.

3- can anxiety create symptoms the more my mind wonders?
Anxiety can both create symptoms and make normal sensations feel like abnormal symptoms.

4- do rashes connected with hiv come and go and change location or are they on a spot for a while and stay? how about tongue ulcers?
The rash of HIV can come and go but once a person has an HIV associated rash, their test will  be positive.  Tongue ulcers are not a sign of recently acquired HIV- another internet fueled misunderstanding.

I hope these comments are helpful. EWH
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4 months ago
Hello Dr.Hook,

Thank you for such informative advice and a clear response, I will do my best to not be repetitive in my understanding with my follow up.

about the rash, I noticed it a couple days after I received my rapid ag/ab test. would that be possible seroconversion? (I had been feeling all different types of symptoms up until that point like fatigue, headache, clamminess, nightsweats) It started on my thighs and it appeared for a few minutes and disappeared onto my shoulders and my arms. every couple of hours changing spots. I don't really notice rashes like this often, it was happening a lot in the beginning and becoming less and less noticeable, this coupled with the tongue ulcers had me fall into the good and bad sides of the internet. my tongue ulcers really freaked me out because even though i have had them before and often they were so much more noticeable now and in bigger quantities, but just like the rashes, they would disappear.

Admittedly  this whole situation has left me with a lot of trauma and dealing with it has been tough. hyper-focusing on these things have not been helpful at all. it's been hard  enough for me to even look at the mirror and i have felt very disassociated with myself. aside from it all my health has really been hard. i don't want to put myself in this situation and I've learned a lot about HIV and all the medical and scientific advancements.
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago
The rash of recently acquired HIV is very non-specific and most people do not experience it. It’s difficult to state whether a given rash is or is not related to the infection. In your case however given the circumstances and the fact that you tested negative just a few days later suggests that this was not HIV. We find that when persons are anxious about a potential exposure they tend to be hyper-aware of their body and notice minor changes that would otherwise be overlooked.

As I said above, the association of oral or tongue ulceration with recently acquired HIV is Internet driven mythology. Please don’t let that bother you.EWH
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4 months ago
Thnank you Dr. Hook.

truly appreciate your honest and sincere answers. I definitely have been very hyper-vigilante. I want to state that I am definitely seeking the professional help for my anxiety and the former mentioned drinking problem. this event has put a lot of fear in me to be more aware and respecting myself more. I wish I spent more time trying to figure out what happened that night but its truthfully not even a blur, just nothing. the messages I had before deleting the dating/sex app that day suggest I had someone over and could of been promiscuous before being robbed, but I cant say I know what happened. making huge strides to change. I am also retesting as soon as I could get another appointment now that its six weeks  because this is only growing into a worse fear and will only make me more sick. I take your advice and your explanations to heart and am grateful. I had been so good in response to covid that this was my breakaway moment and I hope I could learn and grow from it. not only for me but for my family.

as a final suggestion and question, would you recommend oraquick? or rapid 4th gen ag/ab tests are better and more accurate?

Thank you and Happy New Year


4 months ago
and also to anyone who comes across this, please if you feel like you have had a dangerous encounter, even if you cant remember, just breathe and try to figure out what to do. don't give up and feel down like I did and then end up worrying yourself like I am. prep is great and pep is an amazing post exposure  offered , although I wish I went and got it earlier I will make sure to get on prep and take care of my sexual health. always use condoms and don't drink and sex!
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago
Thanks for your thanks and your wise counsel to others who may read our exchange.

Congratulations as well on your decision to seek professional help in addressing your challenges.

Regarding further testing, the Oraquick test is our least favorite test.  It is a tiny bit less sensitive than other tests and only tests for HIV antibodies while the rapid  4th generation antigen/antibody are more sensitive.  I would go with the 4th generation test.  

This completes this thread.  Take care. EWH 
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4 months ago
Dr.hook, absolutely thank you so much, I appreciate everything. all the best.
Edward W. Hook M.D.
Edward W. Hook M.D.
4 months ago
Glad I could help. EWH ---