As you can see from my past question, I had an encounter with an Female Asian CSW who did not speak English well in a massage parlor around 2am approximately 3 weeks/21 days ago from today. As I was intoxicated, i do remember using a condom because I vaguely remember her rolling one on after having issues maintains an erection, but then my memory is hazy. I do remember ejaculating into a condom. My anxiety is literally getting the best of me and now I’m thinking what if a condom want used an I’m imagining using one. My reasons:

1.) I had a negative Chlamydia and Ghonorrhea urine test 9 days post the encounter. I had burning and stinging in my urethra. But I was told the exam trumps symptoms. As a result I resumed unprotected intercourse with my partner.

2.) I’m nervous if ARS. It’s 21 days post, no fevers, no rash, no sore throats thank god. My issue though is general malaise, feeling hot, slight aches which I hope is anxiety, but what I know is not anxiety is swollen glands. I have what I assume is one under my ear on/around the bone directly behind my ear flap. It sometimes aches, sometimes doesn’t. I feel as though I’m lymph nodes are swollen in my groin as well but I’m nervous to check. 

3.) Would a 4th generation duo test be reliable at 21 days? I know 4-6 weeks is conclusive, and 6 weeks for absolutely conclusive especially with higher risk. I don’t know if my exposure is considered high risk even if unprotected.

Thank you and I’m sorry for these questions and coming back. 

1) Correct about testing overruling urethral symptoms. From your description of the exposure, I don't see how you could have acquired either gonorrhea or chlamydia. But in any case, your negative test results are conclusive. You did not put your regular partner at risk for either of these STIs.

2) You describe no symptoms that sound typical for ARS. Congratulations for not checking for lymph nodes on your own:  given your OCD in general and your anxieties over this particular event, the odds are good you would feel -- or believe you feel -- swellings or lumps that don't mean anything. (A careful exam reveals groin lumpiness in most adults!) I would entirely discount any "feeling" that your nodes are inflamed or enlarged. Here too a rereading of your previous thread should be reassuring. Dr. Hook gave a conservative figure about the risk of HIV from a single episode of unprotected vaginal sex with an infected partner:  he said 1 in 1,000 transmission risk, whereas the actual estimate published by CDC is 1 chance in 2,500, and that's only if the female partner definitely has HIV. The chance your partner had HIV probably was no higher than 1%. Thus, even with unprotected sex, your HIV risk was in the range of 1 in 250,000. And you used a condom; if assumed to be 99% protective, we're now at one chance in 25 million!

3) Normally we would not recommend HIV testing as soon as three weeks. But in your case, I think you should go ahead with an AgAb (4th generation, duo) blood test. Although 6 weeks is required for conclusive results, 90-95% of newly infected people have positive results by 3 weeks, so a negative would (or should) provide strong reassurance. And even though it would not prove with certainty you don't have HIV, a negative result WILL prove your symptoms are not ARS. The symptoms of acute HIV infection are caused by the immune response, not the virus itself. Therefore, it isn't possible to have ARS symptoms with a negative HIV antibody test.

Finally, perhaps it will help you to know that in the 17 years of this and our preceding forum, with thousands of questions from people worried about a new HIV infection, not one person reported they actually had acquired HIV. You will not be the first! If and when that happens, undoubtedly it will be after a truly high risk event, like unprotected anal sex with a known infected partner, and not a trivial risk (virtually zero risk) event like yours.

If you go ahead with an early HIV test, I'll be happy to comment further if you would like to post the result -- but I won't have anything more to say until then. Stay mellow while you wait:  I am very confident it will be negative.

Best wishes--   HHH, MD

My anxiety is out of control so I’m going ahead and getting tested today with a 4th generation test approximately 26 days out from my incident. I say approximately because the event did happen around 2am in the morning so it’s like 25/26 days. 

I’m just in full blown panic mode because now I woke up with tonsil pain like a small ulcer or sore throat is starting to form on the right side of my throat. No other symptoms other then the lymph nodes I spoke about.

I read here before and on the old forum but I don’t know if I read it wrong that ARS almost always begins between 10-21 days and with the patterns of symptoms, 25 days would be pretty late for ARS considering I heard it’s pretty much impossible for symptoms to be ARS at 28 days. Is that true?

I will post my results when I get them. In the meantime I appreciate your help and will try to mellow out.

I just can’t believe this is happening. Presumptive condom use, now sore throat 25-26 days later, and unable to get tested when I was ready to go. It’s like the perfect storm. 

Panic at the possibility of HIV is irrational. There is no realistic chance you have HIV. Please re-read paragraph 5 in my initial reply above ("Finally, perhaps it will help....").

No further comments unless you go ahead with another test and wish to post your result.

While I know it’s not conclusive, I also was imagining a no risk situation being a risk.

I appreciate your help and will carry on. 

Seriously, thank you for all you do

That concludes this thread. I hope the discussion has been helpful. But please note the policy against repeated anxiety driven questions. This will have to be your last about this exposure and HIV testing. Best wishes and stay safe.