76 days ago I engaged in protected vagina and unprotected oral (both ways) with a 40 year old promiscuous black woman of African descent. She has been living in ireland for over a decade. 

I've tested for Chlamydia, Gonnorhea, Syphilis and HIV several times and have undoubtedly over tested for HIV. 

HIV Tests are as follows:

4th Gen: 4, 5, 6, 7, 10 weeks

INSTI POC rest (3rd Gen?) : several times up to and including 10 weeks and one test yesterday (75 days) 

All of the above were negative. 

I want to clarify ALL of the above were finger stick samples, not venous. The 4th gen tests were self samples. They send out a vial of blood, you collect 15 drops of blood from your finger and mail the sample to the lab. 

The reason I am anxious is that I had a pain in the armpit region yesterday that still persists. Its located very slightly above nipple level on the edge of my pectoral muscle. I'm not sure if I can feel a swollen lymph node or not using my fingers. It's almost like it's a pain on the very top of my ribcage. Intercostal muscle strain maybe? 

My questions are as follows:

1) Is the window period of 4th gen tests the same for both venous and finger stick samples? Are they both absolutely conclusive at 45 days. 

2) The NHS/HSE have a window period of 7 weeks on the information sheet with the test, any reason for this? 

3) As I have tested with 4th gen to 70 days post exposure and insti test to 75 days, is it absolutely certain I didn't acquire HIV from this encounter? 

4) What is the window period for INSTI POC test? 

5) As it seems to have appeared 75 days post exposure, is it in anyway biologically or scientifically possible that the swollen armpit lymphnode could be linked to either ARS or HIV acquisition from the above exposure? 

6) is it absolutely save to have unprotected sex with my regular partner without fear of passing anything on? 

And finally 7) is cunnilingus an independent risk factor for the acquisition of HIV? 

Thank you Doctors

The bottom line is that you can be very confident you do not have HIV. You have been seriously overtested! First, you had a lower risk exposure than you might think. Even if your partner had HIV (which she probably did not), condoms work; and HIV has never been documented to be transmitted mouth to penis, so even unprotected oral sex is entirely safe. However, for absolutely conclusive results, you could have a lab-based antigen-antibody (AgAb, "4th generation") blood test instead of another rapid test. In the meantime, it IS 100% certain your symptoms are not due to HIV:  it is not possible to have HIV symptoms with negative antibody test, including the rapid tests. And your symptoms don't suggest HIV anyway.  To your questions:

1) Yes, the AgAb tests are conclusive after 6 weeks or 45 days, for both rapid/fingerstick and lab-based tests. However, some of your fingerstick tests might have been antibody tests, not AgAb -- those are conclusive only after 8 weeks, not 45 days.

2) Different agencies quote slightly different windows for a variety of reasons -- how they interpret the science, conservative approaches to assure people are tested at conclusive times, and so on.

3) Yes, those results are conclusive, regardless of risk at the time of exposure and regardless of symptoms.

4) INSTI tests only for antibodies, not antigen -- hence 8 weeks (although officially 3 months).

5) Nope. Not possible. You cannot possibly have symptoms due to HIV with negative antibody tests for HIV.

6) From an HIV standpoint, you definitely can have sex without putting your partner at risk.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

Just some clarifications/ further questions. 

The 4th gen tests I had were not rapid tests, rather they are what are called self-sample tests in the UK and Ireland. The lab will post you out a mini-vial to collect a small blood sample (approx 15 drops) using a lancet on your finger. You then send the sample back and the lab will process the sample. I believe they extract plasma from the sample and run the test as they normally do a venous sample. 

1) Would this be as accurate as a standard venous sample test as they both use the same machine, and it is NOT a rapid test? 

2) I had unprotected oral sex both ways. Is cunnilingus a risk factor for HIV? 

3) I only took an insti test one day after the possible swollen lymph node appeared (Day 76 post exposure). Would this rule out HIV as the cause and could HIV or ARS ever cause an isolated swollen lymph node 75 days after an exposure? 

4) I see that Sweden have officially declared the INSTI test conclusive for HIV testing at 8 weeks for HIV1. Do you believe its also conclusive for HIV2 at this point? 

5) As I have explained the testing procedure for my 4th Gen tests above and that they are lab based, albeit with a fingerstick sample rather than venous, does this prove with 100% certainty I didn't acquire HIV from the above exposure? My last test was 10 weeks post exposure. 

Thank you doctor 

I just want to add its difficult at the moment in ireland to test in a standard manner, as our health service is experiencing a ransomware attack and many of its systems are down! Covid has also closed our sexual health centres. 

And to add, the services for the self sample fingerstick 4th gen lab based tests are Shl.uk and SH24.org.uk. Both are accredited by the NHS and HSE and use world renowned labs. The NHS are moving towards these self sample services if an asymptomatic person wants STI testings, the in person clinics also suggesting users test this way. 

Thanks again, Doctor 

Just in case this changes your assessment as it may be a fever. 

1,5) Yes:  fingerstick blood is just fine for lab-based testing -- i.e. no less suitable than blood from a vein. Your test results PROVE you do not have HIV. The answer won't change just because you use different words to ask the same question!

2) There has never been a reported case of HIV that apparently was acquired by cunnilingus, either for the oral partner or vaginal partner. That doesn't mean the risk is zero, but obviously it is exceedingly low, given the billions of cunnilingus events that must have happened in the last few decades of the worldwide HIV/AIDS epidemic.

3) As I said above, "You cannot possibly have symptoms due to HIV with negative antibody tests for HIV." If the node had been caused by HIV, the test would have been postive.

Just a couple of final questions. 

I'm now on the 92nd day since my exposure. I've developed what I think might be a minor rash on my stomach area as of day 90 post exposure. 

1) Is it at all possible that this rash is related to ARS or the possible HIV exposure three months ago? 

2) As said above, I had a negative fourth generation test on fingerprick blood sample but carried out in a lab on day 77. On day 90, I had a negative Insti rapid test and rapid Clearview negative test. Do these results conclusively prove I did not acquire HIV1 OR HIV2 from the exposure? 

3) Is it safe to resume unprotected sex with my regular partner? I've also tested negative for other STDs along with HIV. 

4) When are POC rapid antibody only tests  truly conclusive for both HIV1 and HIV2 when negative? 

Thanks again

1) Rash is never the only ARS symptom, and this rash isn’t suggestive of ARS anyway. You can’t go through life attributing every new symptom, tingle or twinge to HIV!

2) Re-read my replies above. Your test results are conclusive and should be believed.

3) Of course you can resume sex with your partner. You should have done that long before now.

4) 6 weeks for HIV1, 8 weeks for HIV2.

That concludes this thread. Do your best to move on without further worry about HIV.