About 3 weeks after I dealt with congestion that could have been caused by allergies. There was a lot of sneezing and then about a week of post nasal drip. I also had a sore throat.  I took a Claritin D that then made my mouth and throat really dry and the sore throat persisted for a few days after. 

I got tested with CMIA 4th gen  duo test at 38 days post exposure and u was negative but then I started getting diarrhea every morning for about 3 weeks. It wouldn’t happen during the day, just in the morning. Sometimes looser than I’m used to and sometimes watery. It cleared up with Imodium. 

I convinced my ex to get tested and he did at 44 days with a 4th gen test with reflex and he was also negative. In the days that followed I have had random days (not everyday, just here and there) of headaches or lightheadedness and fatigue. No fever. 2 weeks ago, I noticed a 2 swollen lymph nodes on my neck while I have been having a persistent dry cough ever since my sore throat subsided. So it’s been about 3 weeks. 

My question is: are these tests conclusive or should I still be worried and retest judging by my symptoms? My ex assures me I have nothing to worry about and he took the test and showed me the results to ease my mind but I am still really worried. 

It is 100% certain you do not have HIV, because indeed the test results you report are conclusive. Your negative HIV test, at 38 days, is around 99% conclusive; and your partner's negative test proves for sure he was not infected at the time of your exposure.

Also even if your partner were infected, the average transmission risk for a single episode of performing fellatio (with semen swallowing) is around 1 in 10,000 (equivalent to giving BJs to HIV infected men once daily for 27 years before transmission might be likely).  Further, your symptoms were not concerning:  new HIV infections do not cause nasal congestion, sneezing, or postnasal drip. Finally, none of the symptoms described in your follow-up message are at all suggestive of HIV.

I hope these comments allow you to move on without worry about HIV. Please don't waste any more money, time or emotional energy on another test; you don't need it. Let me know if anything isn't clear.

HHH, MD

And even though your test result is not quite conclusive for infection at 99%, it is conclusive in regard to symptoms:  it is not possible to have symptoms caused by HIV and have a negative antibody (or AgAb) test result. It is the immune response to HIV, not the virus itself, that causes all of its symptoms, thus not possible to have symptoms without detectable antibody. And as I already said, your symptom are not typical of HIV anyway. 

Don't overthink it:  all is well!

1. Should it be any concern that the swollen lymph nodes occurred about a week and a half after I was tested? As in that particular symptom wasn’t around when I tested negative. It appeared 7 weeks post exposure. If by the off chance it was an ARS symptom, would the test be a false negative since the symptom hadn’t occurred yet. 

2. Should the fact that I only have 2 small swollen lymph nodes make me worry less as it’s only in one area? I’ve had them for over 2 weeks now. 

3. Do ARS symptoms happen all at once and can they come and go or do they basically disappear around the same time? 

4. At times through this entire ordeal my skin would feel hot when I self checked but I didn’t feel feverish and didn’t have access to a thermometer. The hot feeling would usually disappear rather quickly so I didn’t assume it could be a fever. This also happened after testing. Is that a worry? 

5. Lastly,  is it possible for there to be a period between P24 antigen depleting and antibodies rising that neither one is detectable because both aren’t at high levels to be picked up by tests? 

Again thank you thank you thank you for your help and candidness. The work you do is amazing. 

2. HIV related node issues always are body wide, i.e. several locations.

3. All at the same time, plus or minus maybe a week or so.

4. Almost certainly psychological.

5. No, not possible. There is online chatter about a "secondary window" between p24 antigen disappearance and detectable antibody. It's basically an urban myth. It is the antibody that clears p24 from the blood. Once p24 appears, p24 or antibody (briefly both) are detectable for the life of the infected person, no exceptions. 

6. No, I have never had such a patient in my personal experience, although we know it happens. It you think about it, this is an illogical question. Rare events happen independent of any particular physician's personal experience. To my knowledge, no patient of mine was ever struck by lightning, but that doesn't mean my patients (or those I counsel on this forum) are at lower risk of being struck than those of some other doctor! 

My final advice is that you stop searching about all this online. It seems clear that's what is generating much of your partial knowledge, uncertainties and fears. Anybody can post anything, and the internet is not a friend to most anxious persons who look for information related to those anxieties. The famous statistician Nate Silver (fivethirtyeight.com) wrote a book about public understanding of statistics, "The Signal and the Noise". In it he writes (approximate quote) "Give an anxious person a computer with an internet connection in a dark room, and soon he'll believe his cold is the bubonic plague." Sound familiar? I suggest laying off entirely -- or at least limit searching to professionally run websites and avoid those run by and for people with the problem at hand.

That completes the two follow-up exchanges included with each question and so ends this thread. I do hope the discussion has been helpful and you'll be able to relax about all this!