I am female and had unprotected sex with a bisexual man from the end of August, last encounter October 9. Mostly oral and touching but also some vag. penetration. He claims that he is not hiv + but I think he is lying. He is confident that I do not 

I had some minor blisters in mouth in September and loose stools at the end of September. On oct 11, had something that seemed like a herpes breakout (never had one before) that lasted for 3 weeks, which came with fatigue and body aches. After 2 weeks I started having major digestive issues, very slow digestion/feeling full after a few bites/etc. nausea/ IBS. Test for hsv1 and hsv2 negative at 1 month.  Went for hiv finger prick test at planned parenthood first week of nov and it was negative.  Rash that felt hot to touch appeared 6 or 7 weeks after last encounter on shoulders but dermatologist said it was nothing and it just looked like the keratosis pilaris that is on my arms. Rash went away but my skin on shoulders and arms are still irritated. I experienced blurry vision and neuropathy. Knees hurt too. Digestive problems lasted for two months, a lot of gurgling at night. Lost 10 pounds. Persistent white tongue. I haven’t had any major sore throats, a high fever (although I did have chills) or any noticeable swelling in lymph nodes. 

 My naturopath gave me monolaurin and a natural antiviral thinking that I have EBV which I have been taking since the beginning of December.

I did an oraquick oral fluids at the end of December and again on January 11 (at least 3 months from last encounter) but they are negative.

I feel slightly better now with the exception of extreme anxiety, some minor, insomnia  and the white tongue.

1. Do you think that I am safe with the negative oraquick results? I was thinking of doing another next month.

2. Could the natural antivirals prevent me from making antibodies? Is it possible that my body can’t fight this virus and that is why I have been having symptoms for three months straight? 

While I understand your concern, you really should not be at all worried about HIV:  there is no realistic chance you have it. Your risk was low -- probably your partner doesn't have HIV (people rarely lie about HIV status when asked directly); and even if he is infected, your exposures were mostly safe. (Even unprotected vaginal sex with an infected male partner, with ejaculation in the vagina, has an estimated average risk of one chance in 1,000 of transmitting HIV.) Second, your symptoms are not typical of an HIV infection (as you seem to realize yourself, given your comments about absent fever, lymph node abnormalities, etc). Third, although the oral fluids HIV test can miss some infections (more information below), the negative result does prove your symptoms are not caused by HIV:  symptoms of an initial HIV infection are not due to the virus itself, but to the immune response to the virus. Therefore, it isn't possible to have a negative antibody test like Oraquick in the presence of HIV symptoms.

To your specific questions:

1. For the reasons above, indeed you are safe in believing you do not have HIV. That said, the oral fluids test misses 2-5% of HIV infections, and is never the best test following a worrisome exposure. However, the finger stick test at Planned Parenthood, about a month after your last exposure, was nearly conclusive. But for a truly conclusive result, have a lab-based HIV AgAb test (antigen-antibody, also called "4th generation" or "combo" test). You definitely can expect a negative result.

2. Sorry, but you won't find any support on this forum for non scientific treatments. "Natural antivirals" are scientific nonsense. I've never heard of monolaurin, but a quick online search shows it is derived from coconut oil; there is no possibility it has any immune system benefit. On the good side, however, it also cannot possibly interfere with antibody production or the reliability of any HIV test. 

If you decide to follow my advice and have an AgAb test, feel free to let me know the result. Stay mellow in the meantime:  you definitely can expect a negative result. (You might also like this fact:  In the ~15 years of this and our preceding forum, with thousands of questions from persons concerned about having HIV, not one has reported that they eventually tested positive. You won't be the first! If and when that finally happens, almost certainly it will be from a genuinely high risk exposure, like unprotected anal sex among men who have sex with men, etc.)

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

HHH, MD

I have additional questions:

He had a small cut/sore on his penis during two of the encounters, does this significantly increase my risk? 

If I have another underlying autoimmune disease, is it possible that seroconversion could be delayed?

What else could cause a rash on the shoulders that is warm to the touch and lasts for a little less than a week? It wasn’t itchy so it couldn’t have been hives. Was the timing of this rash consistent for ARS? 

I am very hesitant to get a lab test since there is no more anonymous testing in my state, which means that my doctors, who are also my close friends, will know if I am positive. I know this should be the least of my worries but I guess I am not ready for that. 

Thanks again for providing this service! 

Penile cut/sore:  Such a lesion on the exposed person might increase the transmission risk. However, on the infected person there is no known increased chance of virus transmission. (More about this below...)

There are no known medical conditions, including those associated with immune suppression or autoimmunity, that delay HIV test positivity. In fact, with the standard recommended AgAb tests, in theory this would accelerate the time to positive results, not delay seroconversion.

By this description, the rash was not typical of HIV; I've never heard of it being localize to the shoulders -- generally an HIV rash is body-wide. In direct reply to your question, there must be a hundred medical conditions aside from HIV that could be responsible.

Confidentiality or privacy isn't a valid reason to forego testing. Inappropriate disclosure of HIV test results is extremely rare; I've never been aware of a case in my 30+ years of testing patients for HIV. In part because the protections against disclosure are so good, anonymous HIV testing is a thing of the past:  no state routinely offers or recommends it currently, as far as I know. To see your test result, your doctor friends would have to intentionally search for your medical record, which is a federal crime subject to a fine of $5,000.00 -- something well known these days by all physicians and other medical professionals. That said, you can always go to a lab in person, or find one online, and use a fake name. That probably happens a lot. (Of course this probably would mean you need to pay out of pocket instead of using your health insurance. But the cost of a single test shouldn't be great.)

The bottom line is that it remains extremely unlikely you have HIV. But for reassurance I still recommend an AgAb test.

Back to your partner's penile "cut/sore":  By far the main cause of such problems is genital herpes. That said, genital HSV1 infections recur infrequently; and presumably his HSV2 blood test was negative or you would have mentioned it. But your negative HSV1 and 2 tests at one month are only moderately reassuring:  it takes up to 3-4 months for measurable HSV antibody to show up. (I strongly doubt you caught herpes -- but something you should be aware of.)

Thanks for the thanks. I'm glad to have been of help. Best wishes and stay safe.