I had fairly brief unprotected vag sex four times for with someone who is hiv +, no ejaculation into the vagina. Oral with ejeculation into my mouth. I don’t know if he is on effective treatment and he won’t discuss it with me

My symptoms following the last event:

Burning abdominal pain for two days

Vaginal, vulvar and anal irritation/blisters/sores for a few weeks accompanied by muscle and joint pain (they didn’t scab)

White tongue for 4 months

Dry mouth

Chills (I didn’t get a high fever but felt yucky)

Fatigue

Gastroparesis, with cramping and loud noises (lasted a month)

Bleeding on my eyes and blurry vision

Neuropathy and weakness in arms

Pink Rash all over shoulders that felt like a sunburn and dry skin body wide

It felt like something was attacking all of my systems

I didn’t notice major sore throat, just some irritation 

I didn’t see any lymph node issues but the back of my neck felt stiff 

Three to Four weeks after symptoms started I got a chembio stat pack antibody only finger prick test at the clinic that was negative. Chembio claims it as 4th gen, but when I researched further, it only detects ab. 

(My rash came after this test)

Lost 12 pounds 

Felt sick and weak for 2.5 months total.

My tongue is still white and my abdomen hurts a little every once in awhile 

Cuts seem like taking a long time to heal 

Major anxiety, can’t sleep at all or think about anything else 

Then I have taken 5 oraquicks after the 3 month period up to four months and they are all negative.

It’s the rash that makes me think this was ARS, because I never had one before 

What is the likelihood that the tests missed my infection? Since I was having symptoms before I took the test, would the test have been positive even though it was ab only? 

Does genital ulceration ever occur as an initial ARS symptom?

Could I have Syphillis? Could hsv1 cause a viral meningitis type reaction? Could reactivated EBV cause these symptoms? Could co-infection of hiv and hsv delay antibody production? What else could I test for?

Could taking immunity boosters affect antibody production?

Please help this has ruined my life.

Sorry to hear about your exposure -- but the quick answer is that it is very unlikely you have HIV. I also doubt you have syphilis, but it might be possible and you should be tested for it.

Some of your symptoms (but not all) would suggest a possibility you have ARS due to recently acquired HIV. However, your multiple negative blood test results are very reassuring. The symptoms of ARS are not caused by the virus itself, but by the body's immune response to the virus. Therefore, when symptoms are due to ARS, the antibody tests always are positive. So your negative results prove you don't have ARS, and almost certainly do not have HIV at all. There are NO medications or illnesses that significantly delay development of HIV antibody or otherwise have any effect on reliability of the HIV blood tests. That said, you really should have an antigen-antibody (AbAb, 4th generation) blood test to be even more certain.

Other possible causes? Painful genital ulcers strongly suggests genital herpes, but the symptoms started much too late -- onset always is within 2 weeks, and usually within 5 days of exposure. And yes, initial herpes can be associated with meningitis -- but you really don't describe symptoms that are typical for meningitis, and the timing also isn't right? Syphilis? Conceivably that could be the cause of some of your symptoms. Have you been tested for it? Reactivated EBV doesn't sound likely at all.

From all you say, I have the impression you haven't been seeing a doctor about all this. That needs to change. You should see a physician you trust -- stop arranging your own tests at laboratories and rely on in-person medical advice. In the meantime, my opinion is that probably none of your symptoms are due to any infection from the sexual exposure you have described, despite your partner's HIV infection. But comprehensive medical evaluation and testing are the only way to be sure. If you follow that advice, I'd love to hear what your doctor finds and the results of additional tests. In the meantime, I think it unlikely you have any infection from the sexual exposure you have described.

Best wishes. Let me know if anything isn't clear.

HHH, MD

Good morning,

Thanks for helping me, the dr responded. Can you please post this follow up question?

Thank you for your response. I was thinking that I was in the clear, but your response suggests that there is still a possibility that I could have it. So, how accurate do you think the 3rd gen chembio finger prick test was about 4 weeks after the last exposure, about 2 or 3 weeks after the onset of symptoms?  The nurse at planned parenthood said that the test would have picked up the infection after a few weeks. Also, have you ever heard of anyone having 5 negative oraquick home tests after the 3 month window period turning out to be positive?  Thanks for your help. I will schedule an appointment for another test.

I'm glad to learn you've not been doing this testing on your own. The Planned Parenthood nurse is basically right, but still you haven't been evaluated as completely as most HIV experts would have recommended. Anyone definitely exposed to HIV, as you apparently were, really should have a PCR test for viral RNA, usually done 2-3 weeks after exposure; and antigen-antibody (AgAb, i.e. 4th generation) blood tests, usually done at 4 and 6 weeks. Various HIV experts would recommend minor differences in this schedule, but you get the idea. The rapid 3rd generation fingerpick tests would detect about 95% of infections at 4 weeks. The Oraquick oral fluids test never becomes positive in up to 5% of infected people -- oral fluids do not have the same antibody levels as blood. Those results are very reassuring, especially since you had several of them -- but not quite conclusive. 

So ask the PP practitioner to order an AgAb lab-based blood test. Almost certainly it will be negative. So don't be worried in the meantime. But of course it's best to be 100% certain.

You don't say anything else about syphilis or other STDs. You definitely need a syphilis blood test if not yet done. And also vaginal swab testing for gonorrhea and chlamydia. And given your history of painful genital ulcers, perhaps evaluation for herpes.

Thank you dr. 

A few more follow up questions to ease my mind before I make an appointment to get another test.

I didn’t get the rash until about 6 weeks after all of my other symptoms started. My symptoms lasted for over two months, and the rash showed up near the end of it all. I read in one of your responses to a question in medhelp that the ARS rash is an early manifestation of ARS, not a late one. The pink rash on my shoulders was confluent, not discrete, looking like a mild sunburn. It did leave a slight hyperpigmentation on the shoulders. It started to fade away but then got worse again after I went to the gym one day.  As I mentioned before though, the skin on the rest of my body did seem more dried out than usual.  Does this description make it less likely or more likely to be an ARS rash? Or is an ARS rash too variable to generalize?

I have also read that tests are always positive if the rash were due to ARS. Does this mean that you cannot have a positive test prior to the onset of rash, even with other symptoms? 

You said that my finger prick test a month after the last encounter would be 95% effective in detecting infection. Would having symptoms three weeks before the test increase the accuracy of the test? Or could a person have symptoms for that long and not have detectable antibodies, and only detectable antigens? How long are the antigens usually present before the antibodies? I fear that the first three weeks of symptoms were caused by herpes and the hiv symptoms started at 4 weeks but since I tested negative for both so far it’s hard to tell. I am surprised that planned parenthood only used a 3rd generation ab only test in this day and age. They also gave me a lot of misinformation and made me think my test was conclusive.

I work at a school and have a busy and productive professional life. I work three jobs. If I have hiv, will I be able to maintain my busy work life? Could I be fired from my job since I work at a school? Would the state tell my employer that I have hiv? Could I lose custody of my child?

Thanks for pushing me to get another test. I am trying to build up the courage and I am scared that even after my finger prick test and now 6 oraquicks I will be positive.

All the other preceding questions are just nibbling around the edges. I agree the rash came on too late to be due to ARS. Are you taking any drugs? Some medications cause photosensitivity -- essentially heightened sensitivity to sunburn, and thus more prominent in sun exposed areas. In any case, this doesn't sound like an ARS rash.

Cross the "What do I do if I have HIV" bridge in and when you come to it. Almost certainly you will not:  I would happily bet a $1 million you do not. Just get tested one last time.

Threads are closed after two follow-up exchanges, but I'll make an exception and leave this open for a week, for you to post your next HIV test result. I will have no further comments until then and will close the thread if not posted within a week.  In the meantime, stay mellow:  You definitely can expect a negative result. (In the 15 years of this and our preceding forum, with thousands of questions from persons concerned about an HIV exposure, not one has reported a positive result. You won't be our first.