15 days ago I met a Mexican national online who is currently living in Ireland. She is quite promiscuous, 20+ new sexual partners a year. 

We engaged in deep french kissing and I also sucked her nipples and fingered her vagina for a relatively considerable period of time. 

She very fleetingly touched my penis with her hand. My reason for concern is approximately 8 days post exposure I experienced a mild headache and some mild sinus issues that remain on and off until now. But perhaps more pertinently, as of day 14, I have relatively significant back pain, for no known reason. The pain is concentrated in my mid to lower back. I've also been experiencing a stiff, or perhaps more accurately a swollen feeling in my neck that often extends into my shoulders and arms. I'm curious as to whether this could be interpreted as a presentation of muscle and joint soreness as a result of ARS. No fever, no obvious sore throat and now rash. The pain in the back seems to be muscular, neck feels but doesn't necessarily appear swollen and often shooting/stabbing pains in my arms.

As to my questions: 

1) what is the risk of HIV for the above activities?

2) in the unlikely event that she was in the acute phase of infection with a high viral load, would your risk assessment change? 

3) Is there any way that back pain could be the primary presentation of ARS 'symotoms'? 

4) It is surprisingly not straightforward to get tested here, at least affordably. I do have a 2nd Gen Biosure/Clearview test in my posession.  If my symptoms were as a result of ARS, how long after symptom presentation would it take for a second gen test to become positive reliably?

5) is there any medical reasoning to test at all as a result of this exposure?

6) Can I safely resume unprotected sex with my partner without testing at all? 

Thank you for your time and consideration. 

You needn't be worried at all about HIV, or any other STI for that matter. Although the timing of your symptoms is consistent with ARS, the symptoms themselves are not: ARS doesn't cause "sinus symptoms" (nasal congestion, etc) and is not a likely cause of back pain or the other symptoms you describe. It sounds like you caught a cold or other minor viral infection. And nobody in the world has ever been documented (or to my knowledge, even suspected) of acquiring HIV from kissing, mouth contact with skin including nipples, fingering, or hand-genital contact of any kind.

Those comments suggest the answers to your questions, but to be explicit:

1,2) These were very low risk sexual activities with no known risk of HIV transmission, regardless of viral load.

3) I've never heard of back pain or muscle aching as the primary symptoms of ARS.

4) I'm a bit surprised to hear it is "not straightforward" to get standard HIV testing in Ireland. There are superb genitourinary medicine (GUM) clinics and plenty of private practitioners who should be readily available. My own experience with this is in and around Dublin, but I would think it would not be an issue, at least in most metropolitan areas. However, a negative Biosure/Clearview test 10 days after onset of symptoms would be reliable evidence that HIV isn't the cause. At test at 12 weeks for sure (and probably 8 weeks) after the exposure itself would be conclusive in the absence of symptoms. And if you pursue and find a resource for an HIV AgAb blood test, i.e. 4th generation, you can be confident in regard to symptoms right now, with 98% reliable results at 4 weeks and conclusive proof 6 weeks after the event.

5) There is little if any "medical rationale" for testing, for the reasons discussed. However, you may still want to be tested for reassurance. Many anxious persons are more reassured by negative test results than by professional opinion, no matter how expert. (We don't take it personally!)

6) If somehow I were in your situation, I would continue unprotected sex with my wife without worry about infecting her with HIV. That said, the same considerations apply as above:  you may feel more confident about the situation with negative testing.

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

HHH, MD

My back pain continues to worsen - perhaps it may be anxiety related over the above incident, but again I remain fever/rash/sore throat free, at day 16 post exposure.

I guess to stem my anxiety and in the plainest most blunt English possible 

1) Was this a low or NO risk encounter for HIV? (Fingering, sucking nipples)

2) Can I SAFELY move on without the need for any testing?

3) Would I put my regular partner in any risk from resuming unprotected sex with her without testing first? 

Thank you and apologies for the somewhat repetitive questions. 

4) I have the opportunity to get tested via an insti test (3rd gen, rapid) today at an outreach programme, this would be 16 days post exposure and two days since the onset of back/muscle pain. Would this test be useful in dictating whether these symptoms could possibly be HIV related? 

2,3) Yes you can "SAFELY" (your shout) move on without testing and without putting your partner at risk. As I said above, that's what I would do if I were in your situation.

4) Symptoms of HIV are caused by the immune response to the virus, not HIV itself. Therefore, antibody is always present if symptoms are caused by HIV, or at least within 3-4 days after onset of symptoms. So a negative 3rd generation antibody test at this point would indeed show that something other than HIV is the cause of your symptoms. Conclusive proof you do not have (asymptomatic) HIV would require later testing.

She was initially unwilling to tell me the result of her test via message later that day, but after some pressing she said "it was not positive". 

A note on symptoms - the back pain continues and I now have pain in one knee and in my fingers. Is this suggestive of anything HIV related? 

I guess if the girl is telling the truth that her test was indeed 'not positive' the stars would really have to align and she would have had acquire HIV in the very days leading up to our contact to provide any risk as she was antibody negative 16 days after said exposure? 

Is there any chance I could have HIV from this? I would have put it behind me if not for the joint and muscle pain.

And final question; most STI/STD testing here is not done via post and is provided by the HSE and NHS. In effect they mail you out a small tube, you prick your finger and fill it with blood. You mail it to their lab and they test it. I was going to do this test 25 days post exposure, is it a worthwhile pursuit a medically or would this purely be to ease my anxiety? 

In looking through all your descriptions, I'm now wondering whether your back and joint pains are due to new arthritis. There are several arthritis conditions that could be responsible. Arthritis would be especially likely if there is visible redness, swelling, or tenderness to touch of the painful knee and finger. Even without swelling or redness, if these symptoms and your back pain continue, you should definitely be seeing a doctor about it -- ideally a rheumatologist (arthritis specialist), although you probably could start with your GP or an internal medicine specialist. You definitely should not ignore those symptoms! But whatever the cause, it is unlikely related to the sexual exposure you described, just a coincidence in timing. And for sure not HIV. 

Also, because of implications for possible arthritis causes, do you have any other symptoms? Like recent diarrhea? Red or itchy eyes? Skin rash of any kind? Do you have any underlying skin conditions, like psoriasis? Is there any family history of arthritis?

Threads normally are closed after three replies, but I will leave it open for one more round in case you want to provide more information about your back and joint pains and the arthritis issues. But no more questions about HIV; I'll have nothing more to say about that.

As for the joint and muscle issue - no redness or swelling, but tender to touch.

My mother has rheumatoid arthritis so it's certainly a possibilty. I have a feeling it may be anxiety - unconscious flexing muscles or tensing muscles due to stress, perhaps balling my hands into fists when asleep or something similar, but if it persists, I will for sure seek an in person medical opinion.

Thank you for your time and all of the information.

Best wishes. 

Thanks for the follow-up, and thanks for your thanks about our services. I'm glad to have been of help.