[Question #9240] Hiv concerning long symptoms

35 months ago

Several weeks ago, I had anal intercourse as the insertive person with another male who claimed to be disease free. I used a condom, but it appeared to be damaged after our intercourse and my penis slipped out as I was removing it. The damage looked like stretching and bubbling but the condom did not appear to be broken. I thought this event was near zero risk so I never even considered I could get HIV.

4 days after, I develop swollen nodes in the front of my throat, and under my jaw. I also had a mild sore throat for about a week. My nodes remain swollen and painful even now. I felt mild pain in my shoulder and groin area but no fever at all. I might have had a rash but I am unsure since I have chronic skin issues. I've felt more and more sick since then, and I've had a duo test on the 12th day of exposure that was negative. Still feeling sick I did an oral test at 6 weeks which was also negative.

Around week 5 I started feeling very fatigued and developed malaise and headaches. Swollen nodes remain, and hurt greatly. These symptoms persist and it's been a total of 8 weeks so far.

1. My first question is, is it possible to develop swollen nodes that soon after HIV exposure?

2. I've read that is ARS does occur there is usually a high fever. I think i have ARS but haven't had a fever yet.

3. If I had started ARS at the first week would my 6 week rapid oral test be positive?

4. Is it possible for ARS symptoms to last for 7 weeks?

5. I'm getting sicker, is it possible my viral load is increasing and causes these symptoms?

I've been to my doctor a few weeks ago but I am afraid to get another blood test at my hospital due to the discrimination my country has if I am positive. Currently, I feel like I am 99.9% sure that I will be positive on subsequent tests. I didn't know how much anxiety a situation like this could cause and your input may help me.

Edward W. Hook M.D.

35 months ago

Welcome to our forum and thanks for your questions. I’ll be glad to comment. Congratulations as well on your commitment to safe, condom-protected sex. I agree with you that the encounter you describe was safe sex. When condoms fail, they break wide-open and the stretching and bubbling of the condom you used, while unusual, is unlikely to represent failure of the protective affect. In addition, when condoms slip off as an individual is removing themselves from a partner , leaving the condom behind, the condom still has done its job. Thus, my assessment, like yours, is that this was a low risk encounter. Further, your testing proves that your recent symptoms were not due to HIV. In response to your specific questions:

1. Development of swollen lymph nodes related to recently acquired HIV at four days following an exposure would be most unusual and unlikely.

2. Correct, high fever is part of the expected symptoms of the ARS

3. Yes, your test would’ve been positive. When symptoms are due to the ARS levels of circulating HIV virus and antibodies are present in large amounts and as a result, 4Th generation HIV tests are always positive.

4. No

5. No, you were testing proves that your symptoms were not due to HIV and the fact that you are getting sicker means that there may be another cause to your symptoms. You may have acquired a non-HIV virus wellness such as mononucleosis. I would recommend that you work with your doctor to determine the cause of your symptoms. There is no reason to think that they are due to HIV. I would recommend that you return to the same doctor you saw before if you feel comfortable with him. He has the advantage of having seen you in the past and thus will appreciate the fact that your symptoms have not resolved but, if anything have progressed and should pursue further diagnostic testing.

I hope this information is helpful. EWH

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35 months ago

Doctor, I appreciate your assessment. I have some follow up questions.

1. I have had severe muscle weakness in my arms and hands since about week 6. I've also had pain in my jaw and face. I know symptoms vary greatly but is this something that would be seen in Mono or EBV or ARS?

2. how reliable is an oral swab at 8 weeks. I intend to test again this week but I would prefer at home test rather than a laboratory. I live in a country where I would be shunned if I am positive.

3. After intercourse a few days later I developed burning in my genitals, no signs of hsv but it persists even after several rounds of antibiotics. Could this be related to ars?

4. My last question is about lymph nodes. I read on the internet that nodes in the neck can swell even after a few days of exposure of the virus . Is there any truth to this or should I be looking for a differential diagnosis?

The last few weeks I've been feeling so off and sick. I have anxiety about what is coming and even have constipation from the pressure. I hope my results turn out for the best.

Edward W. Hook M.D.

35 months ago

Straight to your follow-ups:

Your combination of symptoms are what health care providers call a "flu-like" illness. both recently acquired HIV (the ARS) and influenzas can cause symptoms of this sort. So can COVID, mononucleosis and many other viral illnesses. In careful studies, when at risk persons have these symptoms, less than 1% have HIV. If an HIV 4th generation test is negative when these symptoms are present, the symptoms are NOT due to HIV.

2. how reliable is an oral swab at 8 weeks. I intend to test again this week but I would prefer at home test rather than a laboratory. I live in a country where I would be shunned if I am positive.

The Oraquick is our least favorite test, particularly for detection of recently acquired infection. On the other hand, if an Oraquick test is negative, at 8 weeks, it is most unlikely that your illness is due to HIV

3. After intercourse a few days later I developed burning in my genitals, no signs of hsv but it persists even after several rounds of antibiotics. Could this be related to ars?

No, nor is it suggestive of herpes

Swollen lymph nodes are quite non-specific and could be caused by any of the infections I mentioned above. Again, it an HIV test is negative in the presence of swollen lymph nodes, then the nodes are NOT due to HIV

You are asking good questions. I hope the information I have provided is helpful. EWH

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35 months ago

That is good information. I have learned much from your replies doctor. Also, I did a rapid blood test today and it was negative. I do have one or two more questions.

1. Is a rapid blood test conclusive after nearly 9 weeks? Have you ever seen someone test negative on a rapid at 9 weeks and later become positive?

2. Is it possible that I am seroconverting still and antibodies wouldnt show up until 12 weeks?

I still have symptoms but with these negative tests I hope to put this event behind me.

Edward W. Hook M.D.

35 months ago

As you know, we provide up to three responses to each clients questions. Is there a result, the responses to your last set of questions will be the final responses to this thread. Following that the thread will be closed without for the responses. Onto your specific questions:

1. Yes, the performance of rapid blood test is equivalent to that of laboratory based tests. Please believe your test results. You did not acquire HIV from the virtually no risk exposure that you described.

2. No, this is simply not a scientifically reasonable possibility. You do not have HIV!

Please put your concerns related to the exposure you describe behind you. You do not have HIV. This time for you to move on. If your symptoms persist, please work with your doctor to look for other causes of the symptoms you have experienced. Take care. EWH

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