[Question #9324] My test and symptoms

33 months ago

Hi , doctors

Please excuse my poor English, but I will try to ask my question here:

30 days ago I had an unprotected sexual relationship in the vagina with a sex worker for money in Dubai, for a period not exceeding 4 minutes, with the discharge of semen inside the vagina and it was a nice, not strong sitting.

I was under the influence of alcohol and I called her the next day and inquired about her health status and whether she had done HIV tests or something else, and she answered me that she had been coming to Dubai for a short time on a tourist visa and that she had not obtained a residence permit to be examined.

I insisted on her to examine herself and she blackmailed me by asking for a large sum to be examined, approximately $700, but I refused, so she banned me from contacting her..

I went to the lab on the 27th and 10 hours after this incident and I had a full panel of sexually transmitted diseases, including hiv combo, syphilis, chlamydia, gonorrhea, hepatitis b ag and c ab viruses, and all was negative .

Now it is day 31 after this incident, which is the third day after conducting the tests, I started to feel a slight swelling in the lymph gland in the neck and I feel a cold and my temperature is 37.9 degrees Celsius and A slight pain in the throat, knowing that it is the cold season for us now, and my wife and children have been suffering from sore throat, heat and cough for the past week

1- My questions revolve around what is the rate of my infection with Hiv or any other diseases, and is my analysis reassuring, and is there a possibility that the result will turn positive after two weeks from now?

2- Likewise, are the symptoms that began to appear now 3 days after the analysis, which was 27 days after the sexual , a test for seroconversion?

3- What about hiv2 my test may not be able to see antibodies to it in 27 days and then appear after that?

4- Since you, doctor, treat patients and see many patients, have you ever had to change as a result of the hiv combo test on day 27 and then turn positive?

These are my questions and I hope to receive the answers that remove this concern from my chest and these fears, especially that I am married and have children and I had a sexual with my wife after the results of my tests appeared in the 27 days after the sexual intact.

I thank you all and thank you for the way you respond and what you offer us.

33 months ago

The nationality of the woman was Arab from Morocco and the analysis was hiv combo .

Thanks.

H. Hunter Handsfield, MD

33 months ago

Welcome to the forum. Thank you for your confidence in our services. I'm happy to help.

My understanding is that HIV is rare in sex workers in Dubai and that very few HIV infections have ever been documented in their frequent clients. That said, I'm not an expert on this and things could have changed. However, if that had happened, I have to believe there would be a lot of online/internet discussion of it. And of course I cannot comment on the chance your partner in particular has HIV or other STDs. However, for HIV, even if a woman is infected, unprotected vaginal sex has an average risk of one in 2,500. Of course in the future I would recommend condom protection in event of future similar sexual adventures! To your specific questions:

1. HIV risk: let's do quick statistical estimate. If we assume a 1% chance your partner has HIV, with 2 unprotected vaginal exposures, each with one chance in 2,500 you would have been infected, your risk would be around 1 chance in 125,000. Your HIV AgAb (4th generation, combo) blood test would have detected around 98% of infections at 27 days. That further lowers the chance you have HIV to about one chance in 6 million. (You can figure out the math.) Even this is probably too high an estimate: probably the odds your partner has HIV is a lot lower than 1%.

Other STDs? Maybe higher, but still low. But you have had no symptoms and all your tests were negative. You can be sure you do not have gonorrhea or chlamydia; but the blood test for syphilis, like the HIV test, can be repeated at 6 weeks for an absolutely conclusive result. Viral hepatitis was zero risk from such a partner: there is no need for resetting.

2. It is not possible to have HIV symptoms with a negative antibody test. So even though your current AgAb test isn't quite 100% conclusive, it DOES conclusively prove HIV is not the cause of your symptoms. Anyway, they began much too late: ARS symptoms always start within 2 weeks of catching the virus. You caught a cold (or COVID), that's all.

3. HIV2 is vanishingly rare outside the parts of Africa where it is endemic, and your negative result so far is over 95% conclusive for HIV2. As already noted, you can have an other test at 6 weeks if you want further confirmation.

4. No, I have never had a patient -- or been aware of any colleague's patient -- whose HIV test was negative around 27 days who later proved to have HIV.

In summary, there is no realistic chance you have HIV or any STD from the exposure described, and you can safely resume unprotected sex with your wife, if you have not yet done so. That's what I would do if somehow I were in your situation.

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

HHH, MD

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33 months ago

I thank you very much, Dr. Hunter, and for this wonderful and reassuring explanation for me, but My previous explanation may not be clear, as I only had unprotected sexual relation once and not twice as you indicated in your response, and this makes the percentages differ is not it ?

You also allow me to explain to you that my symptoms started on the thirtieth day after 3 days from my negative test , so did these data change from your previous replay?

my greetings and my appreciation.

H. Hunter Handsfield, MD

33 months ago

Sorry I misunderstood. That reduces my calculations by half.

I correctly understood the timing of your symptoms, and explained why that timing helps explain why they cannot be due to HIV acquired during the exposure a month earlier.

Thanks for the thanks. I'm glad to be of help.

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33 months ago

Thank you doctor for your previous answer

I was planning to do a hiv combo test next Wednesday which is the 43rd day after sexual but last Saturday in the night which is the 39th day after sexual I had a very strong fever of 39.2°C, severe sore throat, swollen lymph nodes in the neck and nasal congestion and took Paracetamol analgesic: Two tablets of 500 mg every 6 hours, and the temperature was stable even with the treatment at 38 degrees. The last two pills I took yesterday were at 12 am. I woke up this morning and my body was immersed in water from sweating, but my temperature was normal 37.2 degrees. The duration of my use of paracetamol is 24 hours, and when I woke up this morning, I decided to leave the paracetamol to see if the temperature rises, and after 13 hours from the last dose it rose, but it reached a maximum of 37.6 degrees, and which is my temperature right Now and i feel better.

I feel a slight cough with phlegm and also my voice hoarse from yesterday until now.

All of these symptoms my sons had in the past week and they recovered from them after a whole week, as they had the same symptoms as mine, from an unresponsive fever, a hoarse voice, and sore throat, and also my mother is now sick with the same symptoms.

I do not know, Doctor, what is really happening and I am afraid that my symptoms are hiv ars, but the duration I suppose is a long 38 days, and I also have a test on day 27 and it was negative.

I look forward to your reply Doctor, you are the only one who can understand what it could be.

I also did a corona virus test and it was negative.

Also, I thought that 6 weeks was crucial for both types of HIV, but I read yesterday your comment that you consider the hiv combo to be conclusive for hiv2 between 6 and 8 weeks.

Does this mean that the result of 6 weeks is inconclusive 100% for hiv 2 ?

Thank you doctor for your kindness and support.

H. Hunter Handsfield, MD

33 months ago

Thanks for the follow-up information.

Your fever and other symptoms came on much too late to be from HIV acquired nearly 6 weeks earlier. And the symptoms aren't right: acute HIV infection does not cause nasal congestion or cough. In addition, the symptoms are clearing up too rapidly: HIV/ARS symptoms do not last less than 2-3 weeks, regardless of paracetamol (acetaminophen) treatment. Clearly you had a respiratory infection, not HIV. I would bet on COVID, although it could have been influenza or just a bad cold.

As for HIV2, it remains rare outside the parts of Africa where it is endemic, or in persons from those areas or their regular sex partners. While I have no direct knowledge about HIV in Dubai, I imagine it is very rare if present at all. In any case, the large majority of HIV2 infected people have positive AgAb tests by 6 weeks, but a small proportion may not have positive results until 8 weeks. Feel free to have another test after that time if it will help you stop worrying. I am confident you don't have HIV of either type.

That completes the two follow-up exchanges included with each original question and so ends this thread. I hope the discussion has been helpful. You can move on without further worry about HIV! Best wishes and stay safe.

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