[Question #9777] follow up questions - HIV risk

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29 months ago
Hello, I'm going to follow up and possible leave the follow-up questions open for a few weeks as I navigate through this and try to understand more/make an informed decision. So, it seems based on your last reply, if there is a risk of an acute HIV infection - it would likely be from his last illness (sore throat, swollen glands, white tongue, chills/fever, muscle aches) which started on Feb. 6th and lasted 3-4 days. 
1. I've read the stats that heterosexual men (even with many partners and/or CSW) have near 0 levels of HIV, so what is the likelihood this acute infection in March was ARS?
2. If I ask him to get tested for HIV with me, what window should he get tested in? If say, it was an HIV infection, he acquired it the week before Feb 27th at the earliest, so would 4 weeks from Feb 27th be enough time for an accurate antibody blood test? Or should he wait 6 weeks?
3. I can also ask him his last time he had unprotected sex, but I guess there is a possibility he could lie.  
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29 months ago
****Sorry I had a typo in the above, he started his most recent symptoms on March 6th that lasted for 3-4 days. So exposure could have been at the earliest Feb 27th or perhaps the week before on Feb. 20th, based on my understanding. 
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Edward W. Hook M.D.
29 months ago
Welcome back to he Forum.  On this occasion, I happened tp pick up your new question and will be responding.  I have reviewed your recent interaction with Dr. Handsfield and agree with all he said.  My sense is that you may be looking for reasons not to believe the information your partner has provided regarding your, so far, no risk encounters.  I worry that you may be over interpreting Dr. Handsfield' s comments.  Nothing about the exposure you describe suggests the ARS.  In response to your follow-up questions:

1. I've read the stats that heterosexual men (even with many partners and/or CSW) have near 0 levels of HIV, so what is the likelihood this acute infection in March was ARS?
As Dr. Handsfield replied, this set of symptoms do not suggest the ARS- the time period of symptoms is too long, the ARS does not recur in the situation you describe.  In studies of persons presenting for care related to symptoms of the sort you describe, less than 1% of at risk persons had the ARS- the remainder had influenza, COVID-19, or other far more common community acquired non-STI viral infections''

2. If I ask him to get tested for HIV with me, what window should he get tested in? If say, it was an HIV infection, he acquired it the week before Feb 27th at the earliest, so would 4 weeks from Feb 27th be enough time for an accurate antibody blood test? Or should he wait 6 weeks?
If you get tested together and his test is negative, you cannot acquire HIV from him.  OTOH, from a largely theoretical perspective, he could still be incubating infection.  Personally, if his test is negative 4 weeks following his last possibly at risk encounter, the likelihood that he has HIV is virtually zero

3. I can also ask him his last time he had unprotected sex, but I guess there is a possibility he could lie. 
I worry about your level of trust here.  Can you believe him?  I hope so.  It sounds like he has been sincere with you-most people tell the truth.  

I hope this perspective is helpful.  EWH.
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29 months ago
Thanks! I DO tend to overthink things :) To confirm:
1. I understand - his past symptoms are not ARS. In theory, his recent symptoms/ illness in early March could be ARS and now he "could" be in an incubation period (in theory). However there is less than 1% chance. Am I understanding?
2. I've decided to ask him to get re-tested with me for my comfort. You're saying, if we get tested 4 weeks from the March illness or his last risky encounter (unknown to me), it would be conclusive for HIV. So, it's not necessary to wait 6 weeks in this case? Does a 4th generation test matter or not, in this scenario?
3. Yes, it's hard for me to trust others with my sexual health. Would love you to tell me i'm being paranoid?! :)
4. Am planning to use condoms until we are re-tested. Based on your replies and Dr.H's it sounds very unlikely he has HIV. So using condoms until testing seems logical/ reasonable to me. Based on your expertise, do you agree?

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Edward W. Hook M.D.
29 months ago
1.  I think you are overstating this.  His symptoms, particularly that they have come and gone really do not fit the description of the ARS.  In theory a single 3-4 day episode couild be the ARS but this is statistically unlikely.  If his illness was the ARS, tests for HIV would be positive from then onward.

2.Correct.  As I said above, if he is tested now and negative you can be sure his illness was not the ARS- persons experiencing the ARS have positive tests from the time of the onset of ARS going forward.  At 4 weeks more than 99% of persons who acquired HIV will have postive tests.  In fact, we have never seen or heard of a person who had a negative test at 4 weeks who went on to have their test positive- it is VERUY rare.

3.  You are being paranoid.  Unless he has been untruthful about other issues, I would believe him.  Most people tell the truth.

4.  I agree 100%.  

I hope the information we have provided will allow you to move forward with this relationship and that it is rewarding for you both.  EWH
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28 months ago
Hi, I wanted to follow up with my last reply. Unfortunately, I found out this man I was dating was actually lying to me about dating (and possibly sleeping with other women). So, luckily for me, we only had sex (with a condom) one time. I think there is low likely I contracted an STD since we did use protection. That said, the only possibly "risk"  (or maybe not?) was - I did masterbate him, then he put on a condom, then I masterbated him a little more with a condom on before intercourse.  From my understanding, this is no-low risk still (i.e. genital - hand - sex progression), but I'll likely still get STD in a few weeks as normal sexual health practice going forward, that I'm dating again. In your opinion, this was still low-risk correct? The condom did not break or fall off from what I could see / feel. I have symptoms (other than a cold!)...Thank you for help. 
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Edward W. Hook M.D.
28 months ago
You are correct, on all counts.  Masturbation of a partner is a no risk activity, even if that partner does happen to have an STI.  This is the case even when partners' genital secretions get on each other in the process.  Similarly, condom protected sex is safe sex and very low risk for acquisition of STIs.  Finally, I should add that in the unlikely circumstance that he has an STI (most persons with multiple partners still do not have STIs), transmission usually does not occur with a single encounter.  While I endorse you plan for testing for the peace of mind it will provide, I anticipate that the testing will show that you have not been infected.  

FYI, testing for the most common STIs (gonorrhea, chlamydia, trichomonas) will provide reliable results any time more than 4-5 days after an exposure.  Testing for less common, less likely STIs will not be conclusive until about 6 weeks after an exposure.

We provide up the 3 responses to each client's questions.  This is my 3rd response.  Thus this thread will be closed later today without further responses.  Take care.  EWH.  
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28 months ago
Thank you so much. Your guidance has been very educational and helpful. Take care!
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Edward W. Hook M.D.
28 months ago
Thanks for your thanks.  Glad we could help.  EWH---