Following the last incident (performed cunnilingus in late August 2023), I ended up doing a lab blood drawn test 7 weeks (48/49 days) later which came back negative. I’ve been fine since then but exactly 8 MONTHS later (late April 2023) came down with a 24 hr fever, followed by a classic 2 day viral rash, which against my better judgement has sparked the latest bout of anxiety. 

7 week test was referred by my GP to a large commercial pathology lab in Sydney. GP simply wrote “HIV serology” on the form, but a heap of Googling later, I’m about 90% certain the lab uses a 4th generation test.

Questions as follows;

1) is there ANY chance that my fever and rash 8 MONTHS from exposure will as ARS/seroconversion? No sore throat, no swollen glands. Reading similar questions suggests no, but worth checking!

2) assuming my blood test was 4th generation in AUSTRALIA, is 48/49 days definitive? Guidance here still defaults to 3 months…

3) if by chance the test was actually 3rd generation, how accurate would my negative result be at 48/49days?

4) appreciate you’re based in the US but on gut feeling, would you suspect the test in Australia was 4th generation?

Thanks again 

As Dr. Hook said (more than once), nobody has ever been reported to have acquired HIV by cunnilingus. Equally important, your several negative test results are 100% proof against having acquired HIV. Finally, it impossible to have HIV symptoms without detectable HIV antibody -- a point that Dr. Hook might not have stated explicitly. It isn't the virus that is responsible for symptoms, but the immune response to HIV. The immune response is indicated by antibody. Therefore, even in theoretical circumstances where someone might have acquired HIV, a negative antibody test proves that you recent fever and rash cannot be due to HIV.

Those comments pretty well cover your specific questions, but to be explicit:

1) No, no chance. In addition to the discussion above, ARS symptoms do not start more than a couple weeks after acquiring the virus.

2) Yes, conclusive after 45 days. 

3) A third generation test is nearly conclusive at the time you were tested, and for the reasons above proves that any symptoms are not possibly due to HIV.

4) I am quite confident that most expert resources in Australia use the AgAb (fourth generation) HIV blood tests routinely.

Speaking of which, I wonder if you've contact or been seen in one of Sydney's federally supported sexual health centres. Australia's SHCs is, in my view, comprise the world's most expert and overall very best network of STI/HIV clinics -- and the Sydney and Melbourne SHCs are the best of the best. Not only do they provide superior care, but their policies and procedures essentially dictate how most private providers and other facilities provide HIV/STI care. You're in perhaps the best place in the world for world class care. It sounds like you have had such care -- but if any doubt remains, you could discuss this with your doctor or contact one of the SHCs.

I hope these comments are helpful. Do your best to move on without further worry about any of this. 

HHH, MD

August 2022 = cunnilingus

October 2022 = blood draw at 49 days

April 2023 (8 months later) = temperature and rash. 

Subtle difference is that the ARS ‘symptoms’ were 8 months post test, not before. 

Assume this doesn’t alter your assessment? 

Perhaps you would also like to know that in the nearly 20 years of this and our preceding forum, with thousands of questions from people worried about an exposure that might have resulted in HIV, not one has yet informed us they tested positive. You will not be the first. If and when that finally happens, undoubtedly it will be from a genuinely high risk event (like unprotected anal with an HIV positive partner) and not a trivial, essentially zero risk event like yours.

I do hope the discussion has been a little bit helpful. Best wishes and stay safe.