Testing after 10 days after the starting of ARS syptoms

[razak111]

Hi Doctor,

        Thanks a lot for doing such a wonderful service.  

I am from India. During October 10, I had a protected intercourse with an escort. It lasted for only 10 sec to 15 seconds, then after that she gave only hand job.  Her hand had vaginal fluid because of this.  I smooched her for 5 secs at the starting.
Actual Worry:
The next day when I checked the other unprotected skin area down the penis, I saw a bleeding cut. I am not sure whether that cut occurred during October 10 or the next day. While giving hand job she touched this area also.

On 21st day after exposure, I started having the following symptoms.
Sore throat
Swollen Lymph nodes
Body Fatigue
Chills.
On 21st day, these were very mild, then on consecutive days these symptoms increased but only average.
On 23rd day, I had diarrhea kind of symptom. It lasted for only one day. This was also mild.
But I had no fever.
Though I had a feeling that I had fever(burning eyes also), My temperature was normal.
On 26th day when I checked the temperature, It was around 98.7.
On 28th day, I had two oral sores in lower lips. (I felt it was caused by my two canine teeths. But I am not sure.)

Testing:
10 days after the starting of these symptoms(30 days after exposure), I had HIV antibody test(spot) and It came 'Non Reactive'.
I had done the complete haemogram analysis also which came normal.

Is this enough doctor or should I have further testing?
Once again Thanks for ur service. :)

[H. Hunter Handsfield, M.D.]

Welcome.  Thanks for your question and for the thanks about the forum.

You had protected sex. Although in theory an open penile sore could increase the risk, the odds are your partner didn't have HIV and condoms work.  As for your symptoms, they include some aspects consistent with a new HIV infection, but also with many, many other conditions that are much more common.  Other symptoms are not consistent with ARS, notably diarrhea is not a usual feature (although it can happen); and absence of fever is strong evidence against ARS.  Finally, the timing is late, since ARS symptoms typically start 7-14 days after exposure.

And as you suspect, your negative HIV antibody test 4 weeks after exposure is highly reassuring.  Time since onset of symptoms is less meaningful than time since exposure -- but in any case over 95% of the time antibody is detectable within 30 days, and within 10 days of onset of symptoms.  (In fact, it is appearance of antibody that is partly reponsible for some of the symptoms of ARS.)

Standard advice from many authorities suggests antibody testing at 3 months for fial reassurance.  Six to 8 weeks is actually sufficient, but 4 weeks is a bit short.  Alternatively, find a doctor or clinic that offers the "combo" or "duo" test for both HIV antibody and p24 antigen.  That test is 100% reliable any time after 4 weeks.

If you decide on further testing, stay relaxed in the meantime.  It is exceedingly unlikely you have HIV and you can expect future test results to remain negative.

I hope this helps.  Best regards--  HHH, MD

[razak111]

Thanks a lot doctor.