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Unprotected encounter, 6 week test, and timing of symptoms
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This forum is limited to prevention of HIV and to safe sex in general. All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Unprotected encounter, 6 week test, and timing of symptoms

Hello Doctors,

I had unprotected vaginal intercourse with a woman I met at a bar while away on a business trip in March.  I understand the odds of contracting HIV from this one encounter are low and symptoms shouldn't be used to diagnose. I've been comforted by your advice to others, but the timing of my tests in relation to my symptoms isn't quite the same as what other posters have experienced and I'm worried.  A timeline follows:

--21 days--full STD panel at Labcorp including HIV ANTIBODY 1/O/2 BY ICMA and PCR DNA.  Negative.  I had experienced some muscle soreness and what I thought were swollen lymph nodes by that time, but I had complete faith in the tests, particularly the PCR DNA.  

--29 days--developed a fever of 102 degrees and very bad diarrhea.  The fever stayed at that level for 24 hours and then hovered around 99 for several days after.  The diarrhea lasted for 4 days.  I developed a rash on my upper chest and back (30-40 very pronounced red dots and blotches).  Some of the blotches are still there today.  I saw a doctor for these symptoms at 32 days.  He administered Western Blot (no idea why he used that test)-- negative.

--At 42 days had another HIV ANTIBODY 1/O/2 BY ICMA.  Negative.

--At 49 days I have aches in legs and arms, tremendous pain in armpits and chest, and very sore shoulders and neck.  Also a swollen lymph node in armpit and possibly other locations.

Until these most recent symptoms, I had been confident in the 42 day test, but now I'm worried again.  Dr. HHH recently wrote to another poster "And the combination of a negative PCR at 3 weeks plus negative antibody any time after 4 weeks is 100% reliable."  Since I have had a similar combination, I am a bit reassured, but this particular poster had no real risk.  Since I did have unprotected intercourse, I wonder if you would be as confident in my combination of tests proving that I am conclusively negative, especially with the cascade of symptoms and their timing.    

Welcome to the Forum.  Straight to the point, you should be entirely and 100% confident in your test results. Rather than go into issues of when one test or another becomes positive, the important point for me to make to you is that if your symptoms had been due to HIV your antibody tests  would have been positive within 4-5 days of the onset of your symptoms and, if there was overlap, your PCR test would have been positive at the time your symptoms began.  The symptoms which occur during early HIV infection are due to the interaction of the HIV virus and antibodies.

I hope this comment is helpful.  EWH
Thank you Dr. Hook, that was helpful and reassuring.  I feel like I can move on now while remembering not to put myself in this situation again.  I neglected to mention that I have had a sore throat with several white spots on my tonsils along with the most recent symptoms, but I realize it is irrelevant given your response.

I was hoping the timing of the tests in relation to the symptoms would point toward HIV not being the cause.  Mostly, I was concerned since I've seen the time from symptoms to a positive test being reported as everything from "a few days" to 17 days; the latter end of that range would have put my tests too close to the onset of my symptoms (I'd consider the fever, rash, and diarrhea to be the first of the relevant symptoms--13 days before my 6 week test).  If you are confident in 4-5 days being the maximum from symptoms to a positive test, I will certainly trust your opinion and move on with my life.  I assume then, you see no medical reason to seek additional testing for HIV (I'm now over 8 weeks removed from the event).

Thanks again.  
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H. Hunter Handsfield, M.D.Blank
University of Washington
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