symptoms & test results

Dear Doctors

During the end of last year (29 Dec) I had an unprotected vaginal penetration for a 1-3 seconds with a girl I met at a bar in Bangkok, Thailand.

I had the following symptoms:

19 days post exposure - a dull constant headache in the frontal part of the head. Some days are worst than others, but it hasn't effected me from going on about my day to day life. I still feel these today.

21 days post exposure - joint and muscle aches. I have muscle & joint aches in my left elbow, left knee, ankles, behind my left knee and lower back. These aches are mild, and short sharp pains, which is achy for less than a min to a few mins. They come and go in those places I listed at random times. The ache is not constant. For example...when I am driving, I feel my knee/ankle. I still get these aches today.

24 days post exposure - mild sore throat for a day. Possibly due to heavy smoking on the weekend.

I thought my lymph nodes were swollen when I could feel 2 pea sized lymph nodes on my neck, however I believe I was just paranoid and they were probably just normal sized.

I had a duo/combo HIV 1 & 2, antibody/24p antigen test on days 19 and 32 post exposure. Both came back negative.

My doctor said these symptoms are not due to HIV, however as these symptoms appeared within 2-4 week post exposure, I am still worried.

Questions -

1) If I test negative on 32 days post exposure, does that mean the symptoms are not due to HIV as if they were due to HIV my test would be positive?

2) In your experience, have you seen anyone turn positive at 3 month mark when they were negative with a duo test at 4 weeks?

3) Would my test result be conclusive? I've read you should test again at the 3 month mark if you have persistent
HIV symptoms...would you recommend a further test at 3 months? I've read the 3 month rule applied to 3rd Gen antigen test, not 4th gen duo tests.

4) Would it be okay to have unprotected sex with my wife?

Thank you

[Edward W Hook, MD]

Welcome to our Forum.  I'll be pleased to validate your doctor's assessment.  Before I do, let me remind you that you do not know that your partner had HIV (most CSWs, in Thailand do not) and that even in the unlikely circumstance that she did, less than 1 in 1000 genital sexual exposures to infected partners lead to infection.  In your case, given how brief your exposure was, your risk is lower still.  

What makes me confident that you do not have HIV however are your test results.  Had you acquired HIV through the exposure you describe, your test at 32 days certainly would have been positive.  You did not get HIV through this exposure and you symptoms are due to some other cause.

In answer to your specific questions:
1) If I test negative on 32 days post exposure, does that mean the symptoms are not due to HIV as if they were due to HIV my test would be positive?
Correct, if your symptoms were due to HIV, your 32 day test certainly would have been positive.

2) In your experience, have you seen anyone turn positive at 3 month mark when they were negative with a duo test at 4 weeks?
No.

3) Would my test result be conclusive? I've read you should test again at the 3 month mark if you have persistent
HIV symptoms...would you recommend a further test at 3 months? I've read the 3 month rule applied to 3rd Gen antigen test, not 4th gen duo tests.
Even with 3rd generation tests, results are conclusive at 8 weeks.  With the test you had, your results were conclusive at 4 weeks,

4) Would it be okay to have unprotected sex with my wife?
Yes, there is no reason for concern about HIV from the exposure you have described.  

Take care.  EWH

[timbo12345]

Thank you for your response Doctor Hook.

Just a general question.

In your experience, what is the longest period you've seen anyone have HIV symptoms for?

[timbo12345]

Doctor Hook

Sorry, just one more question, then this thread can be over.

1) I've been reading that tests normally take 1-2 weeks after HIV symptoms appearing for it to turn positive. Is it possible for the duo test to not turn positive after showing HIV symptoms because I haven't seroconverted or symptoms haven't been present long enough for the test to pick it up?

[Edward W Hook, MD]

No, you are worrying needlessly.  the symptoms of the ARS are the result of the interactions between the virus (which is the source of the p24 antigen) and the antibodies to HI.  Thus the reason that the DUO test is so reliable.  You are worrying needlessly.  EWH

[timbo12345]

Doctor Hook - Sorry for reviving this thread, but somethings have occurred and I just need some answers.

Just to update - my headache is practically gone, but i still have muscle/joint pain from time to time.

However, in the past two days I have a sore throat, and I notice a bunch of spots on my leg which I am afraid could be a HIV rash.

Is it possible that since the p24 antigen only detects HIV 1 viruses that I could have contracted HIV 2 and experiencing symptoms now?

[Edward W Hook, MD]

No change in my assessment or advice.  EWH