7 week negative - late seroconversion?

Hi Doc,

I'm 26, white male, healthy, not sexually active at all - except for - I had a risk exposure (which I consider high) with a white female escort in South Africa.

The sex was protected, however the condom broke. I realised this immediately and withdrew. Where (I think) my problem comes in: I had a cut on my finger, about 1 centimeter in length, which occurred 12 hours prior to the exposure. I inserted this finger into her for roughly 2 minute or so.

Testing done to date:
2 weeks: duo test & full std profile - hiv negative, but diagnosed with Chlamydia (did 10 day doxy treatment) and one swollen lymph node under my jaw, right hand side;
4 weeks: elisa test - hiv negative; and
7 weeks: rapid test - hiv negative.

I phoned the escort several times and questioned her about her status. She assured me that she's HIV negative, do regular testing, and that I'm worrying over nothing. (I believe she's dishonest).
Just past the 7 week mark (2 days after the rapid test), I developed a swollen lymph node on the right hand side of my neck and one behind my right ear, this now together with the initial lymph node under my jaw.  I experience general neck stiffness.  

These are the only symptoms that I have experienced up to date. No rash, fewer, fatigue, diarrhoea etc etc.

I don’t know the status of the lymph nodes in my groin area, as this has not been examined by a doctor...useless for me to try and diagnose it.  However, I have a burning sensation in the area behind both knees.

I am away in a foreign country and won't have access to my doctor or regular testing lab for 2 weeks.

Am I a late seroconverter? I am convinced that I will be your first example of 6 / 7 week negative, later turned positive.  
Is it of any significance that only my right side lymph nodes are swollen?
Can the doxy treatment affect my test results?

Your assistance is greatly appreciated

[Edward W Hook, MD]

Do to condom breakage, you have apparently had a single exposure to someone who may be at relatively high risk for STD and possibly HIV.  Let’s start with some generalizations about risk and then go from there.  Most commercial sex workers (CSWs), despite being at higher risk, do not have STDs or HIV -even in South Africa.  Even if  they have "something", that something is far more likely to be an typical STD such as chlamydia than HIV - your experience appears to bear that out.  In addition, a single exposure to an infected sex partner usually does not result in infection (the transmission rates for different STDs differ between them but for female to male transmission, none of the rates exceed about 20% per episode of intercourse (that’s the rate for gonorrhea) and for some, like HIV, the risk is far smaller, like 0.01% per sex act).  Thus you can take some comfort there.

Add to that multiple negative tests for HIV with reliable tests.  These PROVE that you did not get HIV.

You now have become concerned because you have isolated swelling of lymph nodes in your neck where they could be due to a sore throat, cavities in your teeth or any number of things that are much, much more common than HIV.  In doing this, your anxiety is causing you to ignore science and the experience with thousands of persons who have actually been exposed to partners with HIV (as opposed to your situation where you think you MIGHT have been exposed but probably weren't) and the timing of their seroconversion.  "Late seroconversion" is about as close to an urban myth for you as it gets.  Believe the science, put your illogical anxiety that you might be one of the first persons to experience the so called "late seroconversion" and move on.

Finally, doxycycline would have no impact on HIV test results or their reliability at this time

Hope this is helpful to you.  Take care.  EWH

[starseaker2828]

Didnt want to high jack someone else post but in relation to Late seroconversion (beyond 12/13 weeks) i heard that it does and can happen (even if tiny percent) but does this happen ONLY in people who have been taking PEP, on severe Chemo, Or some other serious illness? Or can it happen for no apparent reason.

Thank you, i didnt want to start a whole new thread for this one question, if not then notify me and i will make one =)

[gdutoit5555]

Thanks for the reply Doctor,

This was very, very helpful! Since you do not suggest follow up testing I will take my 7 week negative test and move on, and not post more threads! Maybe just one test if I get married in future.

If the swelled nodes persist after i'm back in South Africa, I will have them checked out to see what is the real cause.

Once again thank you.

[Edward W Hook, MD]

I agree withy your plan and the course of action that you plan to take.


If there are others who have other questions about late seroconversion, they need to ask their own question.  sorry but those are the rules.   EWH

[starseaker2828]

Thats cool Doc, i will post a question on my own then lol =)