Have I slow immune system?

Hello Doctor, thank you for providing this forum. Hope you can answer my questions.

I had unexpected and unprotected oral (both ways) and vaginal sex (c. 2 minutes) with a female Colombian friend of unknown HIV status on 4 Dec in London. It was her period. She said after she is a sex worker. Was refused PEP next day.
I am 38, uncut , Prince Albert piercing, no ring for 15 yrs though there is still a hole. I'm a heavy smoker / drinker.

I'd various symptoms day 22 to 33 as I know are non-specific (torso rash , throat infection, isolated odd muscular pains, finger / toe joint freezing, heat on upper back, thighs and underarm, muscle loss).  From day 40 for 2 weeksI had headaches and photophobia in evenings.
On the day of my 63 day test I'd a new rash on my side 3 clusters of tiny red papules, prescribed Ketconazole for but cleared itself. I have had painful nodes throughout my body until a few days ago (day 73).

The last few weeks I have had crawling sensations in my left leg, increased eye in floaters in the last week then pins and needles starting in my left foot have spread to both legs and arms.

Full STI check  (day 28), Positive for Chlamydia ( treated) HIV1/2 Neg ELISA 3g.

HIV Test 4 Feb (day 63) Biolytical INSTI and DUO. Neg

She maintains she is Neg and tested Neg for all STDs/STIs on 8 Jan. but got Azithromycin for the Chlamydia.

I've a blood test booked on day 88.

1) Are results so far indicative? Should I test past 12 weeks?

2) Could apparent neurological symptoms be early symptomatic HIV without having enough antibodies to detect?

3) Would chronic depression, stress and anxiety delay my antibody response?

4)Requesting an anti-depressant from my Doc on Friday, Paroxetine and Zispin I've had before (for S.A.D.). Are any contraindicated for HIV?  

5) Should I wait for my 12 wk results before working with my Doctor for a differential diagnosis? .

Many thanks.

[Edward W Hook, MD]

Your risk is very, very low.  Your partner was forthright that she is a CSW so you can presume she has told you the truth on other issues such as her infection status as well.  This taken with your multiple negative tests provide definitive evidence that you do not have HIV and you can have confidence that the azithromycin will have cured your chlamydial infection.  I don't think you even need the 88 day test but you certainly do not need additional testing afterward.

BTW, as for your piercing - the epithelium has no doubt healed in a way that this area is more, not less resistant to infection and does not increase your risk (as opposed to if the ring was still present).

On to your questions:

1.  See above. You do not have HIV and certainly need no testing past 12 weeks.
2.  No way
3.  No depression and anxiety might increase your sense of the severity of your symptoms but would not in any way effect antibody response.
4.  No contraindications and a good idea I suspect.  (You do not have HIV)
5.  No, move forward on it now. You do not have HIV.

EWH

[Frank303]

Dr,
Thank you very much for your prompt reply.

When I attended to request PEP I'd just taken an overnight journey and I never mentioned the perceived additional risk of the piercing (a stupid move many years ago) to the triage health advisor. Thank you for clarifying that.

1) I've already booked the test on day 88 so will take it. The test centre agree "an infection should have shown by now" and they were adamant I never tested until 12 weeks.
2) Phew! See 5
3) That I have the symptoms pinned down to days post-exposure (and graphed on a spreadsheet) does suggest a strong element of anxiety .
4) See 3, 5.
5) Appointment made. A Dr (G.P) suggests post-viral fatigue, I'll mention that to my GP but outwith scope of this forum

One final question if I may. At my age (38) would circumcision be a good or bad idea

A) In terms of HIV/STD protection (in case of condom failure)?
B) Otherwise?

Thank you again.
Frank

[Edward W Hook, MD]

Concerning circumcision.  this is a personal choice.  Here are some facts to consider.

1,  Circumcision is associated with a 50% reduction of HIV risk, if exposed.  So, how likely is it that you will be exposed-- you control our lifestyle and can judge this.
2.  Circumcised men are at reduced risk for cancer of the penis.  But, cancer of the penis is very rare.
3.  There is the cost and discomfort of the procedure.

With or without circumcision it is unlikely that you will get cancer of the penis and you can ascertain what your continuing HIV risk will be.

Hope this helps.  EWH

[Frank303]

Many thanks Dr Hook,
The clinic recommended I tested after 12 weeks. I took my last test yesterday (92 days) and the result came back today Negative.
Family Doctor has ordered blood tests to look into the cause of symptoms

No further testing for me in relation to this incident. That was a tough lesson in being prepared which fortunately didn't turn out worse.

[Edward W Hook, MD]

Congratulations on your negative test resutls.  Time to move on.  EWH

[Frank303]

Does advice (particularly on testing window) change now she has said she has HIV?(Note the test was a VIDAS EIA not 4th generation DUO).

[Edward W Hook, MD]

No.  EWH