Homosexual Encounter - HIV risk

Dr. HHH,

I am a 27 y/o straight man, and 7 & 1/2 weeks ago I had anonymous, unprotected, insertive, anal sex with a man I met online. It was obviously a terrible mistake, as it was the first and only homosexual experience I have ever had. I only penetrated his anus for less than one minute, if not 30 seconds. I did not ejaculate. I realized what I was doing and ended all relations at that time.

My symptoms are as follows: at approximately 10 days after this encounter I had several aptheous ulcers appear in my mouth, which have since subsided with use of peroxide rinse. I also had a sore throat/upper respiratory infection at about 5 weeks (several of my co-workers experienced a similar illness before and after, I may have gotten it from one of them). During said upper respiratory infection I had a swollen lymph node on the right side of my neck near my tonsil. That has since subsided, but now I have a hard, pea sized lump on the lower right side of my neck, above my clavicle that is giving me mild discomfort. I have never had a swollen lymph node in this area, but from everything I have read online, that is likely to be the cause of this lump.

I had a negative at-home HIV test at 31 days after exposure. I have since emailed this person to question again of his status (he has claimed to be disease free, but he is definately at high risk if he regularly receives insertive anal sex, unprotected and anonymous). My questions are, based on this encounter, what is my risk of having contracted HIV, how accurate would my test results be at only 4 and 1/2 weeks, and how much like acute HIV symptoms do mine sound?

Your expert opinion is appreciated.

[H. Hunter Handsfield, M.D.]

Indeed that was a serious mistake.  It was good that you apparently asked your partner about his HIV status, which I hope was before you had sex with him and not afterward.  You are correct that such reassurance is not totally reliable, as people can lie or could have been in the window period  when last tested.  But asking and having a partner say he is uninfected still improves the odds.  Still, you should have used a condom.

OK, lecture over.  Your symptoms don't matter, because your negative test at 31 days is strong evidence you weren't infected.  A test result more than 3-4 weeks after exposure always outweighs symptoms in assessing the likelihood of a new HIV infection. Even without testing, symptoms never are a useful indicator of HIV infection, since every symptom caused by primary HIV infection occurs in innumerable other health conditions, all more common than HIV.  And your symptoms don't sound much like HIV anyway.  Lymphadenopathy (lymph node inflammation and enlargement) due to HIV generally involves several areas of the body, not just a single lump here or there.

Bottom line:  Almost certainly you didn't catch HIV.  But to be absolutely sure, have another HIV test 6-8 weeks after the encounter (or up to 3 months, for even greater security).  You can expect a negative result. Of course see a health care provider if you continue to have symptoms that concern you.

Regards--  HHH, MD

[randomperson007]

Doctor,

I just wanted to update - I posted this question soon after discovering the sore/swollen lymph node in my neck. Since that time I have discovered another similar lump above that one, and one on the opposite side of my neck in almost the exact same spot. Additionally, I have another sore spot on my side, almost on my chest just to the left of my left nipple. When feeling this area, I can feel several lumps. This has me very worried.

Could you possibly tell me what would cause such symptoms if not hiv? Regards

[sanzip123]

i think you were looking for the following statement from Doc , so you have asked this question otherwise u know that your answer is there in archives,
Bottom line:  Almost certainly you didn't catch HIV

[H. Hunter Handsfield, M.D.]

Many minor infections (strep, cold viruses, etc) cause lymph node enlargement.  HIV is an uncommon cause, and when it does that, it's usually not a single node, but enlarged nodes all over the body.  HIV doesn't cause "sore spots".  And the negative blood test shows HIV isn't the cause of your symptoms.

[randomperson007]

Thank you for your input doctor. I am planning an additional test this week and will post the results.

[randomperson007]

I am currently awaiting the results of another Home Access HIV test. This was taken at 61 days after possible exposure. I am almost certain it will be positive. I have two swollen nodes on the left side of my neck, one on the right, and two lumps which I feel are lymph nodes on my left side in my pectoral muscle under my arm (not in my arm pit). I also have soreness in my groin area, although I can't feel a specific lump. There is really no other explaination.

[H. Hunter Handsfield, M.D.]

I disagree with your prediction your repeat HIV test will be positive.  

Self-assessment of enlarged lymph nodes by medically untrained persons usually is wrong, and other things can cause lumps under the skin--and most entirely healthy persons can find lumps if they try hard enough.  It is stupid to be doing all this on your own by Home Access testing, without direct advice by a health professional.  See a provider to learn what is causing your symptoms.  In the meantime, you can expect a negative result from the repeat test.

[ray767]

A related discussion, I need answers!!! I'm paranoid! was started.