please assess risk with HIV encounter

[Hopefulforhelp]

Hello again Doc H. I am highly concerned I've exposed myself to HIV. I have tested, but I am still within the window period. Logic tells me I'm going to be negative, yet my fear is out of control. I have asked my doc for anxiety meds, but the effects likely wont help for a few weeks.

To recap my Pos friend and I had several exposures. The friendship remains but the relationship couldn't work. Kissing, protected oral (me to him) unprotected oral (him to me) protected vaginal intercourse, and anal fingering (him to me) I know, no documented cases of transmission by fingering. Extra conditions present are what is alarming.

The anal fingering happened 3+ wks ago. After, I wiped a fair amount of blood from my anal area. I didn't realize it then and thought it was residual bleeding from my period. I wasn't concerned for HIV as I thought we were entirely safe. Until a couple of weeks later when I wiped a fair amount of blood from my anal area after a large bowl. I have since been told I have hemorrhoids. Either way, bleeding is bleeding. I know HIV can not penetrate intact skin. I did not get any of his seman or blood on me, I think. The additional problem is he had cuts on his fingers. Both very small. One old and well scabbed over and the scab did not come off. The other was a few hours old. I highly doubt he used this finger as he put a bandaide on after showering just before our time together.

1 what is my statistical risk. I'm trying to tell myself very low based on what I've read.
2 I've read if positive it can show up as soon as 10 days post exposure, that the Oraquick rapid 1/2 can detect in 99% by 20-25 days. Yet a conclusive negative isn't until 8weeks. Given my 'symptoms', if due to HIV, would I have tested pos itive, at day 21?
3 symptoms, I have most all, except the most defining one of fever. Is a fever always present? I've read 95% it is. My nodes are mildly enlarged per my doc. What is really freaking me out is this blotchy rash and freckles popping up everywhere. What does an ARS rash look like? Most sites I've seen pictures on are rather severe. Can it be mild too? My appetite is strong as ever, Is that a defining symptom or not? Muscle weakness and sorethroat are profound as is tiredness. I know I can't self diagnose or do so via symptoms. I'm actually looking to calm myself with true fact until I can test accurately.
4  I assume the higher the viral load the more contagious? Is that true?
Given all the odds I believe are in my favor, I am routing for anxiety. I am trapped in my fear and the one unexplainable symptom of rash is getting worse. It started at roughly 16 days after and I tested at 21 days after, negative. I just went for a CBC+ to explain my crappy feeling. I probably should have asked for viral load testing but was scared. My doc has no idea of my HIV fear, only the clinic does. The clinic thought I'm ok but I told them about the blood, they suggested an ID clinic. Please help!

[Hopefulforhelp]

Hello Doctor, I can't thank you enough for the sound advice and comfort this site has given me. The work you do is incredible. I really thought he and I were being safe, that we talked about all possible risks, plus the counselor and reading. What baffles me is how some could say there is absolutely no risk in my situation if a mere needle stick can get someone infected, odd.

I know I placed myself at risk, more than others yet still minimal. I know symptoms are meaningless as far as diagnosis. I have tested negative after 26days which is a good sign. My CBC came back with a slightly elevated WBC count and high end yet in range RBC platlet, all good as 45% of acute HIV+ would likely show opposite (right?) I still logically believe I'll be ok, but that darn fear.

My symptoms that started in the ARS timeline are diasappearing. With some exceptions. Also, I've noticed what I think may be an HSV2 issue, I know probably due to stress but I'm concened it's my immune system faultering. I take Lysine, Selenium, GSE, vitamins and other supplements to keep my immune system up since the HSV2 diagnosis. It's worked great so far.

I still plan to test at 6 wks and again at 3 mos, just to be certain. I've read all I can, I've questioned myself to maddness and I no longer care to think about this.

My last, and I do mean last post on this issue is very 'what if' and I appologize for that. Given the remote possibility of late seroconvertion out to three months+, what if I am one of them? What if these 'symptoms' in particular the unexplained rash are HIV related? What if my body has not recognized it and mass T cells have not been wiped out yet? With that thought, I ask...

In terms of treatment, does it really matter? Would it make a difference to know now, two weeks from now, or two months?

Thank you for all the help, you've been very kind.

[skerdstraght68]

yes he meant most would be positive at 3 weeks

[Hopefulforhelp]

Thank you for the calming reply. If I may one more question... You wrote 'Most people with symptoms tested at 21 days would have a negative test, so that result is reassuring.'

Did you mean most with symptoms (if due to HIV) would have a positive result? I'm assuming I'm ok as you stated 'reassuring' I'm sorry for being a nut case about this and truly can't wait for the anxiety meds to start working.

I just did another Oraquick now day 26 which is when PPH says it would pick up 99.9% if I was positive (sorry, couldn't resist as the clinic sent me home with one) Again, it was negative. I will retest at 6 weeks for final confirmation as you suggested. God willing that will be the end of it.

I feel I'm in the clear and it's definately an anxiety issue I'm having. If meds alone don't end the fear, I will seek counseling. I normally don't go into a panic mode with any new partners that I've protected myself with. I think the excessive fear is due to his positive status. To bad I have that issue as he's really an incredible man.

Thank you for the awesome service and accurate information you provide. It is truly appreciated.

[H. Hunter Handsfield, M.D.]

Yes, your risk is very low.  However, most questions on this forum--in which I say "zero risk", "zero for practical purposes", etc--concern 1-time exposures, usually with a partner who isn't particularly likely to have HIV. Your exposures apparently were repeated, with a known infected partner.  So clearly your risk is higher than many.  But still low, since all were highly protected.

1) I have no way to estimate a numerical risk.  Undoubtedly less than 1 chance in 1000, probably a lot lower--but I can't say more.

2) Your statistics about test performance look about right.  Most people with symptoms tested at 21 days would have a negative test, so that result is reassuring.  But you need a final test at least 6 weeks after your last exposure.

3) You quote accurate information about symptoms, including the fact that absence of fever is evidence against ARS, regardless of the other symptoms.

4) Yes, HIV infectiousness is directly related to viral load.

It sounds like your own anxiety is influencing your doctors' "advice".  I see no reason for consultation with an infectious diseases specialist at this point.  You do not need viral load testing, repeated CBCs, etc.  There is no getting around it:  What you need is one more HIV test 6 weeks after your last exposure.  Nothing else means much of anything.  (It will be negative.)

Good luck--  HHH, MD