Negative Test at 41 Days

Doctor,

This forum has been a great source of information for me over the past two months and has helped to calm some of my fears.  My question is similar to others I have seen but not exactly the same...I am a 22 year old man.  My potential exposure was receptive fellatio on 22 June in Europe which I know carries a low but still existent risk.  Symptoms are very consistent with ARS: fatigue, very frequent diarrhea, swollen glands in neck (although not confirmed by a doctor), and the most alarming: recurring aphthous ulcers (large, painful) on both sides of the front of my tongue.  These started 11 days after exposure, and are still here today nearly two months later.  They disappear for a little bit but continue to come back.  My doctor has assured me that these are coincidental or due to the anxiety I have been experiencing.  Onto the testing:  I tested negative for STDs and have had two negative HIV antibody tests at 20 days and again at 41 days, both which came out negative.  I will test again at 3 months.  I have read several times on your forum that tests will always be positive two weeks after symptoms show up if those symptoms are due to HIV.  Since these ulcers started on day 11, does my 41 day negative test rule out HIV?  Also, should I be worried about HIV-2.  My 20 day test was done by my doctor and I know it tests for both 1 and 2, but my 41 day test was done at a local health department and was anonymous and I am not sure if the test was for 1 and 2 or just 2.  

What are your thoughts?  

[H. Hunter Handsfield, M.D.]

Before I even read your post, based only on the title you chose for the thread plus your username:  With a negative test 6 weeks after your last possible exposure, almost certainly you do not have HIV; and if you have symptoms, they are not due to HIV, regardless of whether you have "all the signs".  Blood test results 6 weeks after exposure (and even 4 weeks after exposure) are ALWAYS more reliable as an indication of HIV infection than symptoms are--no matter what the symptoms are. So almost certainly you can relax about the possibility of having HIV.

Now, going on to read your question:  I stopped again after "receptive fellatio".  That is so low risk that some experts believe it never occurs, and almost 3 decades into the AIDS epidemic, there are few if any proved transmissions.  Most likely you didn't even qualify for HIV testing, except for anxiety relief--unless you know for sure your partner had HIV, and maybe not even then.

So now I have kept reading.  Next stop:  aphthous ulcers are not a sign of new HIV infection, to my knowledge; fatigue, diarrhea, and so on have innumerable causes, all more common than HIV; your doctor has assured you that your symptoms don't suggest HIV.  And if a doctor could not confirm that you had enlarged lymph nodes, surely you did not have them.  I'm starting to wonder what additional information or reassurance you are expecting from me....

Finally, I have no way of knowing whether your health department's routine HIV tests include HIV-2 as well as HIV-1.  Why don't you just call and ask them???  But even if not, you can put HIV out of your mind.  Totalling up the odds given all the issues I already mentioned, there simply is no chance you have HIV.  Follow your own provider's advice, and/or return to him if your symptoms persist or continue to concern you.  Otherwise, move on.

Good luck--  HHH, MD

[allthesigns]

***I am not sure if the test was for 1 and 2 or just 1****

[allthesigns]

By receptive fellatio I meant I was the one performing it.  

[H. Hunter Handsfield, M.D.]

Got it.  But now I don't know if you are male or female, i.e. whether you and your partner are gay men.  If so, the risks of all STDs are higher than for most heterosexual exposures.  Still, oral sex is low risk for HIV, even for the person who performs oral sex on an HIV infected man.  (CDC calculates the risk as an average of one transmission per 10,000 exposures to known HIV positive partners.  That means a BJ a day on an infected partner might not lead to HIV for 27 years (10,000 divided by 365).

So if you are a woman exposed to a heterosexual male partner, pretty much everything in my original reply still applies.  If you and your partner both were men, the risks are higher for all infections, except chlamydia.  (Chlamydia is the one STD that tends to be more common in heterosexuals.  But chlamydia rarely infects the mouth or throat, so it's not an issue anyway.)  Still, you can be pretty confident you weren't infected and that your repeat tests--whenever you do them--will be negative.

[allthesigns]

I am a male as well...it is in the original post.

[allthesigns]

Doctor,

All STD tests have come back negative...its just HIV I am worried about at this point...knowing now that I am a male and performed fellatio on another male, what do you think about a negative test at 41 days?  

[H. Hunter Handsfield, M.D.]

I already answered that.  Read my original response.

[allthesigns]

Will a test always be positive 2 weeks after the onset of symptoms if those symptoms are due to HIV?

[allthesigns]

Doctor,

I will be testing at the 3 month mark in two weeks.  While I have relaxed quite a bit about HIV, I would like your opinion on the recurrent ulcers I am still having.  My doctors are chalking it up to stress but I just don't know if I can accept that as the problem.  The lesions are pretty deep. I was prescribed tetracycline pills and told to dissolve the contents in water and swish around four times a day.  I also tried Lysine.  Neither have been effective.  Any suggestions or thoughts on what might be causing these damn ulcers?!

[H. Hunter Handsfield, M.D.]

The most common causes of ulcers in the mouth is aphthous stomatitis (canker sores).  But that's only a guess, and in any case it is obviously nothing related to HIV, which is the only topic for this forum.

[allthesigns]

You can close my thread after this, I promise.  Sorry to keep bothering you Doctor, but I keep coming across new things that require clarification.  What are the risks of acquiring Hepatitis A, B, or C through performing oral sex?  I have been vaccinated for Hep B, but not A.  Would coinfection with A or C delay seroconversion?  Also, would it be possible to contract HSV-2 and not ever show any signs symptoms? Could this delay seroconversion?

Also, I have developed a clear penile foul smelling penile discharge despite testing neg for chlamydia and gonorrhea. I've been prescribed tetracycline so I'm hoping this will get rid of it.  What do you make of this?

[H. Hunter Handsfield, M.D.]

No hepatitis risk.  No medical condition delays HIV seroconversion.  It is possible to catch HSV-2 without symptoms.

It sounds like you have nonchlamydial, nongonococcal urethritis (NGU). Doxycycline is the right treatment.  Just follow your provider's advice.

This thread is over.

[allthesigns]

Thanks

[allthesigns]

Doctor,

As expected you were correct.  Had my negative 14 week test yesterday.  I'm moving on once and for all.  It's time to enjoy life and get away from these forums!

Thanks again for your help.  

[SoStumped]

Thanks for the follow up.  I know forum users will appreciate it.  Goodluck to you.